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The Affordable Care Act and Transgender Patients

admin November 16, 2018

One of the more insidious consequences of a health system run as a private industry with minimal regulation is that discrimination can often make its way into the healthcare and insurance practices.  Whether it be for pre-existing conditions, gender, sexual orientation, body type, or legal residence status, there is a shocking number of stories out there told by patients who have faced unfair treatment, neglect, and even hostility due to the prejudices of an insurance carrier or healthcare provider.  Among the groups who face such unfair treatment, the transgender community seems to experience it in the most widespread, and often life-threatening manner.  If the Affordable Care Act holds up, there will be a wide range of protections implemented to put a stop to the victimization and neglect of transgender patients.

In a recent article for The National, Marisa Carroll profiles one transgender patient and cites several other cases documenting the abuse and neglect many such patients face in America’s current healthcare system.  Many can not get private insurance, as most coverage carriers claim trans identity as a pre-existing condition.  Since members of the transgender community often face workplace discrimination, the resulting, higher-than-average unemployment rate means employer-provided coverage is not as likely an option for them as it would be for others.  If they can get coverage, many are turned away, neglected, or ignored by doctors who have prejudicial feelings toward transgender patients.  One in four transgender patients have reported being verbally harassed by doctors and hospital staff.  Shockingly, 2% have even been physically assaulted.  Even if a transgender patient is insured and can obtain treatment, many find their insurance carriers denying coverage on the basis of pre-existing condition, even for illnesses and injuries that clearly have nothing to do with trans identity.

Fortunately for  these patients, the Affordable Care Act contains many provisions that will protect them going forward.  Starting in 2014, the Patients’ Bill of Rights will prohibit insurance companies from denying anyone coverage or compensation due to a pre-existing condition.  Not only will this open up avenues for insurance coverage for transgender patients, but it will also ensure that insurance companies can no longer claim “pre-existing condition” to deny compensation for treatment of common infections, injuries, and even heart attacks, as some currently do.
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Another provision includes funding for LGBT-related cultural competency training for clinics, hospitals, and doctors alike.  With greater awareness, one may hope that fear and prejudice may decrease among medical staff members nationwide, making hospitals and doctors offices a safer, more welcoming environment for transgender patients.  Of course there are no guarantees in human nature, but it is certainly worth the effort even if only a few doctors and healthcare workers come away from the training with greater understanding and compassion for their patients, regardless or sexual orientation or gender identity.  Such would mean a substantial number of trans gender patients who could start to seek out healthcare without fear of neglect, prejudicial treatment, or verbal or physical abuse.

While already a contentious provision, the expansion of Medicaid would also serve the transgender community well.  Pre-expansion, low-income adults without dependents are ineligible for Medicaid in forty-three states.  Yet transgender citizens, with the prejudices they often face in our culture at large, are four times more likely than the general population to live on less than $10,000 per year, putting them at great need for assistance.  Under the Medicaid expansion, all people living under a given income bracket will now be eligible for this assistance.

The Affordable Care Act may not be a perfect system, and some may debate that doctors, medical staff, and insurance companies should be able to treat patients however they please, like other businesses and their customers, in the healthcare system as it currently stands.  However, few can argue that anyone should be afraid to seek treatment due to a possibility of abuse.  It is hardly fair and lawful for insurance companies to refuse to cover broken arms and heart attacks on the grounds of gender identity as a pre-existing condition.  While it may be understandable that some people have trouble coming to terms with  alternative orientations and lifestyles, it can not be right to let those patients suffer and die needlessly as a result.  And while some may argue that the percentage of the general population facing such treatment is small enough to be considered negligible, there are others: others with transgender children, friends, or loved ones; others who live every day with trans identity and the cultural prejudices it brings; others who truly believe that being transgender makes no person better or worse than any other.   These people would most likely agree that even a small percentage of patients receiving such shocking treatment is far from negligible, and that a system that allows the abuse and neglect of even a small portion of the population is not a system that works at all, and that it leaves the rest of the population vulnerable to similar prejudicial treatment.

Are you a transgender American currently facing prejudices in the healthcare system?  Do you have a friend, relative, or loved one who is?  Do the provisions that look to aid transgender patients going forward strengthen your support, or opposition to, the Affordable Care Act?  Do you believe it is the right of an insurance company, doctor, or hospital to treat certain patients with prejudice?  If so, why?  Does capitalistic liberty trump the high stakes and need of patients who face such treatment, or vice versa?  Please share your thoughts, input, and experiences in our comments.

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