Nearly half of all transgender people in the United States say they’ve experienced mistreatment by a medical provider, including refusals of care and instances of verbal or physical abuse, according to a report released earlier this week by the liberal think tank the Center for American Progress.
The report highlights disparities in health care experiences between transgender Americans and their cisgender counterparts, based on a survey of 1,500 LGBTQ individuals about their life experiences that was conducted in June 2020. The survey found that 47% of transgender people reported experiences of mistreatment by medical providers, with that number rising to 68% among transgender people of color.
The survey also found that more than one-quarter, or 28%, of transgender survey respondents, said they had either postponed or avoided seeking medical care out of fear of experiencing discrimination, and 46% said they had been denied gender-affirming care by a health insurance company, reports The Hill.
Additionally, nearly 1 in 3 transgender Americans said their primary insurer refused to change documents or records to reflect their correct name and gender identity.
The Center for American Progress also attributed health inequalities to the cost of medical care, with 51% of transgender individuals saying they avoided needed medical care due to high costs, and 40% of transgender people saying they avoided preventative screenings because of high costs.
CAP noted that harassment and discrimination “contribute to high rates of stress,” which, when coupled with social determinants of health, make transgender individuals “more likely to experience poor health outcomes.”
Sharita Gruberg, the vice president of the center’s LGBTQ Research and Communications Project, and one of the report’s authors, told NBC News that the “onus should not be on individuals” to find access to quality, LGBTQ-affirming health care.
“It really should be on these institutions to do the right thing, and the resources and guidance is out there,” Gruberg said.
In its report, CAP urged the Biden administration to put in place “nondiscrimination laws and inclusive policies” that would ensure access to affirming medical care, especially with regard to transgender patients.
The report called for guidance from the U.S. Department of Health and Human Services informing state Medicaid programs that insurance exclusions that refuse to cover medically necessary gender-affirming treatments are inconsistent with federal law. It also called on the Office of Personnel Management to eliminate any discriminatory exclusions in the Federal Employees Health Benefits Program to ensure government workers can access medically necessary care without having to pay exorbitant out-of-pocket costs.
CAP also urged the federal government to collect more data on the experiences of transgender individuals and how they interact with the health care system, including information on how they have been impacted by the COVID-19 pandemic.
But the report noted that nondiscrimination protections alone are not sufficient to eliminate the disparities that exist between transgender Americans and their cisgender counterparts, noting that other factors also play a role in inadequate medical care, such as persistent poverty, higher rates of criminalization, and unemployment. For example, trans people in the District of Columbia, despite having some of the most comprehensive pro-transgender laws in the country, are still more likely to be uninsured, be living with HIV, use illicit substances, and experience feelings of suicidal ideation.
“Trans-sensitive health care is not simply access to medical transition through hormones and surgeries,” the report reads. “While medical transition is widely recognized as holistically beneficial to those who seek it out, the pressing health care needs of many transgender people include care for chronic conditions, care associated with disability, and mental health treatment — and not all transgender people would choose to medically transition even if this care were available.
“Meanwhile, many health providers lack basic knowledge of the health experiences of transgender people and must increase their cultural competence to effectively serve their transgender patients,” the report continues. “Proactive efforts to promote access to health care, including through targeted support for affirming health care programs and increasing cultural competence among health care providers, are also needed.”
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