The problems with healthcare in the United States are endless, and they certainly didn’t end with the Affordable Care Act (AKA Obamacare). And as a trans person who is also disabled, I am particularly struck by how complicated healthcare issues can be. Let me explain.
President Obama recently issued an executive order updating the ACA to prohibit discrimination based on gender identity and expression. What that means is that insurance companies can no longer have blanket trans exclusions, or deny services to trans patients that they offer to cis ones. This sounds like a win for trans folks, right?
Well, not exactly.
While Obama’s executive order seems, at least ideologically, like a radical step in the right direction, it practically doesn't translate to much. First and foremost, it doesn’t mean that insurance companies are required to cover all trans related care, or that they are required to cover it at all.
There are many ways that insurance companies can, and will get around this rule. When New York made a similar change to its law a year ago, the state came up with a very clever way of skirting it. Instead of covering hormones for everyone, they stopped covering them for anyone; I remember this because it affected me. This meant that cis women didn’t get estrogen treatments, and cis men didn’t get testosterone. Why did they do this? Were they being blatantly transphobic? Probably not. The more likely answer is that they were trying to save money.
So what does this mean for trans healthcare? Well, even the category of “trans healthcare” itself is in its infancy. Most doctors don’t even know how to treat most trans patients, let alone prescribe them hormones. And as a disabled trans person, I find the puzzle even more perplexing.
I take testosterone as part of my transition to male, and every doctor I’ve met has questioned my medical ability to take this hormone. One doctor went as far as to suggest that testosterone itself might be causing a debilitating medical problem. While i don’t doubt that testosterone has affected my body (it has raised my cholesterol, for one thing), there is no evidence that it caused any major problems for my disability in particular. Most of the problems my doctors pinpointed were present long before I began T.
Ironically, with more insurance companies beginning to ease up on restrictions (and with more trans people accessing healthcare), it seems likely that incidences of ignorance like the kinds I’ve encountered—plus other more insidious encounters of transphobia—will increase.
I recently went to a medical facility in Georgia to see a doctor who is a pre-eminent specialist in his field, and who was recommended to me by a (cis) friend. I was looking forward to the visit, but still decided to bring a friend (who is also trans) with me to the appointment for support. As soon as the specialist saw on my chart that I was on T, he began to tremor and then started mumbling. He asked me why I was on it, and when I replied that I was transgender, he looked even more uneasy. In response, he said that he would have never known I was transgender, that he had never met a trans person before, and that he wasn’t exactly sure what he thought about trans people. When he left the room, his nurse continued to make transphobic remarks to me, as my friend (who, once again, is also trans) sat there becoming increasingly uneasy.
I should say that I am grateful for medical professionals. I interact with doctors on a daily basis—I depend on them for my life. However, no one can tell me for sure whether having top surgery is safe for me. Many doctors have never treated someone with my condition before (a chronic illness called Ehlers-Danlos Syndrome—EDS—that affects connective tissue). Other doctors have never treated a trans patient before.
We need to make trans healthcare better for everyone, including disabled trans people. We need medical professionals out there researching the interactions between disabilities, surgeries and hormone therapy. Disabled trans folks are humans—and we need quality and safe life-saving care just like anyone else. No one deserves to hear prejudiced remarks made about them from their own doctor.
Though our cultural focus has been on the transphobic “bathroom bills” right now (and rightly so), we must not forget that trans people all around this country are dying because of lack of safe and affordable healthcare. We can and we must do more than an executive order.
We must to go to medical schools and educate the next generation of doctors. We must do more research into the long term use of hormones. We must open more free clinics for the community. If saving lives isn’t a priority, then I don’t know what is.