Trans and non-binary people require improved, and consistent access to

health professionals educated in issues that can improve their physical,

mental, and emotional wellbeing.

Introduction
The 1.7 million trans and non-binary Americans face dire social conditions which make them
one of the most at-risk U.S. populations.1. According to The Commonwealth Fund: 78% of trans
kids k-12 are harassed at school; 26% of trans people are physically assaulted; 19% are homeless
at some point during their lives. And, perhaps the most telling statistic, a staggering 40% of trans
people attempt suicide, as compared to the much lower 4.6% of the general population.1
Unsurprisingly, trans people develop health problems related to these above conditions; they
often also have long-term health needs related to gender-affirming care. Getting basic access to
healthcare, including life-saving gender-affirming care improves their overall health outcomes.
Yet, discrimination in insurance and medicine and even medical administration stands in the way
of access to needed care.

Main Point
Non-discriminatory practices among insurers, medical providers, and medical administration will
improve access to an informed, prepared, and non-discriminatory medical system. This, in turn,
will improve health outcomes for our very vulnerable trans and non-binary population. In fact,
better practices, training, and administration in healthcare is the only thing that can improve their
health outcomes. This goal is most definitely achievable. Unfortunately, 2021 has seen an
onslaught of anti-trans and non-binary state legislation. Immutable federal protections requiring
parity for trans and non-binary people with cisgender people in all matters touching upon
healthcare is imperative.

Background
These overall negative health outcomes - as illustrated by the alarming rate of suicide attempts
by trans and nonbinary people - are not inevitable. 2 Access to gender-affirming care alone
reduces the suicide rate among trans and non-binary people. 2

So, what is in the way of access to medical professionals? The discrimination trans and
non-binary Americans face in the medical world - from doctors, medical institutions, and
insurers, makes this population much less likely to access the medical care they need.2 The 2015
Transgender Survey, the largest survey ever conducted of the US transgender population, showed
that 55% percent of transgender people had been denied coverage by their insurer for
gender-affirming medical care2. As stated earlier, access to gender-affirming care is key to
reducing the suicide attempt rate.

This vulnerable population has been prevented from finding firmer footing in healthcare due to
the changing status of their healthcare rights. The Obama administration set out
nondiscrimination protections for trans and nonbinary people in Section 1557 of the Affordable
Care Act. 3 That federal law established that it is illegal to discriminate on the basis of "race,
color, national origin, sex, age or disability in certain health programs and activities."4 This rule
explained that protections regarding "sex" encompass those based on gender identity, which is
defined as "male, female, neither, or a combination of male and female.”4 This set the course for
trans and nonbinary people to begin educating the medical community on their specific physical,
mental, and emotional needs and actually achieving parity of treatment as compared to
cisgendered people.

The Trump administration reversed the gains for trans rights with a regulation erasing protections
for transgender patients against discrimination by doctors, hospitals, and health insurance
companies. 4 The regulation was part of a broader Trump administration effort to limit the legal
definition of sex discrimination to omit protections for transgender people not only in healthcare,
but in housing and education, too. 5

President Biden reinstated some protections against discrimination. On the first day of his
presidency, President Biden Issued an executive order to expand federal discrimination
protections for LGBTQ people.6 The Department of Defense is in the process of reversing the
Trump Administration’s trans military ban. 7 The Fair Housing Act is being enforced to protect
LGBTQ people.7

Now that federal law is not an obstacle, one would think medical institutions and professionals
would be eager to begin providing the lifesaving work of learning about and providing quality
healthcare to address the general and specific medical needs of trans and nonbinary people.
Unfortunately, the medical concerns specific to the trans and nonbinary community, namely
gender transition and gender affirmation care are still often out of reach.8 This care is often
explicitly excluded from both public health care programs and private insurance policies.5
Sometimes medically meaningless preconditions and limitations are established making “access”
extremely difficult. 8. These can include having to obtain letters from mental health professionals
for procedures and medications prescribed by medical doctors; this can require reaching an
arbitrary age for treatment, despite no actual medical necessity.

