In June of this year, the Trump administration finalized 85 FR 37160, a rule excluding transgender people from sex discrimination protections under the Affordable Care Act. Roger Severino, Director of the Office for Civil Rights at the U.S. Department of Health and Human Services, was an advocate for revoking these legal protections from transgender people. When Severino said “HHS respects the dignity of every human being,” I felt the dignity of my own humanity sinking.
For myself and others in the transgender community, overcoming pervasive barriers to healthcare is a normal part of life. Many of us have to teach healthcare professionals how to address our medical concerns. “Probably the biggest issue for me is finding a doctor who is informed about transgender-specific care, and even then they are usually booked out for months. I can’t wait that long for a prescription refill,” says a transfeminine woman preferring to remain anonymous.
Dr. Luisa Kcomt, who worked for over 20 years as a social worker and also specialized in hospice and palliative care, sees a similar trend among her colleagues. “Many of them didn’t know how to support transgender patients during the end of life journey,” she says. “I wanted to fill this gap by increasing healthcare providers’ knowledge and comfort level in serving transgender patients.”
As part of her research, Dr. Kcomt identified the factors affecting healthcare access among transgender people. Her findings were based on a secondary analysis of the 2015 U.S. Transgender Survey, the largest study of the experiences of transgender people to date, with 27,715 transgender adult respondants. Dr. Luisa Kcomt used a weighted subset of 19,157 participants between the ages of 25 and 64 that includes transfeminine (55.1%), transmasculine (23.9%), non-binary/gender queer (16.1%), and cross-dressing (4.9%) individuals.
Dr. Kcomt notes that the stigma transgender people face is different from that experienced by others in the LGBTQIA community. “The stigma is pervasive, it’s systemic,” says Dr. Kcomt. “It stems from lack of knowledge production and lack of information dissemination about gender diversity.”
Dr. Kcomt and her colleagues found that nearly a quarter (22.8%) of the survey respondents avoided healthcare because they feared discrimination. Furthermore, race, poverty, health insurance access, visual conformity (the ability to “pass” as a man or woman in society), and disclosure of transgender identity were significant factors impacting an individual’s likeliness to experience access to and marginalization within healthcare settings. Providers need to be mindful about the risks and frequently multiplicative challenges that transgender patients with intersecting identities are likely to experience. These results were published in May in the Social Science & Medicine – Population Health journal.
Continued scrutiny and stigmatization of the transgender identity has had measurable socio-economic impacts that further reduce healthcare accessibility. The new Supreme Court of the United States ruling protecting employed LGBTQIA individuals from being fired on the basis of their gender identity helps prevent loss of access to employer-based health insurance policies. However, pre-existing disproportionate rates of unemployment due to slower hiring rates among transgender people continue to cause widespread homelessness and poverty with a related outcome of lower access to healthcare services and adequate insurance coverage.
The new rule excluding transgender people from sex discrimination protections under the Affordable Care Act is cause for concern, says Dr. Kcomt. “Basically, it’s going to be scarier for transgender people to seek healthcare when there’s no formal mechanism for them to file complaints or law that explicitly upholds their rights.”
Transgender people comprise roughly 0.6% of the United States population. We rely on healthcare professionals and the larger cisgender population – those identifying as the gender they were assigned at birth – to protect and improve our access to healthcare. “Ultimately, what I want people to understand is that trans people are people and they deserve the same dignity and respect as everyone else,” says Dr. Kcomt. “They are resilient people who experience many challenges while trying to live an authentic life. As a society, we need to recognize and embrace gender diversity.”
Emerson Grey is a chemical engineering PhD student at the University of Colorado Boulder. As a graduate research fellow in Dr. Stephanie Bryant’s group, he is developing polymer microspheres that will deliver anti-inflammatory therapeutics to cells in the lungs. He goes by @EmGreySci on Instagram and Twitter and maintains a personal website at www.emgreysci.com.