by Gerrie Schipske, Attorney, CLA SoCal Health Consumer Action Center
Transgender people face many barriers in their lives. In many instances, they face stigma and harassment. Some face violence.
Obtaining quality healthcare should not be one of those barriers. Despite the passage in California of the “Insurance Gender Nondiscrimination Act of 2005,” one in five transgender people have no healthcare coverage. Those who do have coverage are often hesitant to seek care because of structural obstacles. They often have encounters with healthcare staff that are not transgender-affirming. More frequently they are unable to locate knowledgeable providers.
Some of the insensitivity transgender people face when seeking healthcare is unintentional. Staff have not been properly trained concerning such issues as how to respond to a patient whose legal name is different from their gender. However, the U.S. Centers for Disease Control and Prevention also cautions: “In particular, many transgender women of color (specifically those who are Black or African American and Hispanic or Latino) have reported being victims of harassment and violence, even in health care settings.”
Removing barriers
Community Legal Aid SoCal is working to help remove some of the barriers transgender people face in Orange County. We have reached out to the LGBTQ Center in Santa Ana and the UCI School of Law Name Change Unit and explained what services we provide.
Consequently, several clients have contacted us and told us of their difficulties accessing gender affirming care. Our HealthCare Access Unit has fought for them. We were able to obtain the care and treatment they required, such as:
· A young Latine transwoman who needed hormone therapy via patch instead of orally because of stomach upset;
· An older white transwoman who needed electrolysis to remove facial hair but could not find a local provider;
· A white transman who was experiencing pelvic pain due to endometriosis and needed a hysterectomy but was denied surgery from a Catholic hospital;
· A white transwoman who received breast augmentation with what turned out to be defective breast implants. She requested removal and replacement and her healthcare plan only approved the correction of one implant;
· A white transwoman whose health plan denied payment for facial feminization surgery on the basis it was “cosmetic and not medically necessary;”
· A Black transwoman who requested facial feminization surgery and received a denial letter that stated: “We know you don’t want to look like a man,” but then followed with a denial of several procedures her surgeon requested.
To fight systemic discrimination
CLA SoCal is working on ways to fight the systemic discrimination against transgender enrollees in several healthcare plans. In these plans, transgender enrollees are unable to find healthcare providers in network who are trained and sensitive to their specific healthcare needs. In most instances, they are required to travel more than 50 miles from their homes to receive care in Los Angeles at Cedars Sinai Medical Center.
The passage of the Affordable Care Act prohibited discrimination based on race, color, national origin, sex, age, or disability. In 2016, the law was defined as also applying to gender identity. The Trump Administration enacted regulations that reinterpreted protections for gender identity and sent the message to healthcare plans and providers they could deny care to transgender patients. Thankfully, these regulations were recently rescinded by the Biden-Harris Administration. The stigma of being transgender, however, still remains in healthcare.
