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Access to health care

The World Professional Association for Transgender Health (WPATH) Standards of Care provide a set of non-binding clinical guidelines for health practitioners who are treating transgender patients. The Yogyakarta Principles, a global human rights proposal, affirms in Principle 17 that "States shall (g) facilitate access by those seeking body modifications related to gender reassignment to competent, non-discriminatory treatment, care and support.

Transgender individuals are often reluctant to seek medical care or are denied access by providers due to transphobia/homophobia or a lack of knowledge or experience with transgender health. Additionally, in some jurisdictions, health care related to transgender issues, especially sex reassignment therapy, is not covered by medical insurance.

In the UK, the NHS is legally required to provide treatment for gender dysphoria. As of 2018, Wales refers patients to the Gender Identity Clinic (GIC) in London, but the Welsh government plans to open a gender identity clinic in Cardiff.

In India, a 2004 report claimed that hijras 'face discrimination in various ways' in the Indian health-care system, and sexual reassignment surgery is unavailable in government hospitals in India.

In Bangladesh, health facilities sensitive to hijra culture are virtually non-existent, according to a report on hijra social exclusion.

Denial of health care in the United States

The 2008-2009 National Transgender Discrimination Survey, published by National Gay and Lesbian Task Force and the National Center for Transgender Equality in partnership with the National Black Justice Coalition, shed light on the discrimination transgender and gender non-conforming people face in many aspects of daily life, including in medical and health care settings. The survey reported that 19% of respondents had been refused healthcare by a doctor or other provider because they identify as transgender or gender non-conforming and transgender people of color were more likely to have been refused healthcare. 36% of American Indian and 27% of multi-racial respondents reported being refused healthcare, compared to 17% of white respondents. In addition, the survey found that 28% of respondents said they had been verbally harassed in a healthcare setting and 2% of respondents reported being physically attacked in a doctor's office. Transgender people particularly vulnerable to being assaulted in a doctor's office were those who identify as African-Americans (6%), those who engaged in sex work, drug sales or other underground work (6%), those who transitioned before they were 18 (5%), and those who identified as undocumented or non-citizens (4%).

An updated version of the NTDS survey, called the 2015 U.S. Transgender Survey, was published in December 2016.

Section 1557 of the Affordable Care Act contains nondiscrimination provisions to protect transgender people. In December 2016, however, a federal judge issued an injunction to block the enforcement of "the portion of the Final Rule that interprets discrimination on the basis of 'gender identity' and 'termination of pregnancy'". Under the Trump administration, Roger Severino was appointed as civil rights director for the U.S. Department of Health and Human Services (HHS). Severino opposes Section 1557 and HHS has said it "will not investigate complaints about anti-transgender discrimination," as explained by the National Center for Transgender Equality. When a journalist asked Severino if, under the HHS Conscience and Religious Freedom division whose creation was announced in January 2018, transgender people could be "denied health care," he said "I think denial is a very strong word" and that healthcare "providers who simply want to serve the people they serve according to their religious beliefs" should be able to do so without fear of losing federal funding. On May 24, 2019, Severino announced a proposal to reverse this portion of Section 1557.

On April 2, 2019, Texas Senate Bill 17 passed by a vote of 19-12. It would allow state-licensed professionals such as doctors, pharmacists, lawyers, and plumbers to deny services to anyone if the professional cites a religious objection. To reveal the motivations behind the bill, opponents proposed an amendment to prohibit discrimination based on sexual orientation or gender identity; the amendment failed 12-19.

On October 15, 2019, federal judge Reed O'Connor vacated the part of the Affordable Care Act that protects transgender people. The ruling means that federally-funded healthcare insurers and providers may deny treatment or coverage based on sex, gender identity or termination of pregnancy, and that doctors aren't required to provide any services whatsoever to transgender people—even if they're the same services provided to non-transgender people, and even if they're medically necessary.

Insurance coverage

Although they are not the only uninsured population in the United States, transgender people are less likely than cisgender people to have access to health insurance and if they do, their insurance plan may not cover medically necessary services. The National Transgender Discrimination Survey reported that 19% of survey respondents stated that they had no health insurance compared to 15% of the general population. They were also less likely to be insured by an employer. Undocumented non-citizens had particularly high rates of non-coverage (36%) as well as African-Americans (31%), compared to white respondents (17%).

While a majority of U.S. insurance policies expressly exclude coverage for transgender care, regulations are shifting to expand coverage of transgender and gender non-conforming health care. A number of private insurance carriers cover transgender-related health care under the rubric of "transgender services", "medical and surgical treatment of gender identity disorder", and "gender reassignment surgery". Nine states (California, Colorado, Connecticut, Illinois, Massachusetts, New York, Oregon, Vermont, and Washington) and the District of Columbia require that most private insurance plans cover medically necessary health care for transgender patients.

Depending on where they live, some transgender people are able to access gender-specific health care through public health insurance programs. Medicaid does not have a federal policy on transgender health care and leaves the regulation of the coverage of gender-confirming health care up to each state. While Medicaid does not fund sex reassignment surgery in forty states, several, like New York and Oregon, now require Medicaid to cover (most) transgender care.

Cancer

Cancers related to hormone use include breast cancer and liver cancer. In addition, trans men who have not had removal of the uterus, ovaries, or breasts remain at risk to develop cancer of these organs, but trans women remain at risk for prostate cancer.

 

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