“It’s widely believed that the Affordable Care Act made it illegal for insurance companies to discriminate against transgender individuals seeking health care coverage,” said Washington, D.C.-based transgender Latina health advocate Joanna Maria Cifredo in an interview published online Wednesday by Latina Magazine. “However, this is partially correct. The ACA made it so that an insurance company can’t deny you health care coverage for being transgender, but that doesn't mean they will cover transition-related treatment, such as hormone replacement therapy or transition-related surgeries that are often deemed ‘aesthetic.’”
Cifredo’s keen analysis points to well-known loopholes within the ACA’s commitment to trans-inclusive health care. In March a federal court ruled in Rumble v. Fairview Health Services that the ACA prohibits discrimination based on gender identity. That ruling recieved a boost Wednesday, when the U.S. Department of Health and Human Services issued a rule confirming that the ACA prohibits discrimination based on gender identity, specifically in health care.
As The Advocate previously reported, the Rumble decision clarified that health care providers and hospitals accepting federal Medicare or Medicaid funds are subject to the ACA's prohibition of discrimination based on sex, which covers discrimination against transgender people. This interpretation tracks closely to recent federal decisions on Title IX protections for trans students and Title VII protections for trans employees.
But Cifredo’s dissection of transgender health disparities points to further work that must be done in implementing the ACA’s transgender protections. This work includes encouraging health care providers and insurers to become more sophisticated in their understanding of transgender patients' personhood.
“Many medical procedures are gendered, someone seeking a treatment for a procedure that would traditionally be rendered to someone of the opposite sex may have that procedure denied," Cifredo told Latina Magazine. "For instance, a pregnant trans man seeking prenatal care or a pap smear may have that procedure denied because most insurance companies do not render that procedure to men. Likewise, trans women who need prostate exams may have that claim denied as well."
While such realities may once have been relegated to the realm of medical "oddity," science and society are starting to recognize that there are many different ways to be a woman or a man, including transgender ways of being. As Cifredo eloquently made clear, the wide breadth of possibilities for transgender personhood reveal a pressing need for health providers to modernize their understanding of transgender bodies so that trans women and trans men — who are, in fact, women and men as much as any other kind of woman or man — receive the quality, competent care they need and deserve.
Some in the health industry are pushing for progress. The American Medical Student Association’s Transgender Health White Coat Cards are based on the organization’s observations that transgender health disparities are often influenced by transgender individuals’ disproportionately high experience of violence, bias, and poverty, and their unique needs while transitioning.
A recent report from the National Coalition of Anti-Violence Projects found that hate-motivated violence against transgender people rose 13 percent last year, while the number of overall incidents of hate-motivated violence against LGBTQ and the HIV-affected people dropped 32 percent compared with the previous year. Similarly, a February report from the Movement Advancement Project and the Center for American Progress found that transgender people are four times more likely to live in poverty than their cisgender (nontrans) peers.
Cifredo serves on the board of directors for Whitman-Walker Health. In 2015, Mujeres en el Movimiento named her one of D.C.’s “Rising Stars” and she received the 2015 Visionary Voice Award from the National Sexual Violence Resource Center for her advocacy for trans-inclusive health care.