“I was left untreated in the ER for two hours when they found my breasts under my bra…”
70% of transgender people report experiencing discrimination in their health care, ranging from verbal abuse to refusal of treatment,[ii] and 19% of transgender people report being denied health care.[iii] A 2011 master’s thesis focusing on the Nashville and Knoxville areas found that the stigma and discrimination toward transgender individuals “create[s] significant barriers to health care for this population.”[iv] The 2014 Healthcare Equality Index lists no Equality
Leaders in the Knoxville area.[v] While some area hospital systems, including UT Medical Center and Tennova, have an explicit anti discrimination for gender identity and expression, others do not. This can force transgender people in the region to choose between a hospital that will be covered by insurance or a hospital where they can feel safe and confident that they will receive treatment.
“To be clear it’s not that transgender youth are mentally ill…”[vi]
A 2014 study found that transgender people are about 2 1⁄2 times more likely to experience depression or anxiety than cisgendered peers, about 3 times more likely to report suicidal ideation or attempted suicide, and nearly 4 times more likely to physically harm themselves.[vii] The lead author of the study attributes these mental health issues to social and environmental factors, not to being transgender.[viii] Psychology no longer considers being transgender a mental illness.
However, transgender people may be diagnosed with Gender Dysphoria, which refers to the feelings of depression, anxiety, etc., caused by “a mismatch between their biological sex and gender identity.”[ix] Hiding one’s gender identity from other people can also cause anxiety, depression, and isolation.[x]
“My choices for health coverage at my employer all exclude any treatment for transgender issues, even though they cover things like hormones for other people.”[xi]
The Affordable Care Act prevents health insurance companies from denying insurance on the basis of a preexisting condition.[xii] This is a major benefit for transgender people, who were often denied insurance on the basis of Gender Dysphoria. However, neither Federal nor Tennessee law prevents insurance companies from refusing to cover transition related care. Insurance companies often refuse to cover such care, arguing that it is not medically necessary. For example, BCBS of TN’s Provider Administration Manual specifically excludes “surgeries and related services to change gender.”[xiii] Even medically necessary care is not always covered: insurance companies may refuse to cover routine gynecological care for a transgender male who has not had a hysterectomy; similarly, insurance companies may refuse to cover routine prostate exams for a transgender female.[xiv]
Gender Confirmation Surgery
“[M]y surgery not only allowed my life to flourish, it quite simply saved it.”[xv]
Gender confirmation surgery, also called gender reassignment surgery, is a series of procedures aimed at providing transgender people with a body that matches their feeling of gender. For male to female transgender individuals, this can include a penectomy, vaginoplasty, and other procedures; the cost of this surgical transition averages $7,000$24,000. For female to male transgender individuals, procedures include a bilateral mastectomy, hysterectomy, and phalloplasty; the cost of these procedures total over $50,000.[xvi] In the past, these procedures were considered elective and were not covered by insurance. However, a growing number of advocacy and medical organizations have found that such procedures are medically necessary for transgender people to live a normal, healthy life.[xvii] For example, Medicare changed its policy in May 2014 to cover gender confirmation surgery on a casebycase basis.[xviii]
Planned Parenthood of Asheville