Matt Kailey

A reader writes: “I am a 26-year-old transman, and I’ve been on T for 18 months now. For several years I’ve lived without health insurance, because it simply wasn’t affordable, and I chose not to apply for Medicaid out of a concern that it would impact the cost of my hormones. (Currently I get my testosterone through a community clinic in New York City, where I get a huge discount because I am uninsured and live well below the poverty line.)

“Could you please explain how the Affordable Care Act relates to transgender health costs? I don’t see myself living above the poverty line any time soon. Do you know how the new legislation might impact me as a low-income trans man?”

I am not clear on the extent that the Affordable Care Act will benefit trans people. The benefit that I have seen seems to be that health-care providers cannot discriminate on the basis of transgender/transsexual status – you can’t be turned away because you are trans, and you can’t be refused health-care services that might be necessary because of your body configuration, but that are not typically provided to people of your gender.

The Transgender Law Center says, “The law (ACA) for the first time prohibits gender-based discrimination by most health care providers – a ban that extends to discrimination based on gender identity and gender stereotypes, and thus provides critical protection for LGBT people. The law will also prohibit insurers from denying or canceling insurance because a person is transgender or has HIV or another medical condition.”

The National Center for Transgender Equality (NCTE) released a “Know Your Rights” health care guide that says, in part, “The ACA creates new rights and protections for appealing coverage denials by your plan for any reason. In addition, it may be unlawful for a plan to deny coverage for services that are included in your plan solely because you are transgender or because of the gender under which you are enrolled in the plan. For example, it may be unlawful for a plan that receives federal financial assistance to deny coverage for a prostate screening for a trans woman or a pelvic exam for a trans man if these services are otherwise covered.” (italics mine)

The Center for American Progress says that the ACA’s impact law’s impact “will be especially profound for lesbian, gay, bisexual, and transgender people,” and lists the top ten benefits of the law for LGBT people, including data collection with regard to health disparities and the needs of underserved populations.

I have not yet seen anything that says that there are any specific provisions that will benefit trans people with regard to coverage for interventions for medical transition, such as hormones or surgery. There might be something, and perhaps readers will know about it.

It’s possible that it will make your medications more affordable, including testosterone, because it is expanding Medicaid eligibility and also some Medicaid benefits. So I think that it might end up benefiting you more as a low-income person in general than as a low-income trans man specifically. But many of these benefits will not take effect until 2014, and the ACA has not been popular with Republicans or Congress. So depending on what happens this election, it’s possible that the ACA, or parts of it, could be null and void before it even begins.

For now, the major benefit to the trans community will hopefully be that we will never have to have another Robert Eads, who died of ovarian cancer after more than twenty doctors refused to treat him because he was trans, or another Jay Kallio, whose doctor did not tell him he had breast cancer because the doctor was so uncomfortable with a trans patient.

While it’s frightening to think of being treated by a medical professional who finds you distasteful or downright disgusting, it’s even more frightening not to be treated at all. And although I believe that there are doctors who will not change their mind or their feelings no matter how many trans patients they treat, I think that there are others who will change their mind once they have more exposure to trans people and are able to see us as human beings in need of care like everyone else.

The fact is that most of the medical care a trans person receives over his or her lifetime will probably be for issues not related to that person’s transness. At least the ACA will bring us to the attention of medical professionals who probably hadn’t thought about the issue before. Whether they love us or hate us, they will be required to treat us. Changing hearts and minds takes time, which is why I think it’s most important to have legislation on our side.

Readers, what do you think? What do you know about ACA?