Health Care Reform: NCTE On its impact on Transgender People
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.
I’m trans and, yeah, it kinda sucks that i’ve had to spend thousands of dollars out of pocket. But resources are finite. If it’s a matter of insurance paying for my procedures, or some kid getting a kidney or liver transplant or leukemia treatment or whatever, the kid wins in my book.
klm
26 Mar 10 at 10:00 pm
klm,
Transition-related health care is incredibly cheap. I can’t find the report right now, but when San Francisco was deciding to cover it for city employees, one person calculated that the cost to each person covered by the health plan to add transition-related coverage was a few cents. It was, and remains, incredibly inexpensive.
It never is and never will be down to “Trans people get coverage or people will lose out on life-saving medical treatments.
However, trans people do need this kind of coverage, especially given how many of us are unemployed or living with low income. Needing medical treatment for a condition that practically no one will pay for only multiplies financial hardship.
Lisa Harney
26 Mar 10 at 10:18 pm
Like Lisa said, trans health care might be really expensive on the individual level, but once you factor in utilization, it gets incredibly cheap in comparison with your typical medical treatment.
The insurance companies tend err on the side of charging a lot if they don’t know how often it will be utilized. I got my insurance company to cover trans related care and their first offer was an extra $70,000 per year (for the whole union contract) to cover surgeries but not hormones. After showing them the SF report Lisa’s mentioning, they came back with another offer: surgery and hormones for $0. That’s right, at no additional cost. I’ve heard of several other instances where the same thing happened. From the employer standpoint, there is no reason not to expand coverage.
Tobi
27 Mar 10 at 12:18 am
Is it actually the case, as i was fairly sure that i read somewhere, that this “reform” will actually force people to buy health insurance, who might otherwise have preferred to remain uninsured, or might simply not be able to afford it, by making being uninsured illegal and punishable by a jail sentence?
(I’ve been searching for where i saw this, but having no luck finding it: i thought it was either here or at Feministe, but it doesn’t seem to be… i’m kind of hoping it was a reference to a proposal that was in an earlier version of the bill but got thrown out of the final version, or something, but it doesn’t strike me as unlikely…)
shiva
27 Mar 10 at 5:01 am
No.
If you live at 100%-400% of the poverty line, you receive subsidies to help pay for insurance.
If you live below the poverty line, you can get medicaid.
If you live above the poverty line and don’t match any of the exemptions, you are required to have insurance. If you don’t buy insurance, there’s a fine. If you don’t pay the fine, there’s no penalty. No one will go to jail for not having insurance.
Lisa Harney
27 Mar 10 at 5:09 am
Right wing commentators have been spreading the rumor that failure to have insurance can send you to jail, but they’re trying to fearmonger.
Lisa Harney
27 Mar 10 at 5:13 am
Read this post with great interest.
The other industrial democracies which cover (to some degree or another) trans care all seem to have, at some point in their discussion, trans care held up as a boogeyman. It isn’t about the low utilization, its about being perceived as a sort of medical welfare queen. As a trans person and aging social democratic type, I have mixed feelings. Being used that way in the debate over what is and isn’t covered will kind of suck. The fallout from that — good and bad — may end up being the big impact of this bill. But seeing the US have a coherent conversation about the commonweal (even if I’m outside of it) is sort of a cool and amazing prospect.
jessical
27 Mar 10 at 12:14 pm
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28 Mar 10 at 10:42 am
It seems to me that as long as the trans exclusion remains in the Americans with Disabilities Act they will find a way to keep us from being able to access the treatments we require. ENDA ain’t gonna do it. Hopefully, we can fight this but I doubt it’ll happen soon and I’ll die pre-op before it does.
Emelye Waldherr
28 Mar 10 at 7:14 pm
If HRC gave a shit about trans people and our needs, they’d be fighting that exclusion.
But HRC cares about mainstream, cis, white, affluent gay men first. They’re fine with benefits trickling down to everyone else, but they only talk like they care about everyone else when they need money.
Lisa Harney
28 Mar 10 at 7:36 pm
I thought you could still get fined X dollars or garnished wages for not having health insurance…
z
28 Mar 10 at 8:36 pm
Yeah, there’s a fine if you don’t buy insurance but there’s no penalty if you don’t pay the fine.
Lisa Harney
28 Mar 10 at 8:38 pm
In 2003 I slipped on some ice and broke my wrist, both major bones right at the joint.
Repairing the break required a lot of medical attention and I was without health insurance.
Fortunately my partner was able to pay for my medical care which ran almost as much as SRS.
The Health Care Industry is about corporate profits not health.
TS and TG people have other issues besides those directly related to our being TS or TG. Even getting included in coverage that covers everything else is a positive for those of us holding on until Medicare because our employer keeps us at part time so they do not have to provide coverage.
As for our specific issues being covered… Blame that one on the right wing misogynistic religious fanatics. Natal women are having their access to abortion and birth control messed with too, while men still get their Viagra covered.
Suzan
29 Mar 10 at 5:52 am
I apologize in advance for what may well be a derail from the OP.
@suzan
“Health Care Industry” is a misnomer. It implies that they “care” about “health”. As you note, it is about money, not health. (full disclosure: I work in a hospital)
@any
As for trans people and insurance, note that insurance companies also deny “mortgage” (aka “life”) insurance to trans people, as we’re probably viewed as high risk. (full disclosure: I was denied mortgage insurance as soon as I informed the agents learned I was trans)
sharav
29 Mar 10 at 10:42 am
“In 2003 I slipped on some ice and broke my wrist, both major bones right at the joint.
Repairing the break required a lot of medical attention and I was without health insurance.
Fortunately my partner was able to pay for my medical care which ran almost as much as SRS.”
It boggles my mind how the US Healthcare system appears to work. In the UK, that’s the sort of thing the NHS would pay for. Which leaves me wondering… what healthcare can you get in the US, without having insurance, for free? Anything at all?
Lucy
7 Apr 10 at 8:46 pm
If you’re poor enough, you can get state-managed medical coverage or medicaid. If you’re old enough, you can get medicare.
Some hospitals and clinics get funding via charity.
Lisa Harney
7 Apr 10 at 8:49 pm
And if you’re below the poverty line and thus not eligible for medicaid (is that how it works?), yet do not have the money to buy insurance due to whatever reason?
Lucy
7 Apr 10 at 8:52 pm
I have no idea why your comments keep getting dropped into the spam folder, Lucy.
Anyway: If you’re below the poverty line, you’re eligible for Medicaid. If you’re at 100-400% of the poverty line, you are no longer eligible for Medicaid but are eligible for subsidies to pay for your insurance.
Lisa Harney
10 Apr 10 at 4:57 pm
Ah. That makes sense, I guess. Thought it would still seem to leave some people unable to afford insurance, even if they are above 400% of the poverty line…
Lucy
10 Apr 10 at 5:28 pm
Yeah, I don’t know how that will work out. I think that a big part of the bill is to encourage employers to take out health plans for employees, but I don’t think it’s mandatory for busineses with fewer than 50 employees.
The only thing that makes this bill an improvement is how ridiculously horrible things are now.
Lisa Harney
10 Apr 10 at 5:30 pm
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