In May 2016, the Department of Health and Human Services added a rule to the Affordable Care Act to prohibit discrimination on the basis of race, color, national origin, sex, age or disability. However, as Mallory Locklear reported for Women’s eNews, although the amendment, known as Section 1557, may protect transgender individuals seeking medical care, its “lack of specificity” means that, in many cases, trans people continue to be denied adequate services. Locklear’s report identifies four factors that contribute to this outcome, including a severe lack of training for physicians, inadequate research funding for trans health care, the concentration of existing resources in major cities, and the need to extend more mental health coverage to trans people.
As a result of lack of training, many physicians are unprepared to address trans patients’ needs. A 2011 study published in the Journal of the American Medical Association found that nearly seven percent of medical schools devoted no hours of their curriculum to LGBTQ-related content during the preclinical years of medical training. During the years of clinical training, when physicians work with actual patients, the same study found that up to a third of medical schools devoted no hours to LGBT content. Overall, Locklear summarized, “the median number of hours committed to LGBT content throughout all four years of medical school was only five.”
Without training, many physicians do not understand that hormone therapy for trans patients involves monitoring similar to what is provided for male patients with hormone deficiencies. Furthermore, many physicians refuse to provide care for trans patients due to moral or ethical reasons.
Lack of research funding is also a problem. A 2014 study found that, when HIV-related research was excepted, only 0.1 percent of National Institutes of Health-funded studies addressed LGBT health. According to Madeline Deutsch, professor in the department of family and community medicine at the University of California, San Francisco, and director of clinical services at UCSF’s Center of Excellence for Transgender Health, “The trans population makes up about 0.3-0.5 percent of the population, so there should be at least that amount of funding.” Given the disparity of care, Deutsch argues that trans health research should get more than that percentage of the NIH funding.
Mental health care is also critical for trans patients. As Austin Johnson, a trans man and doctoral candidate in sociology at Kent State University, told Locklear, “Not only do 41 percent of trans people attempt suicide in their lifetime, over 40 percent experience clinical levels of depression and anxiety.” Notably, health insurance can reduce the risk of depression, drug abuse, and suicide—each of which is costly to treat or handle. As Locklear reported, a 2015 study found that, “when the positive effects of health insurance are taken into account, providing full health coverage to trans individuals is cost effective.” The study’s authors estimated that providing trans coverage would cost other plan members less than two additional cents per month.
The issue of transgender health care made news in May 2016 when President Obama announced the amendment to the Affordable Care Act to provide legal protections against discrimination by health insurance companies and medical providers. As Jeffrey Young reported in the Huffington Post, “Under new regulations, transgender people are guaranteed equal treatment by insurers and medical providers, and will have the right to make civil right claims against those that deny them coverage or necessary care because they are transgender.” However, the focus of establishment news coverage quickly shifted to debate over the use of public bathrooms by transgender people, including challenges to the state of North Carolina’s anti-transgender bathroom law.
Mallory Locklear, “Health System Skimps on Trans Healthcare Training,” Women’s eNews, June 15, 2016, http://womensenews.org/2016/06/health-system-skimps-on-trans-health-care-
Student Researcher: Genessee Sanchez (Citrus College)
Faculty Evaluator: Andy Lee Roth (Citrus College)