We Got You Covered… Not! (Part 2)

Yesterday I wrote about how the CDC’s policy on free mammograms to low income women does not cover trans-women, today we look at the Affordable Care Act (Obamacare) and how it might not cover us.

Health Insurance Exchanges Might Not Be Accessible to Trans* People
Huffington Post
By  Scout, PhD
Posted: 10/09/2013

Secretary of Health and Human Services Kathleen Sebelius was clear that with one in three low-income LGBT Americans living without health insurance, this is a huge opportunity to stabilize the health of our communities. Plus, with expansions in regulations, insurance providers can no longer discriminate against people for being LGBT, charge higher premiums for this status, or deny coverage because of preexisting conditions like HIV or being trans*. This alone could really affect the many trans* folk like me who've spent years hiding their trans* status from health insurers to make sure we don't get denied routine coverage. Those fears are not an exaggeration. A few years ago, when my doctor helpfully changed my sex from female to male on their records, my insurer reacted by denying 100 percent of benefits until we finally caved and pretended it was a mistake.
[…]
Then the news turned grim. In one example of how data collection helps us see problems, the Center for American Progress commissioned research on the messaging about how and why LGBT people should enroll in the new insurance offerings. The findings showed that the existing messaging works for most LGB people, but not for trans* people. The researcher was blunt: The trans* focus groups were some of the saddest she had ever run. The participants had such a profound history of discrimination that they had developed extreme wariness of any representative of the health care system. Plus, trans* people needed to have very specific questions answered: Will the policy cover hormones, have friendly providers, or cover gender confirmation surgeries? But people had no confidence that insurance navigators could answer these questions, and, worse, no confidence that they'd even be treated decently once they disclosed they were trans*. Again, these fears are not without exaggeration either; the evidence from the most recent assessment of trans* needs showed that nearly one fifth of respondents had not just been discriminated against by health providers but outright turned away from care for being trans*. So, while the new protections are wonderful, saying them in Washington doesn't mean my people can trust that they will be in effect all around the country.

I do a lot research for the committees that I am on and one of the most annoying things for me is a study or a research paper that says “LGBT” when it is really only “LG.” There is a tremendous lack of research on trans-healthcare and trans* information on aging. The article goes on to say,

To make matters worse, the feds can't identify one single state or national survey that's added trans* measures as a result of their enhanced data collection efforts. (Meanwhile they have added an LGB measure to their most influential survey.) It's pretty harsh to showcase trans* data that highlights a sincere need, then realize that in most all cases trans* data are not being collected in our national health surveillance system. That's like lighting a candle in the woods, seeing red malevolent eyes, then putting the candle out again!

My theory on it is that the people who are doing the surveys know nothing about trans-people and think we are the same as gays and lesbians. At a committee meeting on LGBT and Aging that I was invited to sit on, at the first meeting that I attended the room was filled with about 10 lesbians and a gay man. When I was asked what I thought was the problems on aging that trans-people and the first thing I said "What ward will we be placed in, the men's ward or the women's ward, because not all trans-people have surgery". They had never realized that, I think that they all assumed that we have surgery.

In my Medicare Advantage policy it says all medically necessary treatment is covered, but way down the bottom they have three or four exceptions (such as dialysis) and one of them “surgery for sex change.”

In addition, how we are treated depends not only on the doctor or hospital but on the individuals within it. I go to a nearby hospital for treatment and when I told another trans-woman that I go there, she said that I should find another hospital because they treated trans-patients there horribly. But my experience was anything but horrible; everyone there treated me with respect.