I will say upfront that the health care bill is a horrible bill and fails to really accomplish full reform. That said, it is an improvement because the US health care system (and I use that term very loosely) is beyond horrible. A system that makes it easier for everyone to get and keep coverage is better than a system that makes it easy for people to be excluded for arbitrary reasons. It still doesn’t go a fraction as far as it needs to, and of course disallowing transition-related health care is still legally allowed discrimination under the reformed health care. The new boss is only slightly friendlier than the old boss.
What the healthcare reform law will do for transgender people:
Increased access to health insurance: Because of rampant workplace discrimination, transgender people are under- and unemployed at significant rates, with an incidence of poverty at more than twice the national average. The reform law’s provisions that impact low-income Americans will provide new opportunities for many transgender people to access health insurance.
Cannot be denied coverage or dropped: Also importantly, the healthcare reform law would prohibit insurance companies from dropping or denying coverage to individuals or their dependents because of their 1) pre-existing condition, 2) medical condition, 3) claims experience, 4) receipt of healthcare, 5) medical history, 6) genetic information, 7) disability, and 8) any other health-status related factor determined appropriate by the Secretary of Health and Human Services. This means that transgender people cannot be dropped or denied coverage by insurance companies because they are transgender or have received transition-related medical care. This is a huge leap forward for the transgender community. However, this provision does not affect insurance companies’ exclusion of transition-related care.
Ban on some forms of discrimination: Additionally, the law also forbids discrimination based on race, ethnicity, sex, age, and disability. If an individual experiences discrimination by a medical provider or organization, (s)he may seek remedies under existing statutes that protect the previously mentioned groups. Even though sexual orientation and gender identity and expression are not included in the anti-discrimination provision, current federal, state, and local anti-discrimination statutes that protect the LGBT community are still in force.
Continued barriers to health care faced by transgender people
Discrimination and distrust: Transgender people suffer from multiple barriers to accessing affordable and quality healthcare, including extraordinarily high rates of discrimination from medical providers and organizations. Lambda Legal conducted a survey which found that 70% of transgender and gender-nonconforming respondents had experience some form of discrimination by medical practitioners. (http://www.lambdalegal.org/publications/when-health-care-isnt-caring/) Because of this discrimination, transgender people mistrust medical professionals and put off necessary preventive care and treatment. This leads to additional complications and deteriorating health, and adds additional costs.
Lack of insurance and denial of coverage: Because of discrimination in the workplace, there is a significant lack of insurance coverage within the transgender community. Even if they do have insurance, transgender people often times cannot access medically necessary care because insurance companies, Medicare and Medicaid explicitly exclude transition-related care. Additionally, many insurance companies refuse to cover transgender people at all. Some insurance companies do provide coverage to transgender people but deny claims citing that transition-related treatments can lead to other, unrelated health issues, even when there is no scientifically based link between them.