It Is Our Health

Healthcare and insurance are our two of our main worries. Will we get proper healthcare for doctors? Will we be turned away when we seek healthcare? Will the insurance cover it?

Bias may affect providers' knowledge of transgender health
Medical Xpress
By University of Michigan
February 11, 2019

People who are transgender face many barriers in the health care system—from intake forms that use non-inclusive language, to challenges finding providers who are knowledgeable about their health care needs.

But more training may not be the answer to improving competent care, a new Michigan Medicine-led study suggests. Surprisingly, more hours of education in the field was not associated with improved knowledge of transgender care among physicians and other providers, according to a new study in the journal Medical Education.

Nearly half of providers in the study said they had cared for a transgender patient, but as many had received no training on the topic.

What distinguished knowledgeable providers from those who were less so, however, appeared to have little to do with their medical education. Transphobia, or a prejudice against people who are transgender, was the only predictor of provider knowledge.
[…]
"Medical education may need to address transphobia and implicit bias in order to improve the quality of care transgender patients receive."

I had a specialist who I had to wait for months to see, they said he was the best in his field but when I showed up I was lead into the examination room. The doctor showed up saw me and proceeded to sit at the computer station; most doctors sat the computer facing me and only glanced down at the computer when entering something in it. Well this doctor proceeded to sit with his back to me and never looked at me. He said he was ordering some test and come back when the results are in; still taking to me with his back to me.

When the results came in I saw him again and once again he sat with his back toward me. He said we now know 27 diseases that I don’t have, but my kidneys were improving so just monitor them and if they get worst see me again.

Now, one I don’t know if that is how he treats all his patients or if was just me that he didn’t look at. Did I get the best care, I don’t know. I never found out why my kidney function dropped so radically but function did improve.

"We obviously have a lot of work to do in improving health outcomes for gender diverse people," Stroumsa adds. "We need to take a close look at our healthcare environments, practices and approaches to medical education. These are just beginning steps in reducing wide health disparities.

"Creating a safe, knowledgeable, trustworthy care environment will help us expand the care we provide to a broader more diverse patient population."

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Fact-Checking Common Myths on Transition-Related Care for Trans People
ACLU
By Ria Tabacco Mar, Senior Staff Attorney, ACLU's Lesbian Gay Bisexual Transgender & HIV Project
February 11, 2019

Dashir Moore, a transgender man from Georgia, wanted a fresh start in life. So at the age of 31, he packed up and moved to Colorado, a state that offered both a great lifestyle and trans healthcare. He hoped he could finally be himself.
[…]
Then he scheduled chest surgery. No stranger to our byzantine insurance system, Dashir called his benefits line to check if the procedure was covered and was told it would be. He also confirmed that he didn’t need prior authorization before the surgery.

But shortly after the surgery, he found out his insurance would not pay for the procedure, and he soon found himself saddled with medical debt and out of a job.

Two days after the surgery, his care coordinator called and told him that his insurance company had refused to pay after all. Dashir learned that his employer had selected a health insurance plan that excludes medical expenses incurred for “Gender Transition: Treatment, drugs, medicine, services, and supplies for, or leading to, gender transition surgery.” Dashir began to receive bills from the hospital, which eventually totaled almost $30,000. His anxiety skyrocketed, and Dashir couldn’t continue to work at his job.

Whoa! How could his employer discriminate and not provide health insurance when Colorado mandates coverage?

Insurance carve-outs for transition-related care are illegal. But as Dashir learned the hard way, that hasn’t stopped some from continuing to deny transgender people the care they need. Here’s the truth about transition-related healthcare.

What I have found working with the trans community is insurance companies have a favorite word that they use all the time… “No!” Even when it is spelled out in their policies that we are covered and that also applies for non-trans related coverage. Many people will take no for the answer without questioning it.

When we appeal their denial we have to have all the facts we can’t just say “well it is covered” or “its discrimination” we need to know why it is covered and sometimes the doctor’s office will help argue your case.

