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Janice Raymond, TERFs, & Insurance Policy

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Someone recently asked me to breakdown the link between the TERF opinion leader Janice Raymond and insurance policies that exclude trans care. Here’s the link to the original article. This article meticulously exposes a few less than truthful fact assertions Raymond has made, but it’s quite long.

So, here’s the TL;DR article excerpt version:


It was Raymond’s NCHCT report that allowed the OHTA report to assert that trans medical care was ethically “controversial”.

Therefore, exclusionary health policies which appeal to Raymond’s “controversial” claim constitute Raymond’s fingerprint. Consider the following:

1.) In 2013, the Department of Health and Human Services’ (HHS) Departmental Appeals Board reversed the HHS rule banning trans medical care. In the document, HHS reviewed the reason HHS had originally banned trans care:

HHS Appeals Board Decision, page 3

The HHS Appeals Board Decision continues (NOTE: “NCD” = National Coverage Determination):

The NCHCT’s May 6, 1981 memorandum, the 1981 NCHCT report, and the notes of the HCFA Physicians Panel meeting on May 11, 1982, are the materials in the NCD record containing analysis by HCFA or PHS of the issue of Medicare coverage of transsexual surgery. Although the NCD was not issued until 1989, it is clear that the NCD was based on the NCHCT report and memorandum from 1981. 

In other words, HHS has concluded that it was the 1981 report that HHS used to issue an NCD banning trans services.

2.) Recall that Raymond’s controversial claim is the very first sentence in HHS’ review of how and why trans services were banned from public health insurance policies. What follows is from a 2009 United Health policy banning trans services:

Note that the exclusionary language in this private insurance policy is the same word-for-word language as the exclusionary language from the HHS’ public insurance policy, as quoted by HHS:

This then, is the smoking gun. Here we have a private insurer quoting word-for-word a governmental policy which relied on Raymond for 1/3 of it’s findings; specifically, it’s finding that trans care is ethically controversial. Thus we can easily follow the timeline for Raymond’s part in the decimation of trans care in America:

From Raymond’s Transsexual Empire (1979)

1979: Raymond writes in her book, “I contend that the problem of transsexualism would best be served by morally mandating it out of existence.”

1980: Raymond is contracted by the NCHCT to write a report on the ethics of trans medical care because the NCHCT must, by law, report on the ethical implications of medical technologies. In Raymond’s 1980 NCHCT report footnotes, her second citation reads, “See Thomas Szasz, review of THE TRANSSEXUAL EMPIRE: THE MAKING OF THE SHE-MALE by Janice G. Raymond, New York Times Book Review, June 10, 1979, p. 11.”

1981: Raymond’s NCHCT report and Raymond’s own citation are used to make the ethical case that trans medical care should be excluded from public insurance policies because it’s “controversial.” Thomas Szasz’s review of Raymond’s 1979 book (in which she calls for trans care to be morally mandated out of existence) is also cited.

1989: The National Coverage Determination (NCD) to exclude trans care from public insurance is published in the Federal Register.

1989 – 2013: Trans medical care is routinely excluded from both public and private health insurance plans.

2012: The State of California finds that barriers to trans health care “was a more reliable predictor of suicide than depression, history of alcohol/drug abuse treatment, physical victimization, or sexual assault.”

2013: HHS finds that the 1981 rational for excluding trans care is “no longer reasonable.”

2014: Private healthcare providers, citing HHS’s ruling, begin rolling back their trans healthcare exclusions. Janice Raymond sets up a webpage to publicly diminish her role in the revocation of trans health care (to which this fact checking article is a response). Raymond clarifies that when, in 1979 she wrote, “I contend that the problem of transsexualism would best be served by morally mandating it out of existence,” she meant, “that I want to eliminate the medical and social systems that support transsexualism…”

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Cristan

Cristan Williams is a trans historian and activist. She started one of the first trans homeless shelters and co-founded the first federally funded trans-only homeless program, pioneered affordable healthcare for trans people in the Houston area, won the right for trans people to change their gender on Texas ID prior to surgery, started numerous trans social service programs and founded the Transgender Center as well as the Transgender Archives. Cristan is the editor at the social justice site TransAdvocate.com, is a long-term member and previous chair of the City of Houston HIV Prevention Planning Group, is the jurisdictional representative to the Urban Coalition for HIV/AIDS Prevention Services (UCHAPS), serves on the national steering body for UCHAPS and is the Executive Director of the Transgender Foundation of America.

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