As we enter the second annual application window for the Affordable Care Act (ACA), more commonly known as “Obamacare,” it’s worth discussing the needs of members of the LGBT community and how have they been aided or not aided as the case may be overall by the role out of ACA.
Before we begin it’s important to acknowledge that there was by and large nowhere to go but up for transgender persons in healthcare, both on gender specific and general care. The obvious and most extensively discussed benefit is the ban on discrimination, which includes sexual and gender identity built in to the ACA.
“The question is, what is gender identity nondiscrimination?” said Kellan Baker, associate director of the LGBT Research and Communications Project at the Center for American Progress. “Does it mean you can’t hang up the phone on a trans person? Does it mean that you can’t cover their cervical cancer treatments unless [a policyholder is] listed female? Does it mean that transition care has to be covered?”
These choices unfortunately have thus far been left up to the states. In making seriously life decisions it is important to familiarize yourself with your individual state’s protections for gender identity. A mere six states have formerly stated intent to interpret the gender-identity nondiscrimination provision to mean coverage of transition-related care. Those states are California, Colorado, Oregon, Vermont and Connecticut.
The concern, beyond the coverage of transitional care is the bigger issue of treatment of a person who’s presented or physical gender does not match the selected gender on the policy holder’s form. Why does this have anything to do with the ACA? It’s alarmingly simple. Through the ACA, in general, single persons making under 400% of the federal poverty line, qualify for credits towards insurance. However the gender selection on the application must match the gender selected on the applicant’s social security card. Which enters you in to a gigantic catch 22: if these do not match you can be denied treatment, but if you have not fully transitioned you can be denied gender specific treatments in most states.
“It’s happening a lot more now because so many more people have insurance,” says Dr. Robert Winn, medical director of Mazzoni Center in Philadelphia, the city’s only community health center focused on the needs of the LGBT population. “Now, a trans man will come in and get their annual gym[ecological] exam, but it might get rejected because they’ll say, ‘This is a male and this diagnosis and the procedure code is female, so were not going to pay for it,’” he said.
Beyond being in detailed communication with your doctor, Transequality.org is coordinating filing of complaints and other instances of conflicts and discrimination of services. Ultimately it is easier than ever as a transgender person to receive health coverage, but still presents challenges it is important to be aware of going in to any healthcare situation, and be your own advocate.