I am a minister of God. I have seen a lot, but some things still surprise me. It surprised me to hear that publishing this opinion was necessary in Hawaii.

Last week I learned that insurance companies in Hawaii do not provide complete care for our transgender siblings undergoing gender affirming procedures. This surprised me.

It should not go without saying that more than half a decade ago, the editorial board of The New York Times published an opinion about the resounding conclusions by the nationwide medical community that care for transgender persons in transition is medically necessary and should be covered by insurance. The opinion continued to explain that federal officials stated that insurers that do not provide these services are discriminating against transgender persons in contravention of federal law.

And finally, perhaps most practically speaking, Johns Hopkins, in a well-known study, showed that providing transgender-related care is cost-effective over the longer term because it greatly reduces incidence of depression, anxiety, and other kinds of lingering, long-term conditions that affect well being and overall productivity.

And these are all reasonable, rational arguments that I am sure have been made by the reasonable, rational people who are seeking this care. But these are not why I was surprised.

I am a minister of God. I was called by my church to minister to all of the world’s people in ways that affirm the worth and dignity of all people. The honor to serve the world in this way led to the deeply humbling opportunity to participate in the Honolulu Transgender Day of Remembrance in November. If you don’t know what the Transgender Day of Remembrance is, it is a day each year when we remember by name each member of the worldwide transgender community who is the victim of deadly violence.

The list of names is long. So is the list of violence. And we read every name together and hold each other in the loving and understanding embrace of aloha.

What surprised me was learning that insurance executives doing business in Hawaii are withholding care for our transgender siblings over definitions of procedures. Studies show these procedures have the power to pull our siblings out of depression, anxiety and despair. Federal officials state that denying these procedures violates federal law. Insurance companies welcomed into these islands, who receive millions of state tax dollars to care for Hawaii residents, are denying these medically necessary procedures to this very small group whose members have suffered enough.

And enough is enough.

Call it illegal. Call it unconscionable. But I am a minister of God, and I call it like I see it: It’s a sin against our siblings and a sin against a loving creator who calls us to love one another as ourselves.

Do not perpetuate this harm any further. We must call at once for insurance companies who are permitted to operate in Hawaii to fund all gender-affirming care for the precious siblings for whom it is necessary. And we call on these companies to do this today. We will all be watching.

The Rev. T. J. FitzGerald is senior minister of the First Unitarian Church of Honolulu.