The Republican Health Care Bills are Deadly for Transgender Americans

by Mara Keisling, NCTE Executive Director

We are not hyperbolic at the National Center for Transgender Equality, but we are shocked and horrified by the Senate and House versions of the Republican health care bill, because our fears have been confirmed: according to the Center for American Progress’ analysis of the Congressional Budget Office score, this bill could kill as many as 217,000 Americans over the next decade. Transgender people are in grave danger. In fact, the Senate bill would do many unconscionable things to devastate transgender Americans and their families. The reality is simple, but must be stated: when people don’t have health insurance, they can die.

The bill would slash Medicaid funding, making even worse cuts than those proposed in the egregious “American Health Care Act” passed by the House last month. Millions of low-income and disabled Americans depend on Medicaid for coverage, including many transgender people, who are more than twice as likely as their non-transgender counterparts to live in poverty, and are also more likely to have disabilities. According to the U.S. Transgender Survey (USTS), 13% of transgender Americans receive coverage through Medicaid. With funding slashed, tens of thousands of transgender people and their families could be without the care they need to stay alive and healthy.

The Senate’s health care proposal would also slash income-based subsidies, which means out-of-pocket healthcare costs would skyrocket. For a community with an unemployment rate three times the national average, and who are significantly more likely to make less than $10,000 dollars per year, these subsidies are crucial to survival. As we know from the survey, one-third of transgender Americans do not visit a healthcare provider even when urgent, purely because of cost. Among transgender people of color, or among those with disabilities, that number is even higher. Under the Republican bills, each of these figures would climb.

Take the example of my friend, and prominent jazz bassist, Jennifer Leitham, whose story was recently shared in a GQ article on transgender health costs. After experiencing complications following gender confirmation surgery, Leitham underwent numerous emergency surgeries, spending ten months in and out of the hospital. Even after insurance, she had such severe out-of-pocket costs, it took her four years to recover financially. The bill proposed by Senate Republicans would make this the reality for even more transgender people, dooming them and their families to financial ruin if not irreversible damage to their health.

Republican bills would allow states to opt out of essential benefits, letting insurers refuse to cover things such as emergency services, hospitalization, chronic disease management, prescription drugs and pediatric care, among other necessary health expenses.

Already transgender Americans are disproportionately affected by health disparities. But the effect of these differences would not contain themselves within state borders. The GQ article also spoke of “Jordan,” a kindergarten teacher in Seattle, where state law explicitly prohibits discrimination in healthcare based on transgender status. Yet Jordan’s insurers were still able to deny coverage of his top surgery because their policies were written in another state — one in which the law does not prohibit this kind of discrimination. While the ACA largely prevented issues like this, the Senate’s proposed bill would re-allow, if not encourage, state-based discrimination in transgender health care.

Finally, the Senate bill would defund Planned Parenthood, an organization that is crucial for meeting the basic health needs of millions of Americans, and is particularly crucial for trans people. Among other fundamental health services Planned Parenthood provides, Planned Parenthood is one of the nation’s largest providers of hormone treatment for transgender people. As importantly, Planned Parenthood clinics are places where transgender people are welcome and given respectful and competent preventive care. Simply put, stripping Planned Parenthood of the funding it needs to operate means stripping transgender Americans of the opportunity to receive the most basic care they need.

Let there be no confusion, the Senate healthcare bill does not endanger transgender and millions of other people as collateral damage. This bill was drafted in secrecy precisely because the endorsing Senators know what it will do to the American people. The decision to push forward with this bill is shameful and Senators’ responses to the protests against this bill by real people who would be put at risk are even more shameful. We must fight this insidious bill and protect the millions of Americans whose lives would be destroyed by its passing. We must prevent transgender people and all Americans — from being stripped of the healthcare they need to survive.

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National Center for Transgender Equality

National Center for Transgender Equality

We’re the nation’s leading social justice advocacy organization winning life-saving change for transgender people. Also at