By Gray Babbs, Em Balkan, Jae Downing Corman, and David J. Meyers, Photo: from article, HealthAffairs, September 11, 2023
In July 2023, the US House of Representatives made bold and decisive moves to erode gender-affirming health care coverage, marking the beginning of a new frontier in the battle for transgender rights. The House passed two bills and released a third bill that would impact gender-affirming care coverage for Medicare, Medicaid, TRICARE, the Indian Health Service (IHS), and the Department of Veterans Affairs (VA). Together, these sources cover more than 40 percent of people in the US. The three bills will ban virtually all federal sources from covering gender-affirming hormones and surgeries. This watershed moment demands our attention and critical examination by raising questions about access to equitable medical treatment and the impact on transgender population health.
The House passed the National Defense Authorization Act for Fiscal Year 2024 and the Military Construction, Veterans Affairs, and Related Agencies Appropriations Act for 2024 and released of the appropriations bill for the Department of Labor, Health and Human Services (HHS), and Education in sweeping attempts to curtail access to gender-affirming care. All three bills ban the use of federal funds for gender-affirming care. The bills bar TRICARE (for active duty military and their families), the VA, and HHS from funding gender-affirming hormone therapy and surgeries. If these policies are signed into law, Medicare, the IHS, the VA, and TRICARE will not cover gender-affirming services, and Medicaid programs will have to choose whether to cover gender-affirming services using only state funds. This is particularly critical because transgender people are more likely to have public insurance than cisgender people. The passage of these policies will have unquestionably detrimental effects on the health of transgender populations in the US.
Transgender And Non-Binary Health And Gender-Affirming Care
Transgender and non-binary people in the US face substantial health disparities compared to cisgender people. Transgender and non-binary people have high prevalence of poor mental health outcomes such as depression, anxiety, substance use disorders, and suicidal ideation relative to the rest of the population. In addition, transgender and non-binary people have a high burden of HIV. Less research has examined chronic conditions, but some research has found that transgender and non-binary people also have a high prevalence of hypertension, chronic kidney disease, chronic obstructive pulmonary disease, and asthma. These health disparities result from stigma and persist across the life course, from childhood to older adulthood. Additionally, transgender and non-binary people face high rates of violence, homelessness and housing insecurity, food insecurity, and uninsurance.
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