Trans healthcare equity: Trans people forgo healthcare due to traumatic experiences

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  Quantumrun Foresight
• April 26, 2022

Insight summary

Transgender individuals face significant challenges in accessing healthcare, with widespread discrimination and lack of understanding within the medical community leading to inequalities and mistreatment. Policies and laws have fluctuated, creating an uncertain landscape for trans healthcare, while insurance companies have been slow to adapt to the specific needs of this community. The push towards healthcare equity for trans people can foster positive changes, such as more inclusive medical research and insurance policies, but also brings potential negative impacts like social resistance and strain on resources.

Trans healthcare equity context

The healthcare system is gender-sensitive, with gender the basis of numerous treatment decisions within the medical profession. However, gender discrimination prevents some trans people from seeking or receiving medical care, which causes health inequalities to develop that negatively impact the lives of transgender people. Many trans people have reported being oppressed, discriminated against, maltreated, and even physically and verbally abused because of their gender identity.

Others have lost their jobs while facing severe pain due to healthcare systems being inaccessible to trans people. Meanwhile, healthcare systems have been slow to recognize the specific needs of transgender patients.

Medical personnel and providers have been known to mistreat trans people through physical or verbal abuse or failure to authorize or treat trans people when they require healthcare. A 2020 report from the Center for American Progress (CAP) revealed that nearly 68 percent of trans people of color and half of all transgender people had experienced discrimination within the US healthcare system. The report also showed that about 22 percent of transgender people of color and 28 percent of all transgender people had postponed medical care due to a fear of discrimination. 

Disruptive impact

Section 1557 of the Affordable Care Act was interpreted by the 2016 Obama administration as prohibiting any discrimination based on sex in federally-funded healthcare facilities. However, the 2017 Trump administration erased these protections, thereby making it difficult for trans people to access federally-funded healthcare. In the US, 24 states and Washington D.C. prohibit transgender exclusions in health insurance coverage. Also, 23 states, one territory, and Washington D.C. have Medicaid policies that explicitly cover transition care for transgender people.

Research by CAP showed that many healthcare providers do not have the cultural competence to provide trans people with appropriate healthcare. The survey conducted by CAP revealed that about 33 percent of trans people have had to teach their doctors about what it means to be a transgender person to receive proper treatment. Approximately 15 percent of transgender people in the survey reported being asked unnecessary and invasive questions during healthcare checkups. Trans representation in healthcare is scarce, and research publications are few and far between. Trans people rights advocates and medical experts believe expanding community care to trans people is the best way to improve the overall health of trans people. 

The insurance industry has posed a further challenge to trans people in relation to healthcare. Companies either do not offer policies for trans people or may not pay out policies already owned by trans people, particularly with gender-affirming surgery classified as being cosmetic. However, some influential medical organizations, including the American Psychiatric Association, note that such surgeries are necessary and are one of many treatments for gender dysphoria. 

Implications of healthcare equity for trans people

Wider implications of healthcare equity for trans people may include:

• The health system being made more equitable and responsive to the needs of minorities so that they can access the quality healthcare given to other social, racial, and gender-specific groups, leading to a more inclusive society where all individuals feel recognized and cared for.
• Improving medical research focused on the healthcare needs of trans people, leading to more targeted treatments and therapies that can enhance the overall well-being and life expectancy of this community.
• Insurers devising new policies that address the specific healthcare needs of trans people, leading to more affordable and accessible healthcare options that reflect the unique needs and challenges faced by this population.
• Governments implementing policies that support trans healthcare equity, leading to a more just society where discrimination is reduced, and human rights are upheld.
• The expansion of educational programs in medical schools focusing on trans healthcare, leading to a workforce that is more knowledgeable and empathetic towards the specific needs of trans individuals.
• Resistance from certain social or political groups to trans healthcare equity, leading to potential social unrest or polarization that may hinder progress in this area.
• The potential strain on healthcare resources due to the increased demand for specialized care, leading to challenges in allocation and potential delays in treatment for other patient groups.
• Possible legal challenges and debates around the definition and scope of trans healthcare rights, leading to a complex and potentially slow-moving legal landscape that may delay the implementation of necessary changes.

Question to consider

• Do you think healthcare research focused on trans people can offer the wider population and medical community benefits that may not have been previously discovered?
• How best can medical professionals be educated regarding the needs of trans people?