What the Affordable Care Act Means for Transgender People


The fight over healthcare in the United States has been a long one, and even came to an utter standstill as the Republican-led House of Representatives shut down the government in an attempt to delay Obamacare from becoming a reality in January. For the people who stand to gain from the Affordable Care Act, the backlash was devastating. Among the working class, elderly and unemployed, there is another group of people who were affected by the legislation; not only did they gain access to better healthcare with the passage of the Affordable Care Act, they also won a small battle of equality.

In the Past

When you wake up every day in a body that doesn’t match your gender, interaction with the world around you becomes complicated and distressing. People will use the wrong pronouns when they refer to you, going to the restroom becomes a difficult task (which can also become dangerous) and not to mention the depression, isolation, and anxiety that can easily be overwhelming. The medical community seems like a logical place to turn for help, but due to the stigma of being transgender in our society, there has been a wide gap between the healthcare a transgender person needs and what they will actually receive.

Gender dysphoria, which is distress caused by discomfort with the sex assigned at birth, is a common experience among transgender people. Many trans men will use chest binders to fight the feeling of dysphoria and feel comfortable in their own body. Surgeries like a double mastectomy or a “top surgery” help with eliminate the feeling of dysphoria, but it’s surgeries like these that aren’t covered by health insurance and leave patients to pay out of their own pocket.

“I just went and got my consultation for my top surgery and it was $7,600,” Kyle Kaplanis said. “So for the average person on the street they probably would never be able to afford that. Fortunately for me, I will be able to pay for that by June, but still it would be nice if that were covered by health insurance.”

Kaplanis is a trans man living in Reno. While he has healthcare provided through his employer, none of his hormone treatment has been covered insurance.

While these procedures allow a transgender person to feel content with their body, health insurance companies don’t consider them “medically necessary”. Procedures like electrolysis to remove hair is something that many trans women seek out that an insurance company would determine to be a cosmetic procedure. Advocates in the trans community argue that these types of procedures ultimately improve mental health for trans people.

“When we look at issues in health care, traditionally health insurance companies have specifically denied transgender coverage,” said Brock Maylath, an advocate for Transgender Allies Group. “They would not cover any sort of sexual reassignment surgery or transgender services. They would exclude surgical procedures, body modifications, hormonal therapy and psychotherapy.”

Obamacare: It gets better

Obamacare seems like a beacon on the horizon, because some of the aforementioned hindrances are going to change, making it easier for patients to get these necessary treatments. Under the Affordable Care Act, it will be illegal for insurance companies to classify being transgender as a pre-existing condition and subsequently deny coverage. Gender identity has also been added to the list of categories that are protected from discrimination, meaning that someone who is transgender can’t be denied necessary treatment based on their gender identity.

“Under the Affordable Care Act, any insurance policy through the exchanges is no longer allowed to discriminate services because someone is transgender,” Maylath said. “Now we expect that there will be pushback, that the bureaucracy will continue to try and deny and find other reasons to deny things, but the Nevada State Insurance Commissioner and the Secretary of Health and Human Services in Washington have declared that they are going got follow the law and the law says that you will not discriminate period.”

Typical discrimination from insurance companies toward transgender people was denial of coverage of cross-gender procedures. Though under the Affordable Care Act, if a menopausal woman is covered for treatment of hormone replacement therapy, a trans woman will be able to get that covered as well.

Maylath also believes that some of the benefits the Affordable Care Act will allow is creating a pay incentive for transgender care, which will lead to doctors becoming more educated and experienced in procedures for trans people.

“In the past, there has never been an appropriate payment process for coding for transgender types of services,” Maylath said. “They have typically been paid for out of pocket by the individual, who has faced a lot of discrimination. As a result there has never been a financial incentive for many physicians to understand or appreciate what needs to be done.”

As of right now, there are still doctors who don’t fully understand what it means to be transgender, there are doctors who don’t want to prescribe necessary treatments whether from lack of experience or some other reason and the treatments themselves from hormones to surgery are not covered by insurance, leaving the patients to pay out of pocket. Kaplanis said that in his experience there was a doctor who didn’t want to prescribe him testosterone, so he instead went to the Northern Nevada Hopes Clinic in Reno for hormone treatment.

“There are a lot of doctors that need to get more education on transgender issues, and what it actually means,” Kaplanis said. “Some of them have different views on what it means to be transgender, because they might view it as a phase and it’s not. This is who we are and we need help just like everybody else.”

More progress to be made

Although improvements have been made, Obamacare isn’t a fix-all solution for transgender healthcare. Some treatments are still considered experimental, cosmetic or just not medically necessary. Transgender people will still have to prove that their procedures are medically necessary in order to have them covered.

“You can’t just go up to your local pharmacist to this,” Maylath said. “You have to go through a health care professional and they have to determine that this is because of gender dysphoria and the appropriate treatment path for the individual. It’s not a snap judgment; it’s a process in conjunction with a medical team that this is the proper clinical path for that individual.”

There is also still a lack of understanding of transgender people in the medical community that needs to be addressed, as well as a lack of understanding from society as a whole.

“The diversity is what makes us special,” Maylath said. “If we deny that specialness we lose our humanity. When I see groups that lack understanding and want to shut the door on that individual, everyone loses.”