‘They are lifesaving’: Starbucks offers expanded benefits for trans people

AUSTIN, Texas – Years before they met, Tate Buhrmester and his wife, Katherine, had hearts tattooed on their inside forearms. They are nearly identical – both simple dark outlines (Katherine’s has a V for Vegan lettered on the inside) tattooed on almost exactly the same spot on their arms. As they sit on the patio of their apartment on a recent afternoon with their arms entwined, the hearts press against each other.

When they met several years ago, they thought it was an interesting coincidence, but didn’t read too much into it. They aren’t superstitious that way, they said – they just both happened to like the simple look and pure symbolism of a heart shape. But it’s one of the ways that they just seem to fit together, they say. Being together is natural, easy.

“When I’m with Tate, I’m home,” Katherine said.

With each other, they can truly be themselves, Tate said. He’s happy – and content in the life he’s living.

Tate Trans partner

It wasn’t always that way. Thirty-three years ago, he was born female. He remembers a childhood where, from a young age, he didn’t quite know where he fit. “I didn’t feel like a girl or a woman. I didn’t really feel like anything.”

Growing up in Riverside, Calif., he didn’t have many friends, except his big Alaskan Malamute, Zack, the first of a string of family dogs who loved him for who he is.  By high school, he’d started binding his breasts with thick rolls of ace bandages, dressing in boys’ clothes and “people would confuse me for a boy,” he said. “It made me feel really good about how I looked. … I thought, ‘This is how I want to represent myself to the world and be seen.’”

When he was 16, he came out to his family as a lesbian – “and it didn’t go over that well,” he said, remembering his mother’s tears. The depression and anxiety he’d struggled with his whole life got worse.

Today, at age 33, he’s a happily married man with a full life – something he could never even imagine when he was younger, he said. The despair he’d once felt is gone. The difference, he says, is simply being able to be who is – a transgender man.

Tate, who has been with Starbucks for 15 years and now manages a store in Austin, Texas, is one of a growing number of Starbucks partners who have used the company’s leading-edge benefits for transgender partners.

Starbucks health insurance plans include not only gender reassignment surgery (which had been covered since 2012), but now also a host of procedures for transgender partners in the U.S. that were previously considered cosmetic, and therefore not covered, such as breast reduction or augmentation surgery, facial feminization, hair transplants and more.

“The approach was driven not just by the company’s desire to provide truly inclusive coverage, and by powerful conversations with transgender partners about how those benefits would allow them to truly be who they are,” said Ron Crawford, vice president of benefits at Starbucks.

“It makes trans people feel like they are people,” said Buhrmester, “like they matter and their health matters.”

Crawford said it’s simply the right thing to do.  “I view this as a diagnosis with a treatment path,” he said. “You have to think of it from an equity perspective.”

To shape the new benefits, he and Alyssa Brock, benefits director, reached out last year to the World Professional Association for Transgender Health (WPATH).

Starbucks was the first company in the world to ask WPATH to help translate their recommended standards of care into a medical benefits policy, said Jamison Green, the immediate past president of WPATH, who worked with the company on the benefits package.

“Starbucks was not afraid to ask all the right questions and demand that people get the best possible care,” said Green. “We produced a list of the most crucial benefits and those that are deemed problematic to insurance companies, such as facial feminization and electrolysis.”

Many procedures considered cosmetic aren’t optional for trans people, Green said, but are essential in their quest to be who they are. Something like electrolysis can be “a life-saving procedure for trans women,” he said.

A 2014 report from the American Foundation for Suicide Prevention and the Williams Institute found that 41 percent of the 6,500 transgender adults who responded to the National Transgender Discrimination Survey had attempted suicide at some point, compared to the 4.6 percent of the overall population.

One reason for the high percentage of suicide attempts may be “due to distress related to barriers to obtaining transition-related health care, such as a lack of insurance coverage, inability to afford those procedures, or lack of access to providers,” the report authors wrote.

