Are You Transsexual? No Health Care for You!

[Maybebaby56]

These preexisting conditions covered under Obamacare may not be protected by the GOP's replacement plan
(http://www.latimes.com/politics/washington/la-na-essential-washington-updates-watch-the-reaction-on-the-floor-of-1493923721-htmlstory.html)

The Affordable Care Act, also known as Obamacare, prohibits insurers from turning away consumers with preexisting medical conditions, a practice that was once standard in the industry.

Among the conditions that once commonly made insurers deny coverage, according to a list assembled by the nonprofit Kaiser Family Foundation, were:

HIV/AIDS
Lupus
Alcohol abuse/drug abuse with recent treatment
Mental disorders
Alzheimer's/dementia
Multiple sclerosis
Rheumatoid arthritis, fibromyalgia and other inflammatory joint disease
Muscular dystrophy
Cancer within some period of time (e.g. 10 years)
Severe obesity
Cerebral palsy
Organ transplant
Congestive heart failure
Paraplegia
Coronary artery/heart disease, bypass surgery
Paralysis
Crohn's disease/ulcerative colitis
Parkinson's disease
Chronic obstructive pulmonary disease/emphysema
Pending surgery or hospitalization
Diabetes mellitus
Pneumocystic pneumonia
Epilepsy
Pregnancy or expectant parent
Hemophilia
Sleep apnea
Hepatitis C
Stroke
Kidney disease, renal failure
Transsexualism

This list just blows my mind, and I'm not just talking about blatant discrimination against a tiny sliver of the population, i.e. transsexuals.  Have a substance abuse problem? Deal with it on our own!  Are you expecting a child?  You don't need healthcare.  Think you might need surgery?  Think again!

It's just insane.  The only people that will be able to get affordable health care will be the people who don't need it.

My SRS date can't come fast enough. 

~Terri

[rmaddy]

My SRS date can't come fast enough. 

I see that I'm not the only one thinking that.

[Zumbagirl]

Who cares?? Just find yourself a doctor who will work with you and pay him under the table if need be. I've been seeing the same endo for about 20 years now and roughly 17 of those years I paid in cash when I showed up for an appointment. Surprisingly when I paid in cash on the spot, the Dr charged me less than 1/2 of what the insurance company charged. Having insurance with coverage, I saw the annual visit jump up almost 3x in price.

[rmaddy]

Who cares??

I do.

A physician who takes "cash under the table" is potentially violating the terms of her/his practice.  This voids their malpractice coverage.  It also makes them liable for charges of insurance fraud (a crime) if they charge a different price to their insured patients.  Few physicians will take such a risk. 

Additionally, some procedures are cost prohibitive for all but the uber wealthy.

If this bill makes in into law, it will be a disaster for trans folk.

[HappyMoni]

From what I am hearing on TV, this action massively cuts Medicaid  at the same time giving a massive tax cut for the very rich. Trans people will be hurt for sure. People will die because of this change.

[Zumbagirl]

I do.

A physician who takes "cash under the table" is potentially violating the terms of her/his practice.  This voids their malpractice coverage.  It also makes them liable for charges of insurance fraud (a crime) if they charge a different price to their insured patients.  Few physicians will take such a risk. 

Additionally, some procedures are cost prohibitive for all but the uber wealthy.

If this bill makes in into law, it will be a disaster for trans folk.

I transitioned in the days when there was zero coverage. All medical plans had a TS exclusion and yet somehow through it all, I managed to do what I set out to do. If someone wants to do something bad enough they will move mountains. I know a woman who lived in someone's garage because she wanted to get Dr O for FFS surgery, and she did it. She's living a pretty good life now.

I don't know where you are getting your information from but let me tell you this, first hand. I went for years, showed up at my endo and said I would pay for my visit in cash. He'd charge me $120. He generally wanted blood work done, so I would go to the closest hospital and say I didn't have insurance (which was technically a lie, since I did, but was excluded) and said I would pay cash right there. Surprisingly the $300 worth of blood work suddenly cost $80. Total cost for me to see my endo every year $200. My hormones which I still to this day pay out of my own pocket cost me more than that every year. I did that same thing year after year after year. To this day very few people know I take hormones.

