State-Level Policy Stigma and Non-Prescribed Hormones Use among Trans Populations in the United States: A Mediational Analysis of Insurance and Anticipated Stigma (original) (raw)
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Insurance Coverage and Use of Hormones Among Transgender Respondents to a National Survey
Annals of Family Medicine, 2020
PURPOSE We undertook a study to assess the associations between barriers to insurance coverage for gender-affirming hormones (either lack of insurance or claim denial) and patterns of hormone use among transgender adults. METHODS We used data from the US Transgender Survey, a large national sample of 27,715 transgender adults, collected from August to September 2015. We calculated weighted proportions and performed multivariate logistic regression analyses. RESULTS Of 12,037 transgender adults using hormones, 992 (9.17%) were using nonprescription hormones. Among insured respondents, 2,528 (20.81%) reported that their claims were denied. Use of nonprescription hormones was more common among respondents who were uninsured (odds ratio = 2.64; 95% CI, 1.88-3.71; P <.001) or whose claims were denied (odds ratio = 2.53; 95% CI, 1.61-3.97; P <.001). Uninsured respondents were also less likely to be using hormones (odds ratio = 0.37; 95% CI, 0.24-0.56; P <.001). CONCLUSIONS Lack of insurance coverage for gender-affirming hormones is associated with lower overall odds of hormone use and higher odds of use of nonprescription hormones; such barriers may thus be linked to unmonitored and unsafe medication use, and increase the risks for adverse health outcomes. Ensuring access to hormones can decrease the economic burden transgender people face, and is an important part of harm-reduction strategies.
The Milbank Quarterly, 2020
Policy Points Protective transgender‐specific policies (including those related to experiences of discrimination, health insurance coverage, and changing legal documents) are associated with increased access to medical gender affirmation services (hormone treatment, therapy/counseling) for transgender and other gender‐diverse people. Restrictive transgender‐specific policies are associated with less access to these services. The relationship between race/ethnicity and use of medical gender affirmation services varies across states and is context specific, indicating that race/ethnicity also plays a role in access to these types of care across states. Advocacy is needed to prevent or overturn restrictive policies and promote protective policies for transgender and other gender‐diverse people, especially for people of color. ContextIn the 2010s, the number of federal, state, and local transgender‐specific policies increased. Some of these policies advanced protections for transgender ...
Coverage for Gender Affirmation: Making Health Insurance Work for Transgender Americans
LGBT Health, 2017
Many transgender Americans continue to remain uninsured or are underinsured because of payers' refusal to cover medically necessary, gender-affirming healthcare services-such as hormone therapy, mental health counseling, and reconstructive surgeries. Coverage refusal results in higher costs and poor health outcomes among transgender people who cannot access gender-affirming care. Research into the value of health insurance coverage for gender-affirming care for transgender individuals shows that the health benefits far outweigh the costs of insuring transition procedures. Although the Affordable Care Act explicitly protects health insurance for transgender individuals, these laws are being threatened; therefore, this article reviews their importance to transgender-inclusive healthcare coverage.
Journal of general internal medicine, 2015
Recently, the Massachusetts Group Insurance Commission (GIC) prioritized research on the implications of a clause expressly prohibiting the denial of health insurance coverage for transgender-related services. These medically necessary services include primary and preventive care as well as transitional therapy. To analyze the cost-effectiveness of insurance coverage for medically necessary transgender-related services. Markov model with 5- and 10-year time horizons from a U.S. societal perspective, discounted at 3 % (USD 2013). Data on outcomes were abstracted from the 2011 National Transgender Discrimination Survey (NTDS). U.S. transgender population starting before transitional therapy. No health benefits compared to health insurance coverage for medically necessary services. This coverage can lead to hormone replacement therapy, sex reassignment surgery, or both. Cost per quality-adjusted life year (QALY) for successful transition or negative outcomes (e.g. HIV, depression, suic...
Examining Associations Between State-Level Transgender Policies and Transgender Health
Transgender Health, 2018
Compared with their cisgender counterparts, transgender individuals face both structural-level discrimination and health disparities across health domains. We used recent population-level data to examine associations between state-level policy ratings regarding transgender people and transgender health (poor physical and mental health days, health behaviors, and health care utilization). We hypothesized more inclusive and protective state-level policies would predict better health of transgender individuals. The sample (N = 1116) was approximately half white (n = 572, 51.2%) and half transgender women (n = 551, 49.3%). More transgender-inclusive and protective statelevel policies predicted better health in three of four health domains. Policy and research implications are discussed.
