After a routine visit to the gynecologist, I received a letter from my insurance company billing me for almost $2000. The letter explained that the procedure I needed was a “gender specific code [and s]ince the referenced code is inconsistent with the Member’s gender, [the company] is not responsible for any additional payment on this claim[s].”
Basically, an already very unpleasant experience was going to cost me $2,000 because I was listed as male under my insurance. My existence and my body were literally incompatible with the health care system. The inability of the insurance company to process the idea that a man could need a pelvic exam was going to cost me $2,000. For others, for whom these financial costs and the confused stares and discriminatory judgment of medical providers cause the avoidance of preventative care altogether, the incomprehensibility of trans existence in our health care regimes literally costs people their lives.
As a trans person I am very familiar with being denied coverage for medically necessary health care. In law school I took out $10,000 in loans (on top of my educational loans) to pay for care that my insurance company excluded from coverage under a blanket exclusion. Since then, I have been employed in various legal jobs with excellent insurance and still have to navigate regular coverage denials for both transition-related care and care that is deemed “gender specific.”
For me, this has ranged from humiliating to inconvenient to enraging but because of my access to legal information, supportive employers and family, and resources, it has been manageable. For many other trans people, these types of coverage denial lead to negative health outcomes and in tragically too many cases, death.
The data from the found that 28 percent of the more than 6,000 transgender respondents postponed medical care due to discrimination and another 48 percent did so because they could not afford it. The found that 41 percent of transgender individuals had attempted suicide at some point in their lives compared with 1.6 percent of the general population. The delays and discrimination literally kill people.
This type of systemic discrimination also contributes to the violence that transgender people experience on the streets when others receive the message that our bodies and our lives are disposable. Particularly for transgender women of color, surviving into adulthood remains elusive. As #BlackLivesMatter co-founder Alicia Garza , “when the average life expectancy of a Black trans woman is 35 years old in this country, we have a lot farther to go.”
With attention finally being paid to the crisis in our community – a crisis that is disproportionately felt by Black transgender women – policymakers and media outlets are asking what can be done.
Yesterday, the Department of Health and Human Services (HHS) offered a transformative answer to the health crisis facing the transgender community. A implementing the non-discrimination provision of the Affordable Care Act (Section 1557) includes critical guidance for improving the health outcomes and lives of transgender people. Though the rule only covers insurance plans purchased on healthcare exchanges and entities that receive federal funding, it has the potential to establish changes in the provision of health care even more expansively.
The proposed rule mandates insurance coverage for “medically appropriate health services” regardless of “sex assigned at birth, gender identity or recorded gender.” It clarifies that care may not be denied based on it being “gender specific” offering for example that “coverage cannot be denied for an individual for whom a pelvic exam is medically appropriate based on the fact that the individual either identifies as a transgender man or is enrolled in the health plan as a man.”
Further, the rule makes explicit that no plan may include blanket provisions excluding coverage for care related to gender transition.
As I wrote after Caitlyn Jenner came out on the cover of Vanity Fair:
“Health care for transgender people remains highly stigmatized and largely unavailable for the majority of trans people. Both private (i.e., employer) and public (i.e. Medicaid) insurance plans continue to have blanket bans on coverage for health care related to gender transition. Even where there has been progress on coverage generally, insurance coverage for care that trans women need is still elusive.
For example, the facial feminization surgery that Caitlyn describes in Vanity Fair is almost universally excluded from coverage. This means that most trans people, particularly trans women of color, cannot access the basic care that they need. It means that going to the doctor feels like a battle — if a trans person can get there at all. It means that trans people participate in criminalized economics like the drug and sex trades to pay for the health care they need or seek the care from friends or unsupervised black markets. It means that trans people die seeking the care they need to live.”
The rule proposed would completely transform the landscape of trans health care and we should be fighting to make sure the final rule includes these critical protections.
