Gender Reassignment and Underinsurance    


For many transgender people, gender reassignment surgery can bring a plethora of positive changes. Gender dysphoria causes psychological distress which results from incongruence between sex assigned at birth and one’s gender identity. This can be stressful and lead to a decline in the person's mental health. The transition process includes gender affirmation (and social affirmation which involves changing pronouns/name), legal affirmation (changing government-issued documentation), medical affirmation (suppression or gender-affirming hormones), along with/or surgical affirmation procedures. These multiple procedures promote better mental health and can go a long way for trans people to feel more included. However, the problem arises with public health insurance plans and coverage for esthetic care. 


For instance, in Quebec, many procedures, such as making someone’s face look feminine or breast implants, are considered to be “esthetic” and are not covered by insurance. Similarly, in the United States, gender dysphoria cannot be alleviated with just talk therapy, since many transgender people need surgery and other interventions. These interventions can cost up to six-figures and are considered to be out-of-pocket expenses. Although, now with the help of the Affordable Care Act and anti-discrimination laws, medically necessary care for trans people are being covered. However, “medical necessity” can still exclude procedures that are considered to be esthetic procedures (breast augmentation, body contouring, and facial feminization).    This is still an ongoing problem that can be seen on GoFundme, as transgender surgery results yield close to 6,026 results because many of these individuals cannot afford the staggering costs (even with the Affordable Care Act).


All of these hurdles with the healthcare system are coupled with Donald Trump’s racist and transphobic dictatorship. Since 2017, Trump has done more damage for the trans community in terms of withdrawing protection for trans children in schools, banning trans people from the military, threateing to cut off funding, and promoting  a series of discrimination policies that have resulted in steps being taken backwards (away from equality). Even with Trump out of office and his corruption exposed, the discrimination is still on-going. For instance, recently Arkansas’ senate passed a bill to allow nursing home staff, physicians, nurses, and other personnel to turn away LGBTQ+ patients. Healthcare is not a privilege, but a basic fundamental right. These practitioners are all taught to look out for their patients’ well-being; however, discrimination can still impact the quality of care that you may receive (or not receive) if you are trans or part of the LGBTQ+ community. 


 The only way to tackle these hurdles and discrimination is to speak up and advocate. Even if you aren’t part of the LGBTQ+ community, we’re all human beings and deserve the same level of care irrespective of our sexuality, race, religion, and other demographic factors. By speaking up we can help trans people feel heard, continue to highlight the gaps in the quality of care, and hopefully lead to a larger effect that could result in equality in healthcare.