Mara Keisling, executive director of the National Center for Transgender Equality, cited a trans woman who broke her arm playing softball. She was insured through an employer plan so assumed that her hospital services would be covered. When she received her bill in the mail, however, she learned the company refused to pay for the treatment: since she obtained the injury playing in an LGBT softball league, they reasoned, the injury was “transition-related.” In another case, a transwoman suffered a coronary event due to prolonged stress caused by dealing with her insurer. The company’s first reaction was to admit to its role in her condition—then use the identical justification in refusing to pay for her EKG. The insurer reasoned that since refusing to pay for her transition-related care necessitated the treatment, the EKG itself was transition-related. “One friend of mine is anemic,” Keisling continued, “and her insurance refused to cover her treatment because she had ‘transsexual blood.’”
The Affordable Care Act will end many of these absurd exclusions. In 2014, the Patient’s Bill of Rights will prevent insurance companies from denying coverage based on pre-existing conditions. What’s more, the ACA will bring Title VII federal nondiscrimination protections to the healthcare field. The Department of Health and Human Services, responding to both pressure from LGBTQ advocacy groups and precedents set by recent federal court cases, recently confirmed that this policy will ban discrimination based on gender identity. This will not only help transgender and gender non-conforming people obtain coverage but will also outlaw the discrimination Kallio and so many others have suffered when pursuing treatment. Considering that one in five transgender people have been refused medical care based on their gender identity, these discrimination protections are critical.
Another major ACA win is the funding for LGBT cultural competency trainings. While many Americans find a trip to the doctor unpleasant, the National Transgender Discrimination Survey found that one in four trans people has been verbally harassed at a doctor’s office or hospital, and a small but striking 2 percent have been physically assaulted while attempting to receive medical care. “Trans people have a lot at stake when they go to the doctor,” says Dru Levasseur, a transgender rights attorney at Lambda Legal, where a transphobic physician or staff person can make an already vulnerable experience unbearable. “Many trans people we see end up waiting and going to the emergency room instead of going to a doctor’s office because they are so traumatized by providers who aren’t respectful.” Others will drive for hours on end to reach a clinic they can trust.
The cultural competency trainings, which have already been implemented in big-city health departments like New York’s, teach staff to provide respectful care oriented to LGBTQ patients’ needs. Among those receiving training is the now-tripled staff of the National Health Service Corps, which places physicians in underserved areas across the country.
The most important piece of the ACA for transgender people might also be the most contentious: the Medicaid expansion. Extending Medicaid eligibility to all people under 133 percent of the federal poverty level (around $14,000 per year for a single person) is great news for transgender people, who are four times as likely as the general population to live on less than $10,000 per year but are routinely ineligible for Medicaid. As of January 2010, for instance, low-income adults without dependent children—a demographic transgender people largely fall under—could not qualify for Medicaid in forty-three states. Single trans people are among the 16 million Americans who will be newly eligible for Medicaid in 2014.
Executed properly, this would mean that trans health issues like hormonal treatments, sex reassignment surgery, mastectomies, and so on, would be covered by default by all health insurance providers. The Human Rights Campaign vouches.
According to the HRC, a large portion of major insurance providers cover SRS and/or hormonal treatment for transgender individuals, or other trans health related treatments.
Transgender people are already protected from federal employment discrimination, employment discrimination on certain levels in several states, and housing discrimination nationally.
Additionally, we know in older news, the Girl Scouts of America organization announced that they would allow transgirls and transwomen into their ranks, unlike their counterpart, the Boy Scouts of America, which does not allow any LGBT persons to join.
Furthermore, in more recent news, after several meetings with trans rights lobbyists and psychologists/psychiatrists alike, recently the transgender condition has been properly renamed from "Gender Identity Disorder", to "Gender Dysphoria" (or, according to some sources, "Gender Incongruence"), and will supposedly appear as such in DSM-V. "Transvestic Fetishism" will also be replaced. Both conditions are promised to have reformed criteria and treatment suggestions.