By Chris Taylor
NEW YORK, Oct 29 (Reuters) - When Sara Davis Buechner began
her transition from man to woman, she knew there were going to
be emotional hurdles, like dealing with her family.
But there were financial costs, too. And she knew they were
going to be forbidding.
Medical procedures like facial electrolysis cost $20,000.
There was a year of therapy, required at the time to make sure
Buechner, a renowned pianist, was a suitable candidate for
transition - at $80 a session.
Since American options were just too pricey, Buechner opted
for surgery in Thailand. The tab? $10,000, including flights.
This was in the early 2000s, and none of those costs were
covered by insurers. She sold one of her two pianos, a Yamaha,
to help foot the bill. "I emptied all my accounts," Buechner
remembers. "And I consider myself one of the lucky ones."
Buechner was more than willing to pay those high bills,
because it was the culmination of something she had known since
childhood: She was female, despite having been born as David.
Transgender issues are more openly discussed these days,
such as Caitlyn Jenner's transition from Olympic athelete Bruce
Jenner. But the costs of transition can be overwhelming,
especially for a population that is already marginalized.
The Philadelphia Center for Transgender Surgery, for
instance, lists menus of procedures for both male-to-female
transitions and female-to-male that total well over $100,000.
Meanwhile, corporations have been slow to help. According to
the 2015 Employee Benefits Survey by the Society for Human
Resource Management, just 5 percent of employers offer gender
reassignment health care coverage to their staff.
That is up since 2011, when only 2 percent of companies did
so. But progress has so far only been incremental.
Among larger companies, the numbers are more encouraging.
One-third of Fortune 500 firms now offer healthcare coverage
including transgender surgery and related medical costs,
according to the Human Rights Campaign's Corporate Equality
Index report.
In addition, the provisions of Obamacare - as well as
state-specific laws in places like California, New York and
Oregon - have been pushing plans towards transgender-inclusive
health coverage, according to the National Center for
Transgender Equality.
"The policy environment is changing for sure," says Jody
Herman, a scholar of public policy at UCLA's Williams Institute.
"The way anti-discrimination laws are being interpreted is
moving in the direction of saying that exclusions to
trans-related healthcare are not acceptable."
LOST WORK
The costs of transition are not just medical, though.
Buechner started losing recital engagements when venues found
out about her personal story. She also had trouble booking any
new ones.
When she applied to become a music teacher at more than 30
U.S. colleges, she didn't get a single response. (She is now an
associate professor at Vancouver's University of British
Columbia.)
No wonder so many transgender Americans are economically
vulnerable. Fifteen percent report making less than $10,000 a
year, according to the Center for American Progress, quadruple
the average poverty rate.
The No. 1 tip from financial advisers: Start financial
preparations early.
"Plan ahead, know what your costs are going to be, and what
your insurance will cover and what it won't," says Paula
Heichel, a financial adviser with Wells Fargo (N:WFC) Advisors WFC.N
in Washington, D.C. who has counseled transgender referrals on
their finances. "These cost are not to be taken lightly, and you
have to be able to pay as you go."
Indeed, with a long enough timeline, it might be worth the
effort to seek employment at one of the 418 major U.S. companies
which offer at least one transgender-inclusive employee health
plan (http://www.hrc.org/campaigns/corporate-equality-index).
Otherwise, the costs could be very significant indeed.
"Just imagine, you have to take every stitch of clothing you
own and put it in the garbage," Buechner says. "The best analogy
I tell people is, 'What if you moved to Bolivia tomorrow, how
much would it cost to start a totally new life?'"
"The costs are enormous. Start counting."
(Editing by Lauren Young and Cynthia Osterman)