When I went through the therapy part of my transition, my shrink wanted to see me every week for my 1 year of RLE. It sucks because the first few visits were covered and all the rest? I had to pay for. It was the price I paid for the surgery letters. Once I had the stupid letters I was done with ole Harry Benjamin and his standards.

[rmaddy]

A return to the situation where transgender people must pay out of pocket for procedures, medications and counseling cannot possibly be a good change, or even a neutral one.  This is why I care that transgender health be covered, and why many others do as well.  Without coverage:

1.  Transition is delayed as people have to save up tens of thousands of dollars.
2.  Corners are cut on what care is received.  Those who are saving every penny for surgery may skip counseling which may help them choose and/or prepare for the surgeries which are right for them.
3.  There is increased pressure to get procedures done abroad.  While overseas procedures are an option, they leave the patient with subsequent post-operative complications in a really bad position.
4.  Some trans people may turn to sex work to get the cash necessary for transition.  Read Janet Mock's memoir for a compelling account of this.

I concede that it is possible that you don't personally care about the changes, but I think you'll find that many other trans people are quite concerned.

[RobynD]

Let's hope the pressure of the legislative recess and the people understanding what a robbery this is will make this plan either dead in the Senate or highly modified. Heck all most really want is the former President's name off it and they are the ones that branded the ACA that in the first place.

As far pre-existing conditions, going back to the days where you had to pay ALOT more for coverage or you were given conditional coverage would be horrible.

Did anyone notice that the good representatives exempted their own health coverage from these terms? You couldn't make this stuff up if you tried.

Some states such as my own Oregon, require coverage of gender dysphoria by law for insurance to do business in the state and most insurance companies just quietly accept that. The state medicare/medicaid system which currently covers about 40% of the population requires coverage. Some services are rationed i believe or just subject to availability of resources i think. I recently heard that GCS surgeries are about a 18 month waiting period for one practice. Being made to wait is a lot more humane than denial.

We need single payer healthcare with humane and universal coverage for all.

[silliemunkie]

Not including transgender care, there are still other conditions listed that would exclude me from coverage. Nothing good is going to come of this, and in the end we are going to pay more for less care. It's sad that our government cannot follow the example of other countries, and get a working healthcare system. Until they are forced to use the same system as the rest of us, nothing will change.

[Georgette]

I don't fully share Zumbagirl's attitude.

Like Zumbagirl, I transitioned in the days before any coverage for TS (1974-77).  Had to save for some years prior.  I had no BA or FFS (only nose and Adam's apple available back then).
All doctors (psychiatrist and surgeons and hospital) and HRT were my costs.  After SRS was able to get doctors and HRT covered, as was then a legal female.

Most of those procedures are somewhat comparable to costs now, after inflation.

Not a big fan of Obamacare, but I agree that this new alternative is crazy and may jeopardize people's health.
Yes it would be nice to have all kinds of conditions covered, but someone has to pay the costs.

I am retired and on Medicare, and the costs just for Medicare coverage just keeps going up.  And it doesn't cover everything.

I don't think the Congress or Senate members coverage was tied to Obamacare.  Theirs was paid from a Health plan covered by their employer (US Fed), just like most all Federal employees.
It is their workers that is being excluded.

[Zumbagirl]

A return to the situation where transgender people must pay out of pocket for procedures, medications and counseling cannot possibly be a good change, or even a neutral one.  This is why I care that transgender health be covered, and why many others do as well.  Without coverage:

1.  Transition is delayed as people have to save up tens of thousands of dollars.
2.  Corners are cut on what care is received.  Those who are saving every penny for surgery may skip counseling which may help them choose and/or prepare for the surgeries which are right for them.
3.  There is increased pressure to get procedures done abroad.  While overseas procedures are an option, they leave the patient with subsequent post-operative complications in a really bad position.
4.  Some trans people may turn to sex work to get the cash necessary for transition.  Read Janet Mock's memoir for a compelling account of this.

I concede that it is possible that you don't personally care about the changes, but I think you'll find that many other trans people are quite concerned.

