As a health policy attorney, researcher, and student, I am used to my discussions revolving around topics like single payer health insurance and alternatives to fee-for-service reimbursement.
Bored yet? That’s my point.
Because when I hear real people start up conversations about these things, like my mother did yesterday as we watched the news out of Iowa, I know something is happening. The election season has officially begun in America, and on both sides of the aisle the debate about how to fix our healthcare system has started in earnest.
Let me make a pitch for why the needs of the trans community should be part of this conversation.
When I sat down late last year to write a paper on the healthcare needs of trans individuals, I was surprised to find that many of the unmet needs the trans community has are exemplary of broader systemic shortcomings. Yes, transgender people sometimes have medical needs specific to their transition process or to the maintenance of their true gender. And yes, many people also face discrimination specific to their gender identity. These should both be priorities.
But many challenges the community faces are analogous to the problems faced by other vulnerable populations. Transgender people report high rates of poverty and homelessness, delay of medical treatment due to lack of funds, and a high burden of HIV. As important as it is to understand why these problems are happening specifically within the transgender community, it is also important to note that other vulnerable populations face similar challenges.
Recognizing that commonality is important because it suggests that there is also a shared interest in how to reform healthcare. Contrary to popular belief, in which access to surgery and hormones are the sole healthcare priorities of the trans population, there are many reforms that would address the discrimination and disparities the community faces. And they are reforms that many other activist groups could get behind.
For example, many people have been frustrated – even in the age of "Obamacare" – that their insurance is not accepted by a wide range of providers, that they cannot find mental health providers who accept insurance at all, that there are discontinuities of care, and that the system is fragmented beyond comprehension or navigability. In each instance, the problem is exemplified when considering the transgender community.
After all, lacking choice of providers matters a lot more when any one provider might treat you with hostility because of your gender identity, or simply not know how to treat you. Having to deal with medical bills and hostile insurance companies is more than just a hassle when you lack a permanent address or a reliable phone line. Constantly being pushed from one provider to the next, with no one managing your care and helping you to navigate the system, is all the more challenging when you have to fear disclosing your gender identity at every turn, or grimace as you are identified as the wrong gender when you are called in a waiting room.
When we start to think of these little indignities as happening at a systemic level, and as occurring to someone who is already at a disadvantage in that system, they suddenly become harder to shrug off. Instead we see people’s basic human needs being unfulfilled.
Our fractured American system – a hodgepodge of public and private options that vary based on one’s state (and sometimes county), immigration status, income (and sometimes savings), age, ability, and more – is frustrating to us all. But the resulting problems are especially pronounced for those facing tenuous living situations or financial insecurity, who live with complicated or chronic medical needs, or who – yes – comprise the transgender community.
The policy goals of transgender and gender-nonconforming activists are known to few and exoticized by most. But in reality, if the country made healthcare better for transgender Americans, it would be improving it for a lot of other marginalized groups, too.
So if we’re finally going to have a discussion on health policy, and one that gets beyond rehashing the old disputes around Obamacare, please:
Let’s talk about trans health.
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