A year after the Affordable Care Act (ACA) was signed into law, South LA– the neighborhood where I work– was still ground zero of the uninsured crisis. In 2011, 28.5 percent of LA’s population still lacked health insurance, and 21.3 percent of Californians as a whole were uninsured at some point during the year. These numbers are scary to think about now– but for Transgender people like myself, the numbers were even bleaker. The worst part? Our existence on the margins of the health care system was– and is– not a coincidence.
Before the passage of the ACA, Transgender people had a uniquely difficult time accessing health care. Gender dysphoria was classified as a pre-existing condition prior to the ACA being signed into law in 2010, which meant that insurers could legally refuse to cover Transgender individuals. This meant that many Transgender people– regardless of their income level– were denied health insurance coverage outright.
The inability to access health care forced many Transgender people to rely on the “grey market,” an underground system where you could buy discounted hormones online or from well-connected drug dealers. Transition surgery was not an option for most uninsured Transgender people, though those who could afford the travel would sometimes go to Mexico to receive surgeries, often in motels, from questionable source across the border.
The ACA was a godsend for many Transgender folks. Between 2013 and 2014 alone, the uninsured rate of Transgender individuals dropped dramatically as more people were able to access health care, many for the first time.
I’m lucky to live in California, because most Transgender people here are now able to access the health care services they need, including hormones, transition surgeries, mental health care, primary care, and more. As Trans* Empower Case Manager at St. John’s Transgender Health Program (THP), I’ve seen firsthand how much being able to access health care drastically improves life for my Transgender neighbors. When the THP started in 2014, we had 9 patients. Today, we serve over 1800 community members– a majority of whom are either covered by Medi-Cal through the Department of Social Services, or by Covered California through the ACA marketplace. In addition to traditional and Trans-specific health services, we provide supportive services such as Victim of Crime advocacy, prescription and pharmacy assistance, job readiness programs, and HIV care– all in a culturally competent, safe setting.
For me, working at the THP is like working with my family because it’s not just about health care. As Ethan, our patient advocate says, “We don’t limit ourselves to medical care; we go above and beyond to ensure our patients have successful transitions that lead to successful lives. I know firsthand how difficult it can be to navigate the health care system, especially if you are Trans, and I want to provide a safe and empowering experience for our patients. I want to make a positive impact in their lives. Without Obamacare, this would not be possible.”
Despite the great strides we’ve made so far, many states still don’t supply Transgender related medication, and Transgender people– who, statistically, have lower incomes than their cisgender counterparts– living in states that refused to accept the Medi-Cal expansions still struggle to access affordable health care at all. Additionally, the codes that insurers use to classify an individual as male or female are discriminatory, as they disallow Transgender people from getting the specific services and care they need due to mis-classification of their bodies. The Trump administration has also been making dangerous moves to further institutionalize transphobia in our health care system through the U.S. Department of Health and Human Services’ Office of Civil Rights, which is working to bolster “conscience protections” that could once again legally allow doctors to deny Transgender people health care.
To honor the anniversary of the ACA this week, I encourage everyone reading to reach out to your representatives and ask them to expand access to health care for the sake of our Transgender brothers and sisters across the country. At the end of the day, everyone has a fundamental right to affordable, comprehensive health care– regardless of gender identity or ability to pay. We have a long way to go in terms of rights for Transgender people in this country. Health care is a good place to start.