Imagine that you’ve just started a new job. You’re ushered through Human Resources to get your benefits started and are thrilled to finally have health insurance after going without it for some time.
As you go through the process of filling out the paperwork, you’re suddenly filled with anxiety and fear.
How do you safely identify your gender with both your employer and your health insurance?
Will you have to educate your doctor on how to best meet your needs? All while fearing that you might face harassment, discrimination, or even denial of care?
Is your insurance company going to refuse to cover your medically-necessary care? If they do, how will you afford to pay for the care you need to stay healthy?
These are just a handful of the questions that many transgender and gender non-conforming people are forced to confront when trying to access the medical care they need.
Making sure everyone in our communities has access to healthcare is a key component of our work to achieve lived equality for LGBTQ people. For transgender and gender non-conforming people, there have been—and continue to be—significant barriers to achieving this.
While statistics rarely paint a comprehensive picture of people’s lived experiences, the data acquired through the National Transgender Discrimination Survey—conducted by the National Center for Transgender Equality and the National LGBTQ Task Force—demonstrates a staggering need, and the story it tells shows just how much work remains before transgender and gender non-conforming people are able to access the healthcare they deserve. Of the people surveyed:
- 50% reported having to teach their medical providers about transgender care;
- 19% reported being refused medical care due because they are transgender or gender non-conforming;
- 28% were subjected to harassment while receiving healthcare;
- 28% postponed accessing medical care when they needed it due to discrimination;
- 48% postponed accessing medical care when they needed it because they weren’t able to afford it.
Many of these statistics are even higher for transgender and gender non-conforming people of color.
Access to safe, culturally-competent, and comprehensive healthcare is not only something that we all deserve; it also saves peoples’ lives. The survey estimates that 41% of transgender people attempt suicide at least once and that 72% have contemplated suicide during their lifetime. With access to gender transition-related care, medical research has shown that the suicide attempt rate drops down to 3 to 5%.
In addition to the often enormous task of finding healthcare providers who are welcoming and willing to provide care, transgender and gender non-conforming people are also faced with the difficult job of finding doctors who are culturally competent—meaning they have some experience and knowledge providing care to transgender people and have an understanding of their needs.
This challenge is further exacerbated in rural areas, with individuals forced to travel long distances—sometimes hundreds of miles—to see a provider that will treat them with dignity and respect.
Unfortunately, finding a provider is only part of the challenge. Many people also face additional barriers when insurance companies refuse to cover medically-necessary care, leading to high costs and many out-of-pocket expenses. These blanket exclusions are often for services that are routinely covered when a person is cisgender (non-transgender), such as mental healthcare, cancer screenings, and hormone therapy. Or they exclude transition-related care, even though it is deemed medically necessary—further risking people’s lives.
While we still have a long way to go to ensure that everyone receives the care they need and deserve, it is also important to note that we have made impressive strides in recent years.
In Oregon, through the hard work of community advocates, activists, and organizations including TransActive Gender Center, the Q Center, and Basic Rights Oregon, the Oregon Health Plan (the state’s Medicaid plan) will now cover transition-related care for transgender Oregonians, including puberty suppression/delay for adolescents. This builds on prior work that required private health insurance plans to remove exclusions on transition-related care, resulting in nearly all insurance plans in the state of Oregon covering care for transgender people.
The next phase of this work in Oregon will be to make sure that these new policies are implemented effectively—that healthcare providers receive training and support to be able to provide culturally-proficient care, and that transgender people have the resources they need to find these providers and navigate their insurance coverage. Our community partners across Oregon are actively engaged in this implementation, and Pride Foundation will continue to work with them to ensure that transgender people across the state can access the care they deserve.
Similar efforts are also underway in Washington. The Coalition for Inclusive Healthcare—a coalition of a diverse range of community partners, including Pride Foundation—is employing a multi-pronged strategy to end discrimination in healthcare coverage.
This collective work resulted in Washington State Insurance Commissioner Mike Kreidler issuing a letter last June to private insurers in the state, clarifying that discrimination on the basis of gender identity is prohibited under both Washington State and federal law. The strongly worded letter helped fuel efforts and work with the Public Employees Benefits Board (PEBB), resulting in a unanimous vote to support transgender-inclusive healthcare for public employees in the state. The Coalition for Inclusive Health has also been simultaneously working to lift the exclusions on transgender-related care from the state’s Medicaid plan. We are hoping see a victory on this front within the next few months.
Pride Foundation is also supporting transgender healthcare access across the region through our community grants program. Last year we provided a grant to Cardea Services to produce webinar trainings and resources for physicians, advanced practice clinicians, and other primary care providers to deliver clinically competent, respectful, culturally-proficient health care to transgender and gender variant people. The webinar-based format allowed people from across the region and country to participate in the trainings, and received an incredibly positive response. Cardea is now working on additional webinars to explore these topics in more depth.
Recognizing the importance of furthering this work in rural states that have less of a statewide LGBTQ infrastructure, Pride Foundation also recently made grants to two organizations in Montana—Bridgercare and Gender Expansion Project. Both organizations are focused on increasing access to culturally-competent, affordable care for the transgender community—Bridgercare through the provision of services, education, and outreach on a sliding fee scale, and Gender Expansion Project through collaborative trainings, workshops, and networking for leaders from around the state and region.
The great work and partnerships happening on the ground in Oregon, Washington, and Montana are important models that can be adapted and shared both across the region and the country. And it also means that we are a few important steps closer to ensuring that transgender and gender non-conforming people will not have to experience fear or discrimination when accessing important healthcare.
We know that there is a long road ahead and that it will require significant time and effort to make institutional changes to complex systems. Pride Foundation will continue our work with local leaders and partners in the coming years, and we remain strongly committed to investing the resources needed to ensure that everyone in our communities is able to access critical and lifesaving care.
Katie Carter is Pride Foundation’s Regional Development Organizer in Oregon. Email Katie.