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The transgender community has more visibility today than they have ever had before. With this visibility has come a national conversation about the discrimination transgender people face on a regular basis. The core issues transgender individuals face are rooted in both disparity and discrimination in healthcare.
Prior to the Affordable Care Act, health insurance companies could deny coverage to transgender individuals on the basis that their identity was considered a pre-existing medical condition.
Identifying as transgender has long been classified as a mental illness, and although the general attitude towards the dated way of thinking is starting to change, some medical professionals continue to view being transgender as a mental illness. There is also a large group of healthcare professionals who are simply not educated on how to care for transgender patients, both of these issues heavily impact transgender people’s access to quality medical care.
What Is Transgender Healthcare?
Transgender healthcare encompasses a range of health services. One of the main aspects of transgender medicine is treatment relating to gender transition. Treatment can include, but is not limited to, hormones, chest surgeries, various gender-affirming cosmetic surgeries, genital surgery, and the monitoring of any health effects these procedures may have.
Along with physical treatment, there is also a strong component of mental health care. Although being transgender in and of itself is not a mental illness, many transgender people struggle with mental health problems such as depression, anxiety, and addiction.
Why It’s So Important
Transgender healthcare is important because it is essential to the mental and physical wellbeing of one of the most vulnerable communities. Physically transitioning can reduce, or even fully alleviate, a transgender individual’s feelings of gender dysphoria. Not having access to transition-related care has led some transgender individuals to seek risky, unprofessional surgeries.
Even the process of transitioning with professional medical care comes with risks. Hormone therapy can cause liver damage and, in rare cases, cancer. For transgender women, estrogen cause blood clots, swelling, high blood sugar, and heart problems. For these reasons, the monitoring of overall health is a highly important component of transgender medicine.
Transgender people also need mental health care that is affirming to their identity and a mental health provider who understands gender dysphoria and transgender issues. It is vital that transgender people feel respected and safe seeking mental health care, as transgender individuals have high rates of depression, suicides, and other mental health conditions. Getting proper care for these conditions can be life-saving.
What Is And Isn’t Covered Under Insurance
Many insurance companies today do have some form of transgender insurance policies. This rise in transgender insurance coverage is largely due to section 1557 of the Affordable Care Act, which bars insurance plans offered on the ACA exchange from discriminating on the basis of gender. Although this does not mean all transition-related care must be covered, it prevents insurance companies from denying coverage or the basis of gender identity and applying for coverage in a discriminatory way.
Unfortunately, even when coverage is offered there are many prohibitive requirements transgender people must meet in order for their transition-related surgeries to be deemed medically necessary. Some of the most common requirements are as follows:
- Referral letters from two qualified mental health professionals.
- Well-documented, long-term gender dysphoria.
- Any mental health conditions the patient has must be well controlled.
Is Hormone Therapy Covered?
The majority of health insurance policies do cover hormone therapy for transgender individuals. Under the ACA, selectively denying certain treatments on the basis of gender identity violates the law. This means that if an insurance policy covers hormone therapy for women in menopause, it must also cover hormone therapy for transgender individuals.
Keep in mind that an insurance policy covering hormone therapy does not mean it will cover other transition-related care; transgender people seeking health insurance must look carefully at insurance policies.
Medicaid Exclusions For Transgender Individuals
Access to transgender healthcare for individuals on Medicaid varies from state to state. There are still several states which explicitly exclude transgender insurance coverage from Medicaid. These states have been able to maintain these exclusionary policies under the ACA by deeming transition-related care as not being medically necessary on the account that it is not considered to be restoring bodily function.
It’s not all bad news though, there are also many states with no Medicaid policy specifically relating to transgender medicine. In these states, the coverage of transgender healthcare is often determined on a case-by-case basis. Additionally, the majority of states on the east and west coasts have Medicaid policies that explicitly include transgender healthcare, and more states are expected to follow.
The Fight Against Discrimination
The fight against the discrimination transgender people face in healthcare is an ongoing one. Some of the ways people are fighting against this discrimination are:
- Pushing for medical schools and facilities to provide better education and training on how to treat transgender patients.
- Bringing lawsuits against insurance companies who deny transgender people care on the basis of their gender identity.
- Fighting discriminatory Medicaid policies.
- Fighting laws that seek to roll back protections for transgender people.
Great strides have been made in the fight against discrimination, but there is still a lot of work to do and progress to be made.