By Kaylia Metcalfe
Obamacare, or the Affordable Care Act (ACA), has supporters and enemies on both sides of the aisle. But one thing is for sure—the policies are more trans-inclusive—and we should all appreciate that.
One of the pivotal points of the ACA is that starting on Jan. 1, 2014, it is illegal for insurance companies to refuse to sell insurance to someone because of a preexisting condition such as GID (Gender Identify Disorder). The diagnosis of GID is what enables members of the trans community access to transition-related care (e.g., counseling, hormones).
Another facet of the ACA is the idea of equality built right into the language of the policy. The nondiscrimination section, along with existing federal health regulations, prohibits discrimination, including discrimination based on gender identity, in any program that receives federal funding, which is almost all programs.
This doesn’t mean that all insurance companies must cover all trans-related procedures or prescriptions, but it lays the groundwork for people to be treated equally. For example, if your insurance company covers hormone therapy for women going through menopause, a trans person is entitled to hormone therapy as well and if denied this sort of coverage because of their status as trans, that constitutes discrimination.
The trans community now has an ally in the Office of Civil Rights and the U.S. Department of Health and Human Services, which will investigate such claims.
Anand Kalra, the Project Health program manager at the Transgender Law Center (Oakland) pointed out another benefit for the trans community via Obamacare in a recent interview with The Advocate: the right to report harassment and denial of services.
The 2012 “Injustice at Every Turn” report of the National Center for Transgender Equality and the National Gay and Lesbian Task Force found that 19% of the 6,500 transgender people they surveyed had been refused medical care because they were transgender. Put another way, nearly one in five transgender people have been told by health workers that they are unworthy of care—from bronchitis to broken bones.
Moreover, it’s all too common that healthcare providers inexperienced in working with transgender clients probe with irrelevant questions and show a gossipy fascination with transgender people’s genitals, even when the care they require has nothing to do with transition. Twenty-five percent of the sample from “Injustice at Every Turn” reported being harassed or disrespected in a doctor’s office or hospital. Previously, these injustices could go on with no recourse, and while we can’t prevent them from happening with the law alone, transgender people now have the right to report discrimination in healthcare and to have their experiences taken seriously.
At the state level, things are starting (slowly) to change for the better for the trans community as well. California, Colorado, Oregon, Vermont and most recently Connecticut all require health insurance providers to cover treatments related to gender transition. Many corporations and universities are also eliminating exclusions voluntarily.
Back to Obamacare: Another huge benefit of the ACA is the expansion of Medicaid eligibility to all people under 133% of the federal poverty level ($14,000 per year for a single person). Transgender people are four times as likely as the general population to live on less than $10,000 per year.
Lastly, the ACA provides funding for LGBT Cultural Competency trainings to help those in the medical field have a better understanding and compassion for the LGBT community and their specific medical needs. Programs have started in some of the nation’s bigger cities while many smaller communities can turn toward their local LGBT community centers for these sorts of programs. Among those receiving training is the now-tripled staff of the National Health Service Corps, which places physicians in underserved areas across the country.
As the long-term effects of the ACA develop, there are sure to be pitfalls and problems, but the desire of the framers to be more inclusive of the trans community is apparent, and that can only forecast good things for the community.
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Kaylia Metcalfe is a writer, blogger and activist in Fresno. She is a cofounder of Skeptics Without a Cause and serves on the Gay Central Valley Board of Directors. Her short story collection “Links” is available at www.amazon.com. Contact her at kayliametcalfe@gmail.com.