Learn More About the Issues on This Page
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Press ReleaseDec 2024
LGBTQ Rights
President Biden Must Veto Defense Bill Attacking Military Families with Transgender YouthPresident Biden Must Veto Defense Bill Attacking Military Families with Transgender Youth
WASHINGTON — The U.S. Senate today passed a version of the National Defense Authorization Act that would ban coverage for gender-affirming care for transgender youth whose parents are active-duty military personnel. The American Civil Liberties Union is opposing final passage of the defense bill over the inclusion of this health care ban and calling on President Joe Biden to veto the bill. Section 708 of the NDAA would prohibit insurance coverage for “medical interventions for the treatment of gender dysphoria” such as hormone therapy and puberty-suppressant medications, which Speaker Mike Johnson says would “permanently ban transgender medical treatment for minors.” The same treatments would be covered by TRICARE for any medical purpose other than treating gender dysphoria, the clinical diagnosis for the psychological distress experienced by transgender people related to their gender identity. “By passing this bill, the House and Senate are forcing thousands of active-duty service members to choose between their careers in the military and the future of their transgender children,” said Mike Zamore, national director of policy & government affairs at the ACLU. “This unconscionable and unjustifiable attack on those families stands in direct contrast to President Joe Biden’s legacy of defending the civil rights of transgender Americans — including when few in his own party showed the courage to do so. President Biden should cement his legacy by vetoing this bill and sending it back to Congress to pass without Speaker Johnson’s last minute health care ban for servicemembers’ kids.” If signed by President Biden, this health care ban would be the first new anti-LGBTQ provision enacted by Congress and signed into law by the president since the enactment of the military’s since-repealed “Don’t Ask, Don’t Tell” policy for LGBTQ servicemembers and the since-repealed federal law barring recognition of same-sex marriages known as the Defense of Marriage Act. It is unknown how many transgender youth are currently enrolled in TRICARE or how many of those enrolled are currently receiving coverage for gender-affirming care. In one 2022 analysis, 2,500 minor patients sought care for gender dysphoria through TRICARE Prime insurance at military or civilian treatment facilities in 2017, and 900 received puberty suppressants or gender-affirming hormones. Earlier this month, the Supreme Court heard oral arguments in a landmark case brought by the ACLU, the ACLU of Tennessee, Lambda Legal, and Akin Gump on behalf of three families and a medical provider challenging a Tennessee ban on gender-affirming hormonal therapies for transgender youth on the grounds the ban violates the Equal Protection Clause of the U.S. Constitution. -
Press ReleaseDec 2024
LGBTQ Rights
Montana Court Blocks State From Refusing to Correct Sex Markers on Transgender People's Birth Certificates and Driver's LicensesMontana Court Blocks State From Refusing to Correct Sex Markers on Transgender People's Birth Certificates and Driver's Licenses
HELENA, Mont. – A Montana court has granted a preliminary injunction preventing the state of Montana from enforcing policies that bar transgender people from obtaining accurate sex designations on their birth certificates and driver’s licenses. After a prior restriction on amendments of birth certificates was struck down by the courts, in early 2024 the state of Montana enacted a new rule that categorically bars transgender Montanans from correcting the sex designation on their birth certificates. Around the same time, the Montana Department of Justice adopted a policy similarly restricting amendment of driver’s licenses. The plaintiffs challenged these policies in state district court, arguing that they violate various constitutional provisions, including the right to equal protection of the law. In a recent Montana Supreme Court decision, two justices concluded that discrimination on the basis of transgender status – as the state is engaging in here – is a form of sex discrimination that violates the Montana Constitution’s equal protection clause. The plaintiffs, two transgender women, are represented by the American Civil Liberties Union, the ACLU of Montana, and Nixon Peabody LLP. Plaintiff Jessica Kalarchik, a veteran who served in the United States Army for 31 years, said: “After finally being able to live my life openly as the woman I know myself to be, I am frustrated that my birth state, Montana, wants me to carry around a birth certificate that incorrectly lists my sex as male. I live my life openly as a woman, I am treated as a woman in my daily life, and there is no reason I should be forced to carry a birth certificate that incorrectly identifies me as male. Fortunately, the court agrees that this ridiculous policy should not be in effect.” “Once again the State of Montana chose to adopt a draconian policy that is clearly intended to marginalize transgender Montanans, only for that discriminatory action to be blocked by the courts,” said Akilah Deernose, executive director for the ACLU of Montana. “Here in Montana we treasure our right to privacy and to live our lives free from governmental intrusion. The State of Montana clearly has not learned any lessons from the past few years, where courts have repeatedly struck down unconstitutional laws targeting transgender Montanans.” “Forcing anyone to carry documents that contradict their identity unjustly violates their rights to privacy, equal treatment, and not being compelled to convey a government message about their sex that they disagree with,” said Malita Picasso, staff attorney for the ACLU’s LGBTQ & HIV Project. “Such a policy marks transgender people for further mistreatment and discrimination, essentially requiring them to carry papers that out them as transgender any time they need to provide identity documents. Fortunately, the court has refused to allow the state of Montana to subvert the freedom of transgender Montanans to control their own identity as this case goes forward.” In granting the plaintiffs’ motion for a preliminary injunction, the court held, “[i]f the challenged state actions discriminate against transgender individuals on the basis of their transgender status, they also necessarily discriminate the basis of sex.” The state has the option of appealing the district court’s ruling to the Montana Supreme Court, but the underlying case will proceed in district court. A trial has not yet been scheduled. -
FloridaDec 2024
LGBTQ Rights
Keohane v. DixonKeohane v. Dixon
On September 30, 2024, the Florida Department of Corrections rescinded its policy regarding treatment of gender dysphoria, which allowed for hormone therapy when deemed medically necessary, as well as access to clothing and grooming standards that accord with one’s gender identity. Under this new policy, grooming and clothing accommodations have been stripped away, and hormone therapy is not permitted unless an exception is deemed constitutionally required. The ACLU brought a class action challenging the policy. -
IdahoDec 2024
LGBTQ Rights
Robinson v. LabradorRobinson v. Labrador
Two incarcerated transgender women have sued the state of Idaho alleging that HB 688, a 2024 law barring state funding for gender-affirming medical care for transgender people, denies them access to the health care their doctors have prescribed for them and is a violation of their Eighth Amendment right to be free from cruel and unusual punishment. They represent a class of all incarcerated folks within the state of Idaho who face the loss of hormone therapy due to HB 668.