Health
While healthcare access is a crisis in America, broadly speaking, it is especially acute for transgender people. We face significantly disproportionate job loss and job fragility and, therefore, a much-higher-than-average lack of insurance. Additionally, most public and private health insurance plans, when they are available to transgender people at all, have discriminatory exclusions for transgender-related care that often is used to exclude virtually all care. Finally, due to the lack of research data about transgender people there is a lack of funding for transgender health care that often precludes effective public health services. Implementing the recommendations listed below will give transgender people equal access to health care, ultimately saving numerous lives.
Federal Policy Changes needed in health care
- Healthcare Reform. The Administration and Congress should ensure that the healthcare reform debate includes and fairly considers the needs of transgender people including the importance of medically necessary transition-related care.
- Eliminating Health Disparities. Congress should amend the Public Health Service powers and duties to include lesbian, gay, bisexual, and transgender people as a “population marked by health disparities.” If amended, both the National Center for Health Statistics and the Agency for Healthcare Research and Quality should study the specific health needs and disparities of lesbian, gay, bisexual and transgender people.
- AHRQ Research. The Agency for Healthcare Research and Quality (AHRQ) should ensure that its researchers include information about lesbian, gay, bisexual, and transgender people when researching healthcare quality, costs, outcomes, and patient safety.
- Genetic Information Non-Discrimination Act. The Department of Health and Human Services (HHS) should promulgate regulations to clarify that transgender status is protected under the Genetic Information Nondiscrimination Act (GINA) and that transgender status does not fall under the exclusion of “sex” in the Act.
- Provider Conscience Rules. The Department of Health and Human Services should rescind the recently issued “Provider Conscience” regulations that allow health care providers to refuse to treat certain individuals based on the providers’ personal beliefs.
- Medicare. The Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) should allow Medicare coverage for medically necessary transition-related health care.
- Medicaid. The federal government should ensure that Medicaid programs in all fifty states cover medically necessary transition-related care.
- NIH Research. The National Institutes of Health (NIH) should fund research on the efficacy of various transition-related treatments.
- FDA Blood Donation Ban. The Food and Drug Administration (FDA) advisory panel should lift the ban on blood donation by gay men, which has been used to exclude transgender donors regardless of their gender or sexual orientation.
- Public Health Surveys. The Centers for Disease Control and Prevention (CDC) should develop a policy that ensures transgender people are included in all population-wide government public health surveys, especially the National Health Interview Survey and the Behavioral Risk Factor Surveillance System.
- Access to Title X Clinics. The Department of Health and Human Services should develop a model non-discrimination policy that includes sexual orientation and gender identity and expression to be disseminated to all Title X Family Planning Clinics.
- Needle Exchange Programs. Congress should repeal the federal ban on needle exchange and authorize the development of transgender-specific needle exchange programs.
- FQHC Training. The Department of Health and Human Services Health Resources and Services Administration should encourage Federally Qualified Health Centers, also known as 330-funded clinics, to use part of their two percent technical assistance requirement for training around transgender issues.
- SAMHSA Special Populations. The Substance Abuse and Mental Health Service Administration (SAMHSA) and the National Institute of Mental Health (NIMH) should specifically include lesbian, gay, bisexual, and transgender people in the definition of Special Populations.
- Allowability of IRS Deductions. The Internal Revenue Service (IRS) should clarify its policies and guidance publications to make clear the allowance of medical deductions for transition-related care.
HIV/AIDS
The continuing HIV/AIDS epidemic is the number one public health problem that touches transgender people and it extracts an insurmountable human cost. The federal government must swiftly move forward in the fight against HIV/AIDS starting with a comprehensive national AIDS strategy that specifically takes into account transgender people and removes the barriers that limit transgender access to treatment and prevention measures. Inclusion of the policies outlined below will combat HIV/AIDS in the transgender community and will also benefit the general public health.
- Non-Discrimination. The President should issue an Executive Order to clarify that all federal agencies are prohibited from using HIV status as a basis for restrictions or exclusions on applicants and employees.
- National AIDS Strategy. The federal government should create and implement a comprehensive and coordinated national HIV/AIDS strategy that includes provisions that address the impact of HIV/AIDS on transgender populations.
- Increased Funding. Both the President’s budget proposal and the Appropriations process should include an increase in funding for HIV/AIDS prevention, care, treatment, and research, including funding for transgender-specific materials and services.
- Targeted Prevention. The Centers for Disease Control and Prevention (CDC) should develop prevention programs that focus on the communities and populations that are most at risk for HIV, including various transgender populations.
- Separate Population Categories. The Centers for Disease Control should identify transgender people as a category distinct from Men who have Sex with Men (MSM) for provision of HIV/AIDS prevention and treatment funding.
- Immigration Ban. The Centers for Disease Control should eliminate the ban on immigration by individuals who have HIV/AIDS. HIV should be removed from the list of “communicable diseases of public health significance” that is used by the U.S. Citizenship and Immigration Services (USCIS) and the Department of State, which currently prevents foreign nationals from obtaining non-immigrant visas and legal permanent residence.
Trans Health Priorities
There are many respects in which transgender people have the same health concerns as non-trans people. From a public health policy perspective, however, there are areas in which trans people have specific needs that must be addressed more actively and specifically than they generally are at present.
Fortunately, there is a growing number of transgender-identified public health specialists and allies who are addressing these important issues. NCTE is fortunate to be able to work with some of these great people as part of the National Coalition for LGBT Health’s Disparities Working Group.
As part of this working group, a trans Health Task Force, including NCTE Board Member Diego Sanchez and NCTE Executive Director Mara Keisling, has initiated several projects of great importance. These include facts sheets on FTM Trans Health and MTF Trans Health created for LGBT Health Awareness Week, a briefing on LGBT health issues for six presidential campaigns, and a document called “An Overview of the Top U.S. Transgender Health Priorities,” which was drafted and used to educate LGBT health providers and others.
This priorities document was created with input from a variety of knowledgeable trans people as well as allies, and based on an analysis of existent research. Thirteen primary public health priorities were identified and discussed in the document.
- Violence and Murder Prevention
- HIV/AIDS and other STD Prevention and Treatment
- Substance Abuse Prevention and Treatment
- Depression, Suicidal Ideation and Suicide Prevention
- Lack of Health Insurance and Underinsurance
- Lack of Health Insurance Coverage for Trans Health Services
- Gender Identity Disorder (GID) as the Principal Diagnostic Means Determining Access to Trans Health Services
- Lack of FDA approval for Transgender Hormonal Therapy
- Widespread Injection Silicone Use
- The Continuing Misclassification of Sex Reassignment Surgery as "experimental"
- Lack of Training in U.S. Medical Schools for Trans Health Service Delivery and Working with Transgender Patients
- Medical, Mental Health and Substance Abuse Treatment Provider Insensitivity and Hostility to transgender people
- Tobacco Use
NCTE and the authors of this document understand that these are not the only significant health issues facing transgender communities. The issues included were selected because they were significant health issues and they fit into categories from the federal government’s outline for better American health (called Healthy People 2010).
And while each of us may not know trans people who are directly impacted by all of these public health concerns, transgender communities are very broad and varied, and collectively we are impacted greatly by each of these. NCTE will continue to work in coalition on important public health issues like these and others at the national level.