Trump’s Health Care Amendments Could Be Deadly For Trans People

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On Friday afternoon, news media lit up with reports that President-elect Donald Trump (BRB, vomiting) would not seek to fully repeal the Affordable Care Act, but instead would amend it to leave certain provisions intact. Of the clauses allowing young people to remain on their parents’ insurance plans until age 26 and guaranteeing coverage despite preexisting conditions, Trump said “I like those very much.”

Moderate liberals were quick to look on the bright side. “Maybe it won’t be so bad!” echoed millions of mouths. But trans folks just grimaced, because we know the truth: This “news” is worse than outright repeal.

First, the idea that it would be difficult to repeal the ACA isn’t new information. The Republican-led Congress tried dozens of times to repeal, delay, or financially gut “Obamacare,” and by and large failed miserably. A program that’s admittedly flawed but provides health insurance for 21 million Americans is difficult to completely get rid of once it’s in place, and congressional Republicans know that. There was never much of a chance for Trump to get rid of the ACA unless he was willing to go down to the House and try some good old-fashioned Nixonian intimidation.

But strategic amendments . . . well, that’s another story. By leaving the most popular aspects of the ACA intact but stripping out everything else, Trump could effectively fulfill every part of his anti-Obamacare agenda that the Republican base holds dear. And that’s a nightmare for LGBTQIA people, especially transgender Americans.

The terror starts with, of course, Vice President-elect Mike Pence (BRB, vomiting again). Pence has a reputation for his tireless “religious freedom” crusade, which targets same-sex marriage and transgender civil rights. Trump and his children have indicated that he’ll delegate major chunks of policy to Pence, and that alone has been scary enough. (While some moderates have been sharing a piece that claims Trump will be benevolent toward transgender Americans, that story was from April and most of those promises were implicitly rescinded after Pence joined the ticket.)

Again, this is information the trans community had before Election Day. But it got worse as Trump rolled out his possible cabinet appointees. Among those on the shortlist for Secretary of Health and Human Services is Bobby Jindal, whose reign as governor LGBTQIA Louisianans remember all too well. Like Pence, Jindal has campaigned with groups that support conversion therapy — which attempts to “cure” same-sex attraction and gender nonconformity through psychological and physiological torture — like the Family Research Council (FRC). Led by Tony Perkins — a lobbyist with ties to the KKK’s David Duke, whom Jindal appointed to the Lousiana Commission on Law Enforcement in 2013 — the FRC is classified by the Southern Poverty Law Center as “an anti-LGBT hate group” and is responsible for introducing a pro-conversion therapy plank into the GOP’s official 2016 platform.

That plank, by the way, was just one of several anti-LGBTQIA policies that ended up as part of the party’s platform — including opposition to same-sex marriage and equal access to public facilities for transgender Americans, the latter of which the GOP called “an ideology alien to America’s history and traditions.” Andrew Bremberg, who served as Policy Director for the Republican Platform Committee, is now the head of Trump’s transition committee for — what else? — the DHHS.

In short, Trump’s plan for the ACA is to allow known bigots to dictate which parts to keep and which to destroy — and whatever they decide, it will undoubtedly end up hurting trans people the most. Though cisgender gay people will certainly be hit hard by whatever comes next (gay and bisexual men are more severely affected by HIV than any other group in the U.S.), transgender men and women, as well as nonbinary people, are in need of regular medical care to tend both to our physical and mental health. Though not all trans people seek to medically transition, many do, and thousands (including myself) rely on government-funded programs to obtain and afford hormone therapy and/or surgeries. Meanwhile, body or genital dysphoria is a condition much like clinical depression or anxiety, and hundreds of thousands of transgender people are in need of counseling to help alleviate it. And this doesn’t even scratch the surface — an estimated 30% of transgender people live with a physical or mental disability, compared to 20% of the general population.

By any measure, trans people are the demographic most often in need of imperative physical and mental health care. But given the likely makeup of Trump’s DHHS, it’s no stretch to imagine what will come next: restrictions on hormone access for people on Medicare or Medicaid under auspices of “relieving the burden on taxpayers”; free reign for medical professionals to discriminate against patients due to “sincerely held religious beliefs”; referrals of transgender youth to state-funded conversion therapy programs, which will almost certainly kill them. All of these scenarios and more are possible by making simple amendments to the ACA — amendments which the Republican-held Congress, eager to please its radicalized base, will likely pass without debate.

It’s no wonder, then, that trans people across the nation are already taking steps to mitigate the effects Trump’s DHHS will have on their lives. Many are requesting three-month hormone prescriptions in advance from their doctors. Calls have gone out on Facebook for cis women and trans men to obtain prescriptions for trans women to use as a replacement for HRT after their stockpiles run out, and the reverse — cis men and trans women investigating testosterone creams — is also happening.

If you’re a health care professional, this would be a great time to contact local transgender support groups and ask what services you can provide; mental health counselors who are willing to provide cheap or pro bono service, for instance, will be revered for generations. And allies who aren’t in the medical sector can still help; trans people on hormones will be especially in need of spironolactone, estradiol, and finasteride (not that, of course, The Establishment endorses under-the-table dispersal of prescription medication). Donate to Planned Parenthood so the organization can continue to offer hormone therapy, and consider giving to your trans friends during any crowdfunding operations.

This isn’t the end for trans people — but the oncoming Trump administration poses severe threats for us, and it’s a certainty that not all of our little community will make it to see 2020. By standing together, though, we can mitigate the damage done, and work to ensure that whatever injustices follow will be met by the full strength of our resolve.

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