Green said that when he transitioned in 1988, he worked for a company that provided robust health insurance, but it came with a huge exclusion. He still remembers it. “It was Item 17. No services will be provided that have anything to do with transsexual services or sex change,” he said. “I said, oh my God, how am I ever going to get anything done? When they take away your health care, they take away your humanity.” 

Finding trans-friendly health providers can agonizing, Green said. Some trans people who have had a faced rejection from doctors will delay seeking treatment, sometimes with deadly consequences. To ease that, Starbucks has advocates trained to specifically work with partners who are transitioning to help them navigate the process, find health providers in network and assist with making sure claims are covered.

“We heard a lot from our transgender partners that this is important to them – and so it should be important to us too,” Brock said. “It’s true to our mission and values of nurturing the human spirit.”

‘I felt so alone’

Growing up as the child of a working single parent, Buhrmester spent a lot of time with his grandparents. His grandfather taught him to work on his prized Model T and he swam in his grandparents’ backyard pool, taking breaks to eat the cookies his grandma made for him. Their names are tattooed on his calf – Sammie Jo and Prudence.

He never knew anyone who was out as transgender and his first memory of knowing someone gay was when a longtime family friend of his sister came out – and was ridiculed and made the brunt of jokes. As he got older, he went to AOL chat rooms to try to find others who felt like he did. “I felt so alone where I was,” he said.

When he went to college at the University of California, Riverside, he became friends with an adviser at the LGBTQ resource center campus who came out to him as a trans man. “I was in awe because I’d never met someone who was trans and I didn’t really know that was a viable option for myself to transition.”

As he met more people in college who were transitioning, he noticed their voice and body changes as they began hormones. And he noticed something else. “I was really envious because I was like ‘I want this so bad, but I could never do that.’ …. But I knew those were traits that I wanted to have as a person and traits that would make me more comfortable with who I am.”

A few years later, Buhrmester, who had started working at Starbucks as a barista, left California for a new start in Bellingham, Wash. It was there that he grappled with whether to start transitioning, something that felt overwhelming. He worried about what his co-workers, family, friends and customers would think. “It was probably one of the most depressed times in my life,” he said.

He heard about a doctor who was friendly to trans people, made an appointment and they began having conversations about transitioning. After his first shot of hormones, “all the anxiety washed away almost immediately,” he said. Since that point, “I’ve felt more calm, happy and more confident than I have in my entire life. And it’s getting better every day.”

At work, he began using male pronouns and changed his name to Tate. “It’s simple and to the point, kind of like I feel I am,” he said.

But the female name was on his timecard at work and the name that he saw whenever he logged in for a shift. In 2015, Starbucks announced that partners could instead indicate a preferred name the company would use.

“I think the next day I signed on (to the company’s internal site) and it said ‘Welcome, Tate Buhrmester.’ It was so cool to see because Starbucks has been in my life for so long. It’s not even my second family, but I’d say my first family. To see Starbucks reflect that back to me was super cool. I remember it to this day.”

‘Nobody else is doing this’

That’s the point, Brock said – for partners to know they are seen as they really are. “We want them to feel supported as a person.”

When she and Crawford began working with Green and WPATH – they wanted to make sure the entire list of procedures would be covered by the Starbucks benefits plan.

“Nobody else is doing this,” said Crawford. “We would love to see more employers doing this.”

Since 2002, the Human Rights Campaign Foundation has been tracking whether major employers rated in the Corporate Equality Index offer at least one transgender-inclusive healthcare coverage plan. In 2002, none were. By 2009, that number had risen to 49. This year, a record 750, or 79 percent, of CEI-rated businesses offered at least one plan option including short-term leave, counseling by a mental health professional, hormone therapy, medical visits to monitor hormone therapy and surgical procedures.

But many employers still exclude procedures they consider cosmetic. Crawford hopes that will change and said that Starbucks would be glad to share the policy Starbucks and WPATH worked on to develop with any other employer who might be interested in emulating it.

“It’s a huge lifting of a burden when you are a trans person and you need to have certain treatments in order to actually stay alive, to realize that you are not going to face horrendous obstacles,” said Green. “It’s like an asthmatic being able to breath.”

