How this California law helped trans people access health care

In many states, legislators are looking to restrict transgender health care, but a new study finds that a law protecting transgender people improved access to gender-affirming care.

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Myles Ma, CPFCSenior ReporterMyles Ma, CPFC, is a senior reporter and certified personal finance counselor at Policygenius, where he covers insurance and personal finance. His expertise has been featured in The Washington Post, PBS, CNBC, CBS News, USA Today, HuffPost, Salon, Inc. Magazine, MarketWatch, and elsewhere.

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As more than 350 anti-transgender bills make their way through state legislatures, [1] new research shows that laws that protect the rights of transgender people can help people access gender-affirming health care. 

A study published in March in JAMA found that there was an increase in patients undergoing gender-affirming surgery in California after the state passed a law in 2013 prohibiting private insurance companies from discriminating based on sexual orientation and gender identity. [2] The study compared discharge data for more than 25,000 people diagnosed with gender dysphoria between 2005 and 2019 and estimated that the Insurance Gender Nondiscrimination Act was associated with a 12.1% increase in the likelihood of someone undergoing gender-affirming surgery in California, as compared with Arizona and Washington, which didn’t have similar policies at the time. The study focused on surgery and not other forms of gender-affirming care, like hormone therapy.

California has one of the longest-standing gender nondiscrimination policies. Dr. Adrian Diaz, part of the general surgery department at The Ohio State University’s College of Medicine and a co-author of the study, says the goal of the research was to see if the policy was having an effect. Prior to 2013, when the law passed, fewer patients were getting gender-affirming surgery, and they were more likely to pay for it without insurance. The increase in surgeries after 2013 was almost exclusively in insured patients.

“Health insurance has been hugely impactful in its role in helping this patient population access essential health services,” Diaz says.

The study highlights the importance of having legal protections for transgender patients, he adds. It also shows the implications of anti-trans laws when it comes to health, says Andrew Twinamatsiko, an associate director for the O’Neill Institute for National & Global Health Law at Georgetown University who did not work on the study.

“I think this is really important just by showing that restrictive laws have real-life consequences,” he says. “It’s not just ideological disagreement.”

The law around transgender health care

Transgender people are also protected under federal policy. Section 1557 of the Affordable Care Act prohibits discrimination on the basis of sex, including gender identity, under any health program that receives federal assistance. 

The Biden administration issued rules in 2022 to reinforce these protections, but they’ve become the subject of litigation.  [3]

“It’s not any secret that transgender and gender-diverse patients and their rights are under attack across the country,” Diaz says.

How to get gender-affirming health care

As a result, the ability to access gender-affirming care depends largely on where you live. Some states, like California, explicitly protect people from being denied health insurance coverage based on gender identity. Other states, like Arkansas and Mississippi, allow private insurers to refuse to cover gender-affirming care, including surgery or hormone therapy. [4]

That’s why it’s important to understand what the law allows where you live. The Movement Advancement Project, a nonprofit tracking LGBT-related policies at the state level, has maps that can help you see the laws and policies in your state. 

“Folks understanding what the extent of the law is, and that the law is on their side, is really important,” Twinamatsiko says.

You should also read your health insurance policy carefully to see if there are exclusions for gender-affirming care.

Of course, health insurance and the law aren’t the only barriers transgender people may face for accessing health care. Some areas may not have trans-friendly health care providers. Transgender people often face stigma, in addition to financial obstacles that may make it difficult to access health care.

But Diaz says this study shows that some communities are working to reduce these barriers.

“Don’t lose hope,” he says. “While a lot of what we hear in the media is negative coming from states trying to ban this sort of care, there’s the other side of the coin. There are many states, many folks, fighting to make this more accessible.”

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