Discussion Points/Evidence
Just as parity between the mental healthcare and physical healthcare provided in the U.S. is now
an expectation and a federal right, parity between the healthcare of cisgender Americans and
trans and non-binary Americans should be an expectation and federal right. Americans have
long fought for rights for Americans with Disabilities, Americans over 40, women, children, and
other groups with less power. Once those rights are achieved, it seems shameful that they ever
were denied. Now, shamefully, our trans and non-binary American neighbors are in the fight for
their lives.
 “Thirty-three states have introduced more than 100 bills that aim to curb the rights of
transgender people across the country, with advocacy groups calling 2021 a
record-breaking year for such legislation. Many of these bills are rapidly making their
way through state legislatures. On April 6, Arkansas became the first state to outlaw
providing gender-affirming treatment to minors, a move that the American Civil Liberties
Union said would “send a terrible and heartbreaking message” to transgender youth
across the country. 9”

In this legislative onslaught, many states are unabashedly targeting the rights of minors to receive
gender-affirming care or even receive a gender marker on identification that is neither male nor
female.10. The legislation also prohibits cities or counties from expanding trans and non-binary
peoples’ rights beyond those the state requires. 10 The only effective means of managing trans
and non-binary people’s rights and protections, especially as they touch on any aspect life saving
medical care, is through a broad, overarching, federal law that prohibits any discrimination
among insurers, medical providers, and medicine administration.

Conclusion and recommendation

Therefore, it is time for a simple but powerful federal law which states: Trans and all gender
non-conforming Americans are entitled to equal rights and parity with cisgender Americans in
all matters. Such a simply stated federal law is unlikely to be misconstrued by courts, or
companies whose decisions have a direct impact on the well-being of these Americans. This
leveling law, or parity law, or law of humanity, should be passed by the U.S. House and Senate
and signed into law by President Biden rather than emerge as an Executive Order. This new law
would be no different than earlier non-discrimination laws protecting other classes of people.

Trans and non-binary people deserve to have the stability of being able to rely on being equal
Americans. Facing discrimination in their care the mental and physical well-being of trans and
non-binary people is greatly diminished. It is time to pass legislation to help this vulnerable
population and end this discrimination.
1. Lewis, Corinne, Yaphet Getachew, and Mekdes Tsega. “Federal Government Eliminates
Health Care Protections for Transgender Americans.” Commonwealth Fund.
Commonwealth Fund, June 19, 2020.
https://www.commonwealthfund.org/blog/2018/federal-protections-health-care-risk-trans
gender-americans

2. Waller, Derek, "Recognizing Transgender, Intersex, and Nonbinary People in Healthcare

Antidiscrimination Law" (2018). Minnesota Law Review. 61.
https://scholarship.law.umn.edu/mlr/61

3. Secretary, HHS Office of the, and Office for Civil Rights (OCR). “Section 1557 of the
Patient Protection and Affordable Care Act.” HHS.gov. US Department of Health and
Human Services, February 3, 2021.
https://www.hhs.gov/civil-rights/for-individuals/section-1557/index.html

4. Simmons-Duffin, Selena. “Transgender Health Protections Reversed By Trump

Administration.” NPR. NPR, June 12, 2020.
https://www.npr.org/sections/health-shots/2020/06/12/868073068/transgender-health-pro
tections-reversed-by-trump-administration

5. Sanger-katz, Margot, and Noah Weiland. “Trump Administration Erases Transgender

Civil Rights Protections in Health Care.” The New York Times. The New York Times,
June 12, 2020.
https://www.nytimes.com/2020/06/12/us/politics/trump-transgender-rights.html

6. Yurcaba, Jo. “Biden Issues First Presidential Proclamation on Trans Day of Visibility.”
NBCNews.com. NBCUniversal News Group, March 31, 2021.
https://www.nbcnews.com/feature/nbc-out/biden-issues-first-presidential-proclamation-tr
ans-day-visibility-n1262613
7. HRC. “President Biden's Pro-LGBTQ Timeline.” HRC, 2021.
https://www.hrc.org/resources/president-bidens-pro-lgbtq-timeline

8. ACLU. “Transgender People and Health Care.” American Civil Liberties Union. Accessed
April 3, 2021.
https://www.aclu.org/issues/lgbtq-rights/transgender-rights/transgender-people-and-healt
h-care

9. Krishnakumar, Priya. “This Record-Breaking Year for Anti-Transgender Legislation

Would Affect Minors the Most.” CNN. Cable News Network, April 15, 2021.
https://www.cnn.com/2021/04/15/politics/anti-transgender-legislation-2021/index.html

10. ACLU. “Legislation Affecting LGBT Rights Across the Country.” American Civil Liberties
Union. Accessed April 16, 2021.
https://www.aclu.org/legislation-affecting-lgbt-rights-across-country