Finding home

Tate Trans partner

Last week, Buhrmester and Katherine stood under the Austin sun and flipped through the six pages of covered services under Starbucks Transgender Medical Benefits, ranging from gender reassignment surgery to hair graft, voice therapy and much more. They marveled at the options and that there is no lifetime cap for the services.

“Starbucks is taking a stand and standing up for trans people and saying that our procedures aren’t just cosmetic – they are lifesaving. They’re affirming,” he said. “They’re vitally important to trans people and it’s not something just to be seen as a cosmetic procedure that’s optional, because for a lot of people, it’s not optional for them.”

Buhrmester describes himself as transitioning, with plans for more procedures in the future. He said he realized last fall that the benefits for transgender partners had expanded when his hormones became fully covered.

But more meaningful than the money saved on health care due to the Starbucks benefits is what it means to him to work for a company who sees him and other trans partners for who they are, he said. “Being welcoming and inclusive isn’t an exception to the rule at Starbucks, it is the rule,” he said.

As he spoke, the couple’s dogs peered out the window at them: Wyatt, a pit bull mix, and Lucy, an ancient chihuahua. (“The only trick she knows is staying alive,” Katherine said.) Both dogs are rescues and he adopted Wyatt around the time he began transitioning about seven years ago. The dog has been with him, offering unconditional love, ever since, he said. That’s not always the case with people. He hasn’t spoken to many of his family members in a long time because he’s afraid of rejection. But he’s beginning to grow more confident. This year, his goal is to be more open about who he is.

Through it all at his side is Katherine. The two met online two years ago. Buhrmester wrote in his profile that he was trans so people would know right away. He lived in Phoenix then, while Katherine was in Austin. They started out talking online – and then she flew to Phoenix to meet him.

Both describe themselves as shy and introverted. But after getting past the initial awkwardness and nervousness, they quickly realized they didn’t want to be apart. “I sound really boring but we both had two cats and a dog and we both like the same things and had the same style. We would always joke she’s the girl version of me and I’m the boy version of her.”

Buhrmester proposed last year, on the street in front of a “Welcome to South Austin” sign, after being too nervous to ask her in a restaurant as he’d planned.

She said yes immediately, and they were married in August. Being with him “just felt right,” she said. In other relationships, she’d felt overshadowed and not heard, she said. “But when I’m with Tate I feel like I can just be myself and don’t have to hide anything. We can be together without saying anything and it’s very comfortable.”

They appreciate the little things about each other, which in relationships often add up to the big things. He loves to watch her put on makeup and she enjoys seeing him make models of cars, like the Model T he used to work on with his grandfather.

“Katherine means to me unconditional love and support of me – and how my transition’s been and what it’s going to look like,” he said. “I feel really lucky because when I was growing up, I never saw myself getting married or finding someone who would like me or who I’d want to spend all my time with. But with Katherine, it’s really easy.”

Now that he has found home within himself, and with his wife, Buhrmester says he feels that he’s able to live up to his potential. “Having my gender align with how I view myself are so important,” he said. “I don’t feel like my personality has changed that much except I’m way happier now. I’m more confident and more comfortable with myself.” 

He grew more secure in himself after he began transitioning and, no longer facing the bleakness of depression, he began to get promoted at work. Last year, he became a manager with his own Starbucks store in a busy location.

Buhrmester “creates a super positive environment,” said Mika Turberville, a shift supervisor at his store. “Within a few days of being there, he wrote us all recognition cards. It touched my heart.”

Turberville identifies as transgender non-binary, using “they/them” pronouns and credits Buhrmester with making the store feel supportive. “Since Tate has been there, I haven’t been misgendered as I used to be. There’s a lot more accountability in the store. Having Tate as a trans man and leader in his store is so powerful. (It shows) you can have a career and be trans and be supported in your career.”

Burhmester said the difference in his life now that he can be who he was born to be is profound. “I went from having no drive in life to feeling super motivated every day and really proud of my store,” he said. “I try to be the type of leader who I looked up to when I was younger, like I never thought I could aspire to being.”

Tate Trans partner
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What’s inside a more accessible and inclusive Starbucks store?