In tandem with the growing visibility and acceptance of transgender people in the United States, we have seen a rapid increase in insurance coverage for health care services related to gender transition. Despite ongoing court battles over federal nondiscrimination protections for transgender people and uncertainty over the future of the Affordable Care Act (ACA), this trend is likely to continue: Medicare, many state-regulated private plans, some state Medicaid programs, and an increasing number of employer-sponsored plans now cover transition-related care for transgender people. These changes are driven by a growing expert consensus on the medical necessity of gender transition, new legal interpretations prohibiting insurance discrimination against transgender people, and mounting evidence that transgender-inclusive coverage is cost-effective.
Transgender people are those whose gender identity — their innate, deep-seated knowledge of their own gender — differs from that typically associated with the sex they were assigned at birth. In the United States today, there are approximately 1.4 million transgender adults (0.6% of the population) and 150,000 transgender teens 13 to 17 years of age.
As a small, poorly understood population, transgender people frequently encounter discrimination that includes mistreatment by health care providers, rejection by employers, and harassment in restrooms and other places of public accommodation. These experiences exacerbate health disparities such as high rates of depression, anxiety, exposure to violence, and HIV infection. Discrimination and disparities are particularly acute for low-income transgender people, transgender people of color, and others at the intersections of multiple marginalized communities.
The above excerpt was originally published in The New England Journal of Medicine.
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