Healthcare Difficulties Persist for Transgender Americans, Despite Increased Insurance Access

May 7, 2018

Diversity Richmond's Transgender Panel
Credit Brad Kutner

As state lawmakers consider broadening healthcare access for lower-income people through expansion of the federal Medicaid program, transgender Virginians are sure to be among those who benefit.

But barriers, either from insurance providers or from the federal government, are still in place.

Katrina Cunningham is participating in a panel of transgender men and women at Diversity Richmond’s National Transgender HIV Awareness Day. Part fashion show, part learning opportunity, Cunningham recalls the earliest days of her transition, without healthcare and seeking treatment anywhere she could.

“I was introduced to a lot of stuff in the street.  So my thing is to go see the right doctors," Cunningham told the panel.

While illegally obtained hormones and uninformed medical providers have long plagued transgender people, overall access to healthcare for the community has increased since the Affordable Care Act was passed in 2013. According to a 2014 Survey by Americans for Progress, the number of uninsured transgender Americans dropped by almost 50 percent a year after the healthcare law went into effect. And now, as Virginia legislators work to expand Medicaid, the number of transgender Virginians who could receive healthcare is set to grow even larger, but the increased access to much-needed treatment will still have problems. 

“Insurance-wise has been the only negative experience I’ve had with transitioning,” says  Oliver Johnston, a 22-year-old Lynchburg native who moved to Roanoke in search of more medical support to aid in his female-to-male transition starting in 2015.

While Johnston found a supportive medical provider, his insurance coverage has been less understanding.  “Every single year my hormones have to get “approved” and they only get approved for another year as if I’m going to stop taking hormones.”

Charley Burton, a 58-year-old black trans man and board member of the Charlottesville-based support

Charley Burton in his Richmond-area office.
Credit Brad Kutner

group Black Transmen Incorporated, faced a similar mismatch in healthcare.  “They’re saying ‘well, we’ve got an ID here that says male. Why is this person going to a GYN doctor and needs GYN services?’ That’s what I’m fighting with right now,” Burton notes

Noah Lewis runs the New York-based Transcend Legal; a nonprofit group that helps trans people get their medical needs covered when insurance companies deny them care. 

Lewis said there’s a myriad of reasons trans people can be denied coverage, and its often the result of not understanding the medical needs they deal with daily.  “Insurance companies say that  these are cosmetic procedures even though they are recognized to treat gender dysphoria.” 

Lewis said some of these problems can be overcome through an appeals process, or by threatening sex or disability discrimination under Title VII of the Civil Rights Act, and rules in Affordable Care Act can help too. But President Trump’s conservative agenda isn’t helping.   “Discrimination against transgender people has been widely recognized by the courts as sex discrimination so the statute is still on the books and can be enforced by private individuals," Lewis says. "The only thing is the federal department of Health and Human Services is not enforcing the protections as they apply to transgender people right now.” 

In an email, Roger Severino, Director of the Office for Civil Rights for Health and Human Services said his office “will continue to vigorously enforce all prohibitions on discrimination in health care according to the law and court orders.”

He pointed to a Federal Judge’s injunction which halted a 2015 memo that offered trans-specific protections. The injunction claimed the Obama-era memo violated doctors’ religious freedoms and Severino said HHS is re-writing the rule while considering the issues raised by the judge.

LGBTQ advocates have expressed concerns about what the rewrite might, or not, include, however they are still praising the broader increased coverage the ACA brought in the first place.

Ted Heck, the transgender health coordinator for the Virginia Department of Health, is all too familiar with transgender people who could benefit from the program’s expansion in the Commonwealth.

Heck said trans men and women often face higher rates of unemployment because of how they identify; it is still legal to fire or not hire someone because of their gender identity in Virginia. “The more intersecting identities that are stigmatized in one person, the more complicated and challenging it gets to access services. It’s one of those issues that doesn’t have an easy answer.” 

This report, provided by Virginia Public Radio, was made possible with support from the Virginia Education Association.