Transgender Care: A Brief Overview of Access, Oppression, and Political Fumbles

Every major publication covered the President’s shocking tweets that banned transgender people from serving in the military. Fundamentally, the President took a cheap shot at the most vulnerable members of the LGBT community to appeal to the most hateful supporters, all in the name of pinching pennies and his floundering political mortality.This month’s column compares healthcare programs that provide transition-related care to transgender people. It looks at the system and how it fails transgender people.

Millions across the country have been able to purchase healthcare through President Obama’s Patient Protection and Affordable Care Act (ACA). Given the threats to the country’s healthcare since the President was sworn into office, the military and its health benefits have become appealing new options to transgender people who might not have access to safe, transition-related care otherwise. Not all transgender people desire gender reassignment surgery, which constitutes the largest expense in transition-related care. Consistent hormone therapy and counseling services, the fundamentals of transition-related care, is often itself prohibitively expensive for transgender people, and, honestly, everyone else.

The President blamed healthcare costs and “disruption” as the reasons for reversing President Barack Obama’s groundbreaking legislation, which he signed only one year prior on June 30, 2016. The RAND Corporation research brief, “The Implications of Allowing Transgender People to Serve Openly in the Military,” cites the insignificant costs of medical care for transgender servicemembers within the military’s total budget. In all likelihood, the President referred to the male-dominated and historically transphobic and homophobic culture that characterizes the U.S. military. Lucky for this country, Transphobic tweets are not military policy, so the Department of Defense must receive a formal directive before it will implement changes.

The Military Health System (MHS) provides medical care and treatment for the thousands of men and women that serve in the Army, Navy, and Air Force. The MHS included hormone therapy and counseling services with the repeal of the military’s ban on transgender servicemembers. Let us turn our attention to the “red” state of Georgia for the moment, since on the surface seems so distant politically from California. The state of Georgia is interesting because it: celebrates its military culture; does not include transition-related care in its Medicaid program; has one of the highest percentages of self-identified transgender people in the nation. In the case of assuring transition-related care through public health insurance, Georgia’s policies fall short of serving its population.

In a 2016 Williams Institute study called “How Many Adults Identify as Transgender in the United States?” notes that Latina/o and African American transgender people are more likely than white respondents to self-identify as such. This proves challenging to transgender people given the country’s enduring transphobia. The 2016 National Transgender Discrimination Survey found that transgender people are four times more likely earn under the federal poverty level ($12,070 for 2017) and twice as likely experience employment discrimination than the typical United States citizen. This experience of poverty and employment discrimination intensify for transgender people of color. Although some writers contest the narrative that military recruiters target low-income youth of color, the education, travel, and healthcare benefits that come with military service still draw people with limited alternatives. This is as true with transgender people as it is with anyone else.

The implementation of the Affordable Care Act on March 23, 2010 expanded access to healthcare for people by introducing a healthcare market and more funds for Medicaid. States administer Medicaid programs, and thus choose to accept or decline said funds. However, in an effort to undermine the country’s then-Democratic President and his legacy, many “red” states declined and continue to decline Medicaid funds. This leaves many people and their dependents uninsured for healthcare. Common sense says the young and able-bodied can forego health insurance, but accidents happen, and can cause catastrophe for one’s finances.

California was one of the first states to implement the Affordable Care Act through Assembly Bill 1602. Once it was approved, this bill created the California Health Exchange, the country’s first health insurance marketplace. Since 2014, Medi-Cal has also made transition-related healthcare coverage available to low-income consumers and people with disabilities. California is one of only five states that include transition-related care in their Medi-Cal programs, the others being Massachusetts, Oregon, Washington D.C., and Vermont. This goes without writing, but transgender people live everywhere in the United States, not only in “blue” states and cities where the majority’s tendency is to accept, celebrate, and even tokenize LGBT people. The bill was authored by then John A. Perez, California’s first openly gay Speaker of the Assembly.

The President’s promise to repeal and replace the ACA exemplifies his inability to stay true to his word. The many attempts to “ram” the legislation through the House and Senate have, ironically, resulted in castrated attempts to prove his potency. (Another irony: drafts are supposed to improve with revision, not worsen). His seven months in the Oval Office have similarly destroyed any notions the public may have entertained about his commitment to LGBT equality with a few misguided tweets. He has consistently demonstrated his lack of competence for policy, leadership, diplomacy, and tact, all necessary for even basic governance. He is clearly no friend of the LGBT community.