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'A death sentence': What changes to US healthcare could mean to the trans community

President Trump's plan will strip anti-gender discrimination protections put in place by Obama

'A death sentence': What changes to US healthcare could mean to the trans community
imcharliebaker | Instagram
Charlie Baker

Charlie Baker’s childhood memories read like those of any other boy: aspiring to an Arnold Schwarzenegger-esque physique, pretending to shave his face, flexing barely-there muscles in front of a mirror.

Except Charlie was not assigned as a boy at birth.This was something he knew was a mistake around the time he first wished giant biceps would appear in his pre-kindergarten reflection.

Below: Charlie Baker pretends to shave as a child

‘I wanted to transition when I was very, very young, but it took me until the age of 25 to put the label of “trans” upon myself,’ he says.

‘So much of that was the idea that this life was going to be so hard.’

Charlie made the leap with his first testosterone shot in August 2016 and found the lows he foresaw superseded by the highs of living the life he always imagined. That is, until President Donald Trump’s January 2017 inauguration.

Whether by stripping students’ ability to choose the bathroom that matches their gender identity or suggesting religious entities can deny their employees contraception, the White House has repeatedly made it clear to the estimated 1.4 million in the US trans community that their rights are on the chopping block.

Kris Hayashi, the executive director of the Transgender Law Center, said: ‘Ever since the inauguration, ever since the election, we have been in this moment of attack, after attack, after attack on our community from this administration.’

Healthcare: the latest hit

And yet it was the House of Representatives who most recently chipped away at trans rights, passing the Republican response to Obamacare, the American Health Care Act, just over a week ago.

Among its many proposals, the Bill will give states the option of waiving the continuous coverage provision put in place by President Obama’s Affordable Care Act (ACA).

The waiver would technically allow insurance companies to take a person’s health history — or pre-existing conditions — into consideration when writing healthcare policies in the individual market. Republicans believe this will lower insurance costs for all, since those who require more resources will pay more than healthier individuals.

There would be a requirement for states to provide a risk-mitigation program or invisible risk-sharing program to cover high-cost bills for those with pre-existing conditions, although similar cash pools have quickly dried up in the past.

Life before Obama’s ACA is also a case study: during that time, insurance companies could charge much more for their services or deny coverage outright, leaving those with pre-existing conditions to pay full price for medical care.

The Trump administration also has plans to repeal Section 1557 of the Affordable Care Act, which prohibits discrimination based on gender identity by healthcare providers receiving funding from the Department of Health and Human Services (HHS).

On the day of the rule’s passage, former HHS Secretary Sylvia M. Burwell said in a statement: ‘[Section 1557] is a key step toward realizing equity within our health care system and reaffirms this Administration’s commitment to giving every American access to the health care they deserve.’

This rule extends to the actual treatment trans patients receive: no longer can a patient who identifies as female, for example, be denied a gender-specific treatment she may still need, like prostate cancer treatment. It also means an insurance company can’t deny coverage of a transition-based service if it’s covered for other patients. Hormone therapy is used to treat menopause, so hormones should be covered for trans patients, too.

The rule does not require insurance companies to cover gender confirmation surgery, though.

‘A death sentence’ for the community

It’s clear why the repeal of discrimination protections would hurt the trans community. But gender dysphoria — defined as ‘the condition of feeling one’s emotional and psychological identity to be opposite to one’s biological sex’ — could also disqualify someone seeking coverage, as it’s on the AHCA’s list of pre-existing conditions.

‘It’s official — I’m a pre-existing condition,’ Charlie laughs, although his tone quickly reverts to a serious one.

‘This has allowed me to see that, if the government is going to pick a queer minority to focus on, then I feel like I’m walking around with a target on my back.’

He’s not the only one feeling that way, either. Hayashi released an impassioned statement on May 8th in response to the proposed changes.

In the statement, he called the administration and legislature’s actions ‘a death sentence for many in [the transgender] community.’ He went on to point out the link between access to healthcare and viral suppression for those living with HIV. Needless to say, taking healthcare away from those with HIV ­— the transgender community is five times more likely than the cisgender population to live with the virus — could truly be the death sentence he describes. But there’s more to the equation, he added over the phone.

‘It’s about what this would mean for transgender people’s access to healthcare of all kinds, which includes access to mental health services,’ he said.

