Transgender Health at the Crossroads: Legal Norms, Insurance Markets, and the Threat of Healthcare Reform

Few groups confront as many barriers to healthcare as transgender patients. Transgender individuals are frequently denied access to health services because of their gender identity or expression, and many report experiencing verbal and even physical harassment in medical offices and hospitals. Those who are able to locate care often find that they cannot actually access services, due to a lack of insurance or financial resources. Even transgender patients with health insurance have difficulty obtaining care. This is particularly true if the care sought is for transition related purposes, since most policies exclude coverage for gender-confirming interventions and surgeries. The transgender population\u27s lack of access to care is all the more striking when considered alongside the group\u27s elevated risk for a number of serious health problems. One study reports, for example, that forty-one percent of transgender individuals have attempted suicide at some point in their lives. This Note examines the current landscape of transgender healthcare and coverage and evaluates how the Patient Protection and Affordable Care Act (PPACA), the Obama Administration\u27s landmark health insurance legislation, may change the state of transgender care. Called the most expansive social legislation enacted in decades, the PPACA extends health insurance to millions of previously uninsured Americans, extensively modifies public insurance plans, and imposes new requirements on private insurance companies. By eliminating pre-existing condition exclusions and mandating certain essential insurance benefits, the PPACA promises to expand access to care. But for transgender populations, the care promised may not be the care sought. Depending on how it is interpreted and applied, the legislation may secure new medical benefits for transgender individuals, or it may worsen the state of transgender healthcare altogether