Yale journal of health policy, law, and ethics, 2011
Tull for helping me conceive of and develop this Note; to Pratik Patel, Eli Lazarus, and my parents for their support and encouragement; and to Anna Shabalov, Matthew Hegreness, and Carolyn Brokowski for their outstanding editorial assistance. This Note examines the current landscape of transgender healthcare and 1. 1 use the terms "transgender," "gender variant," and "gender nonconforming" interchangeably to reference a wide range of people whose self-identity does not conform to the identity or norms usually associated with the sex they were assigned at birth. Some of these individuals may seek medical care to transition to a different sex while others do not. See A. Evan Eyler, Primaty Medical Care of the Gender-Variant Patient, in PRINCIPLES OF TRANSGENDER MEDICINE AND SURGERY 15, 19-21 (Randi Ettner et al. eds., 2007) (discussing a range of health treatments sought by transgender patients). I use the term "transsexual" to refer to individuals who seek genital sex reassignment surgery only when the phrase is used in the literature being cited. Like Katharine Franke, I believe the term "transsexual" focuses too much on the alteration of genitalia and ignores the diversity of transgender individuals and their health needs. See Katherine M. Franke, The Central Mistake of Sex Discrimination Law: The Disaggregation of Sex from Gender, 144 U. PA. L. REV. 1, 32 n.130 (1995). Finally, I refer to the various procedures that alter a transgender patient's physical appearance to reflect the individual's gender identity as "transitionrelated," "transitional," or "gender-confirming" care. 2. JAIME M. GRANT ET AL., INJUSTICE AT EVERY TURN: A REPORT OF THE NATIONAL TRANSGENDER DISCRIMINATION SURVEY 73-74 (2011), available at http://transequality.org/PDFs/ NTDSReport.pdf (reporting that 19% of a national sample of transgender individuals had been refused care by a medical provider due to their transgender or gender non-conforming status; 28% of respondents experienced verbal harassment in a medical setting; 2% were physically attacked in a doctor's office). 3. Transgender individuals are "less likely than the general population to have health insurance, more likely to be covered by public programs such as Medicare or Medicaid, and less likely to be insured by an employer." Id. at 76. 4. Id. at 77. 5. Id. at 82. Transgender populations also experience extraordinarily high rates of physical violence, sexual assault, and HIV, as well as above average rates of drug and alcohol abuse. Id. at 80-81. 376 XI:2 (2011) TRANSGENDER HEALTH AT THE CROSSROADS coverage and evaluates how the Patient Protection and Affordable Care Act (PPACA), the Obama Administration's landmark health insurance legislation, may change the state of transgender care. 6 Called "the most expansive social legislation enacted in decades," 7 the PPACA extends health insurance to millions of previously uninsured Americans, extensively modifies public insurance plans, and imposes new requirements on private insurance companies. 9 By eliminating pre-existing condition exclusions and mandating certain essential insurance benefits, the PPACA promises to expand access to care. But for transgender populations, the care promised may not be the care sought. Depending on how it is interpreted and applied, the legislation may secure new medical benefits for transgender individuals, or it may worsen the state of transgender healthcare altogether. The PPACA's impact on transgender patients will hinge on administrative and legal interpretations of the legislation. Medicine and insurance play a part in determining sexual identities for transgender persons, but importantly, so does law. Legal institutions have traditionally understood sex as immutable, unambiguous, and fixed at birth.' 0 The law assumes that sex is binary: an individual can be a man or a woman, but not both or neither." Nevertheless, current medical discourse, along with a growing body of legal scholarship, suggests that for gender-variant populations, sex is not solely defined by biological factors, but is actually "a human-made process, often involving a legal process."' 2 The state's role in determining and defining sex compels us to consider how benefits, particularly health benefits, are allocated to or withheld from transgender individuals. This Note proceeds in three Parts. Part I explores the complicated relationship between transgender medicine and transgender law, which has 6.
Barriers to insurance coverage for transgender patients
American Journal of Obstetrics and Gynecology, 2018
Barriers to insurance coverage for transgender patients Transgender people report discrimination in access to health care that is associated with numerous poor health outcomes, including higher prevalence of HIV infection, substance use disorders, and suicide attempts. The field of obstetrics and gynecology is uniquely positioned to meet a wide range of health care needs for transgender people, and obstetrician-gynecologists can and ought to provide genderaffirming care for these patients. Despite growing evidence that gender-affirming care is both necessary and cost-effective, transgender patients continue to face barriers to securing insurance coverage, which prevents clinicians from practicing standards of care. The purpose of this article is to delineate the major barriers transgender patients face when seeking insurance reimbursement for services routinely available to cisgender (nontransgender) women.
Journal of health care for the poor and underserved, 2017
Transgender people face numerous barriers when utilizing health care in the United States. The current study sought to highlight transgender consumer perspectives in order to present theoretically informed, concrete recommendations for increasing transgender health care utilization. The search yielded several prominent themes associated with barriers to health care for transgender people: 1) provider lack of knowledge concerning transgender identity issues and transgender health issues, 2) transgender patients' previous negative experiences with the health care system or anticipation of these experiences, 3) transgender patients' inability to pay for health care services, and 4) health care provider refusal to provide health care services to transgender people. We present a modified version of Adapted Behavioral Model of health care utilization for transgender people focused on transgender individuals as a guiding theoretical framework that informs our recommendations for in...