The importance of insurance
 
There are also serious challenges for many transgender people who don’t have health insurance. 

“For many people in the gender-diverse community, access to insurance can be problematic, because there’s just pervasive discrimination throughout our entire system, and it can be harder for these patients to find employment and maintain employment,” said Natalie Frazier, clinician supervisor at Planned Parenthood South Atlantic, based in Raleigh, N.C.

More than 1 in 4 transgender people have reported losing a job due to bias, and more than three-fourths have experienced some form of workplace discrimination, according to the National Center for Transgender Equality. And it wasn’t until 2020 that the Supreme Court ruled that federal law bars employers from discriminating against potential and current transgender employees. 

Where there are still gaps in care left by health systems, providers like Planned Parenthood and FQHCs step in. More than a third of patients working with Planned Parenthood South Atlantic are uninsured. And the care is needed: Once its clinics started offering hormone replacement therapy, one location in West Virginia saw a huge boost in patients and revenue, mostly from transgender patients. 

“These clinics have often been a place that have been not just willing to care for the needs of LGBTQ patients, but because of their mission, have been much more sensitive to the unique needs of marginalized populations,” said Ehrenfeld of the Medical College of Wisconsin.

But these lower-cost centers only go so far. A portion of transgender patients choose to have gender-affirming surgeries, but without insurance, cost can be a big barrier. The cheapest vaginoplasty, a procedure that uses existing genital tissue to create a vagina and vulva, is around $19,000 in the U.S.

“And that’s from the hospital system that’s been doing these procedures on a cash basis for many years and has put in a lot of effort to keeping their costs down,” said Callen-Lorde’s Goldstein. “But if you get a quote from a New York hospital that’s offering these procedures, the cash price is going to be around $60,000.”

Lack of metrics

Beyond insurer issues, the next frontier may be in quality and safety, a heavily measured area for some specialties, but not for transgender-specific care. People typically find care based on word of mouth or from local directories where providers submit their information and identify themselves as an inclusive provider.

“The entire healthcare ecosystem needs to identify quality metrics, a way to say this is how we know that these are the providers that we should be referring folks to,” said Koch of BCBS Minnesota. 

One measurement could be patient satisfaction surveys for people after a surgery. Some suggest that providers or insurers could form an association to create a national database on providers to track surgery outcomes. But quality measurement in this field, like any other, can be nuanced and potentially used by insurers to limit access to providers.

“An insurance carrier say they find anyone who meets the criteria, so they just can’t offer a service, or that they only have one provider that qualifies but isn’t very good at the procedure you need,” said Baker from the Whitman-Walker Institute. “(What) insurance does not cover, providers will not provide and then it becomes this cyclical relationship where you can’t get this care because it’s not reimbursed.”

And the very last thing that Baker, along with everyone interviewed for this story, wants to see is care and coverage slip back to the way it was even just a decade ago.

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Originally Appeared Here