Here in Connecticut there is CT Insurance Commissioner Bulletin IC-34 which covers insurance for use with state licensed insurance companies, for Medicare there is the Centers for Medicare & Medicaid Services (CMS). Under the Obama they issued a policy requiring coverage for us but under the Trump administration they now say…

Currently, the local Medicare Administrative Contractors (MACs) determine coverage of gender reassignment surgery on a case-by-case basis. We received a complete, formal request to make a national coverage determination on surgical remedies for gender identity disorder (GID), now known as gender dysphoria. The Centers for Medicare & Medicaid Services (CMS) is not issuing a National Coverage Determination (NCD) at this time on gender reassignment surgery for Medicare beneficiaries with gender dysphoria because the clinical evidence is inconclusive for the Medicare population.

In the absence of a NCD, coverage determinations for gender reassignment surgery, under section 1862(a)(1)(A) of the Social Security Act (the Act) and any other relevant statutory requirements, will continue to be made by the local MACs on a case-by-case basis. To clarify further, the result of this decision is not national non-coverage rather it is that no national policy will be put in place for the Medicare program. In the absence of a national policy, MACs will make the determination of whether or not to cover gender reassignment surgery based on whether gender reassignment surgery is reasonable and necessary for the individual beneficiary after considering the individual’s specific circumstances. For Medicare beneficiaries enrolled in Medicare Advantage (MA) plans, the initial determination of whether or not surgery is reasonable and necessary will be made by the MA plans.

So in other words… we are screwed.

Also many companies have health insurance through ERISA which is a federal program and is not under state insurance laws.

So don’t automatically assume you have insurance coverage. And if you do have insurance coverage be prepared to fight for it.

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HIV transmission networks among transgender women in Los Angeles County, CA, USA: a phylogenetic analysis of surveillance data
The Lancet
By Manon Ragonnet-Cronin, PhD, et al
Published: February 11, 2019

Background
Transgender women are among the groups at highest risk for HIV infection, with a prevalence of 27·7% in the USA; and despite this known high risk, undiagnosed infection is common in this population. We set out to identify transgender women and their partners in a molecular transmission network to prioritise public health activities.
[…]
Interpretation
Clustering of transgender women and the observed tendency for linkage with cisgender men who did not identify as MSM, shows the potential to use molecular epidemiology both to identify clusters that are likely to include undiagnosed transgender women with HIV and to improve the targeting of public health prevention and treatment services to transgender women.

So what does that mean?

Transgender women in Los Angeles are more likely to be in high HIV incidence clusters than any other group
More likely to connect to each other and straight men than to gay men
AIDS Map
By Gus Cairns
07 March 2018


A phylogenetic study of HIV infections in Los Angeles has found that transgender women (TGW) are more likely than any other risk group to be in a genetically connected cluster of cases, which is a marker of high HIV risk. But they are less likely than gay men and other men who have sex with men (MSM), who also tend to be in transmission clusters, to be diagnosed.

The study also found that TGW are more likely to be connected to heterosexual men than would be expected if they mixed randomly, and much more likely to be connected to other TGW. Although, numerically, more transgender women are connected in clusters to MSM (because there are more MSM than any other group), they are less likely to be connected to them than would be expected in random mixing.
[…]
This was the case with people whose ‘risk factor’ was that they injected drugs. The zero assortativity seen in this group means that infection via needle sharing was in fact probably not how most of them acquired HIV – they probably got it through sex like everyone else. Los Angeles county has had syringe and needle exchange since 1994 and this probably shows that HIV infection via needles is rare, thanks to this.

Assortativity in MSM and in heterosexual men and women (to each other) was high, which is what you’d expect.

But it was also quite high in TGW, although not as high as in heterosexuals or MSM. This implies a degree of sexual contact between TGW.

So what does this mean to us? It means that we get AIDS through having sex with other trans women and not through needle sharing or having sex with men.