Charlie had a similar fear when asked what he thought of ‘death sentence’ as a descriptor.

‘How many more trans people are going to kill themselves now because life just got that much harder? The trans community certainly doesn’t need another social signal like this.’

It’s harder to fix than it may appear

With approximately 0.4% of the US identifying as trans, it’s safe to label the population a minority. This alone can lead to stress, says Dr. Jody Herman of the Williams Institute at the UCLA School of Law, which researches sexual orientation and gender identity law, as well as public policy.

‘Minority stress is the result of experiences of stigma and discrimination and it can have an impact on mental and physical health. We view health disparities are largely caused by minority stress,’ she said.

A 2014 study also showed transgender adults were more likely to experience poor overall health and more days suffering from mental or physical health problems. They are also less likely to have insurance than their cisgender peers, despite the fact that the number of LGB people without insurance dropped from 21.7% to 11.1% between September 2013 and May 2015.

What makes it even harder to obtain healthcare and insurance is the lack of employment opportunities for trans men and women. Those provided insurance by employers will continue receiving coverage in the switch from the ACA to the AHCA, for the most part. But transgender people are two times more likely to be unemployed than the average American. It’s also four times more likely that a transgender person will have a household income of less than $10,000. That’s usually not enough to afford insurance now, let alone once the new law makes it more expensive.

Herman has yet to analyze the potential impact of the new law, she says. But she is able to say that ‘it would certainly impact trans people if gender dysphoria were considered a pre-existing condition.’

AHCA or not, there’s work to be done

Even if the AHCA is squashed in the Senate, the current healthcare system is far from perfect.

Hayashi is 42 and began transitioning in his mid-20s. But it was only three years ago that his healthcare was covered by insurance — he said California, where he lives, had trans healthcare protections in place even before Obamacare passed.

Charlie is covered, too. His employer provides comprehensive healthcare, which means a monthly supply of testosterone and syringes costs about $50 each month.

He’s lucky that he can hide his chest by layering sports bras, but knows others who have to use heavier binding — sometimes injuring themselves because it’s ‘like a corset, but for the ribcage,’ he says.

Still, he admits he avoids going to the doctor if he can, even when it’s a check-up that insurance will cover.

‘Even if I were to go to the doctor with a cold or something straightforward, doctors don’t necessarily know how to treat me because I am trans,’ he said.

According to the 2015 US Transgender Survey, this isn’t an experience unique to Charlie: 23% of respondents said they forewent a doctor’s visit, even when they needed one, because they feared mistreatment for being trans.

On top of that, one in three reported having a negative experience related to being transgender when seeing a healthcare provider. Examples of negative experiences included ‘verbal harassment, refusal of treatment, or having to teach the healthcare provider about transgender people to receive appropriate care.’

How do we fix it?

Hayashi couldn’t reiterate enough the importance of the community’s visibility, especially as they prepare for yet another fight for their rights.

He said: ‘This is really a moment where the transgender community are in need of all the support and resources possible. Whether that is people making donations or volunteering their time, this is a very critical moment for our community.’

Charlie agrees that people are the solution. He has always found solace in the supportive community of family and friends behind him.

‘My dad, this red Republican from Ohio, has just been especially incredible. It’s brought us a lot closer,” he said.

Little things that mean a lot. #Dad Ftm #Trans #Love #Saturday #Chicago

A post shared by Charlie (@imcharliebaker) on

Charlie also tries to give back because he knows not everyone has the support he does. He cites that as his inspiration in starting a YouTube channel in which he shares everything from his changing singing voice to his pronouns of choice.

‘Before I transitioned, I used YouTube as a way to see trans guys like Aydian Dowling living normally. I needed to see that I wouldn’t be stuck in some negatively androgynous space for my whole life,’ he said.

‘Now it’s my turn. I feel very much like I can give back and show it’s possible.’

Like Hayashi, he believes enlightenment is key: ‘I want to move through a loving world and I believe the way to create a loving world is to create an educated world.’

He says education has to extend to everyone, even to those within the LGBTI community, where he sometimes feels like an outsider.

‘The letters are LGBT, and G is not the only one that matters. This is a time when we need to say, “Yes, you’re gender queer, yes, you’re sexually queer, but this is a struggle all of us are in together.” It’s inclusion,’ he said.

‘We need to realize that if the government is going to exclude us, we need to include each other.’

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