Although transgender people can celebrate a recent string of monumental health victories, access to competent and quality health care remains one of the most challenging barriers that transgender people face on a day-to-day basis.
Most insurance plans continue to exclude gender affirming health care, and the exclusions can range from denials of sex-specific care (like denying a trans man coverage for a Pap smear), to defining trans as a “pre-existing” condition as a basis to deny any type of medical care, to denials of medically necessary gender confirming health care such as hormones, mental health care, or gender confirming surgeries.
Transgender Law Center strives to remove the barriers to competent health care access for transgender people in a number of ways, including:
- Advocating for laws and regulations that prohibit health care discrimination,
- Training doctors and clinics to provide culturally competent care for trans people, and
- Challenging discriminatory practices through impact litigation.
The Affordable Care Act.
One of the most significant health care victories of 2012 was the upholding of the Affordable Care Act (ACA) in the Supreme Court. The ACA promises to be a substantial step forward in ending LGBT health care discrimination.
Health and Human Services (HHS) Secretary, Kathleen Sebelius: “the Affordable Care Act may represent the strongest foundation we have ever created to begin closing LGBT health disparities.” Transgender Law Center, in partnership with partner organizations, worked to ensure that the ACA is trans-inclusive. As a result of that coalition work, the ACA now prohibits gender-based discrimination from health care providers. Section 1557 of the ACA prohibits “sex” discrimination, which is defined by the HHS to include gender identity and gender stereotyping. This provision will be essential in developing new legal advocacy tools.
• 28% of transgender people report being harassed in a medical setting.
• 19% of transgender patients reported being denied medical care based on his or her gender identity.
(Injustice at Every Turn, 2011)
Transgender Law Center Executive Director Masen Davis:
“Because each state will be determining what health benefits will be covered by its exchange and because many of the plans that will be in these exchanges currently have transgender exclusions, we must work to educate policy makers at the state level as to how these exclusions contradict the anti-discrimination language in the ACA.”
So what will the ACA mean for transgender people? It means that transgender people will no longer be denied basic health care coverage or services because their transgender or HIV status is defined as a “preexisting condition.” It means that more transgender people will be able to access basic health care services. Transgender people are twice as likely as the general population to earn less than $10,000 per year, and the expansion of Medicaid along with the increased access to health care through the exchanges will dramatically increase the number of trans people who currently have access to health care coverage. This expansion of coverage will especially impact transgender people of color who face the highest levels of discrimination and health care disparities as well as the lowest income levels.
Insurance policies approved in California can no longer deny treatments to transgender people that are given to non-transgender people.
Insurance Division Clarifications.
For almost a decade, Transgender Law Center has worked closely with the California Department of Insurance (CDI) and the Department of Managed Health Care (DMHC) to remove the discriminatory exclusions of gender-affirming health care that exist in most health care plans. As a result of that work, the CDI and DMHC have clarified that insurance policies approved in California can no longer deny treatments to transgender people that are given to non-transgender people. The announcement was a monumental victory and will result in access to medically necessary health care for thousands of transgender Californians. We are also working to end health care discrimination locally. The Transgender Law Center worked with the city of San Francisco in 2012 to end its discriminatory exclusions within the city’s health care plan (Healthy San Francisco).
As more and more transgender people have access to health care, we are working to ensure that health care providers have the information and support that they need to provide competent and quality health care to transgender people. That is why we launched Project Health.We’re thrilled to see other states take a similar approach to ending health insurance discrimination. As a result of California’s pioneering work in this area, insurance divisions in Colorado, the District of Columbia, Oregon, and Vermont all began requiring health insurers to remove their discriminatory exclusions in 2012.
Project HEA LTH and TransLine.
We know that many well-meaning health care providers and doctors need information and support on how to best care for transgender patients. Transgender Law Center in partnership with Lyon-Martin Health Services, formed Project HEALTH, a one-of-a-kind program. Project HEALTH has trained hundreds of health care providers, doctors, insurers and other institutions, and the program offers a unique medical rotation internship for aspiring physicians. To help answer questions from doctors on how to give the best care for trans patients, the program launched TransLine, a groundbreaking virtual terminal for doctors to dialogue with other physicians who are themselves transgender or experts in the area.
In addition to the need for access to competent health care, many transgender people are struggling with HIV/AIDS. The transgender community has been disproportionately impacted by HIV/AIDS. HIV/AIDS rates within the trans community are devastating, and there is much work to be done in addressing the epidemic. The Presidential Advisory Council on HIV/AIDS (PACHA) passed a groundbreaking resolution in 2012 recommending ways to address the high rates of HIV/AIDS among transgender communities throughout the United States. PACHA’s advice and recommendations are vitally important in assisting the White House to implement the National HIV/AIDS Strategy. This resolution is groundbreaking in nature, as it is the first time PACHA has issued a transgender-specific set of recommendations. Transgender Law Center Senior Strategist, Cecilia Chung noted, “We’re incredibly grateful to PACHA for passing such a strong and compelling resolution.
These recommendations, if implemented, will meet some of the dire needs of our community by providing data collection, education, and culturally competent especially important as our community continue sprevention and care for transgender people. This is facing extreme violence and discrimination–both of which contribute to a higher prevalence of HIV/AIDS.” We have made great strides in removing the discriminatory barriers to health care in 2012, and working together, we will continue to push the growing momentum forward until each and every transgender person has access to quality, affordable, and competent health care.