I guess my point is, if you're counting on something being there and it isn't then what is your plan B going to be? This is an expensive life altering process to undertake and operating under the 'hope and dreams' that insurance will be like free money to pay for it all, is like lighting a worn down candle and hoping you don't get burned. I personally believe that a good sized portion of the "community" operates under the snow white mentality waiting to be rescued, be it insurance or a boy friend with deep pockets.

I transitioned in the days when there was nothing, no job protections, nothing at all. I walked into my employer and told them of my transition and was fired and walked out of the building (straight up truth). Yet, despite the setbacks I am still here and it made me a stronger person with even more resolve.

There is always going to be a downside to being a transgender person and a check from the insurance company isn't going to fix that.

[EmilyRyan]

Sometimes a plan B-Z doesn't exist what do you do then??

[SophieD]

I don't think it is a "snow white mentality" to expect inclusion of transgender medical care in health insurance.  If it is, bring in Grumpy, Doc and Sleepy, and about that apple the House just passed - thanks very much, but no thank you.

[Deborah]

If this shouldn't be included then every condition that people bring upon themselves should also be excluded.  So, no medical care for diabetics who eat crap.  None for cancer patients who ever smoked. Let overweight heart disease victims suffer and no meds for high blood pressure for anyone that doesn't exercise.  And let's not forget to ban treatment for any congenital condition since God doesn't make mistakes.  That ought to make insurance a lot cheaper for the healthy people and save a ton of money for tax breaks for the wealthy.  It's the conservative way.


Conform and be dull. —James Frank Dobie, The Voice of the Coyote

[Zumbagirl]

Sometimes a plan B-Z doesn't exist what do you do then??

You should always have a plan B going through a gender transition.

[Michelle_P]

I guess my point is, if you're counting on something being there and it isn't then what is your plan B going to be? This is an expensive life altering process to undertake and operating under the 'hope and dreams' that insurance will be like free money to pay for it all, is like lighting a worn down candle and hoping you don't get burned. I personally believe that a good sized portion of the "community" operates under the snow white mentality waiting to be rescued, be it insurance or a boy friend with deep pockets.

My budget includes a non-recurring expense reserve intended to cover FFS, GRS, and a nice two month vacation in Thailand for myself and a friend.

This may not be practical for everyone.

Transgender youth now have the opportunity to grow up in their true gender as they identify, and be assisted in growing into themselves without going through decades of soul-crushing dysphoria and all that comes from it, anxiety, depression, increased risk of suicide and substance abuse.

Telling them to come up with a few hundred thousand to take care of themselves very likely will mean that they will have to endure some of the dysphoria that we old transitioners did.  That's a pretty cruel thing to do, snatch away their hope because we want to pretend the care will cost too much, while spending more than that to cover liver transplants for cirrhosis patients and heart surgery for sedentary morbidly obese patients.  Gosh, it is almost like someone made a moral judgement over who is worthy of medical care and who is not.

We could achieve a larger savings by simply denying coverage for conditions that resulted from actual poor choices made voluntarily by patients.  You know, the rationale used for denying care to transgender patients by those who insist that being trans is a lifestyle choice.

It disgusts me.

And the larger goal is obviously not improved medical care or better coverage.   It is tax relief for folks with over $250,000 annually in capital gains.  It is a break for insurers who want larger profit margins and want to reduce their 'losses' (claims paid are losses).

Don't pull my leg telling me we can't afford better medical care.  I know the numbers.  I have an excellent understanding of medical markets and pricing worldwide.  I know what is possible, and what is political talking points.

[Brooke]

Well, as someone born with cerebral palsy, and stroke. I can definitely attest to the pre-existing conditions being unfair for the disenfranchised. My parents were both self employed, no access to employees based health insurance.

When I was 15 I started having seizures, whoops that's another no-no.  I don't think every person in every walk of life should need to have a plan B.

In the end- I just wish that coverage determination was based on medical necessity between the patient and their provider. I would love a healthcare system who's primary coverage was not tied to an employer. I think it's really this aspect that screws people over. If your employer doesn't provide coverage for whatever reason, your self employed, disabled, working multiple part time jobs, contract employee etc- you're screwed as it is to get a cost effective insurance plan. If you happen to be born or become disabled mid career, you're stuck on state/federal medical insurance.

As for lowering costs. Health insurance works by pooling healthy people with some sick people. You can either have cheaper coverage or better access to coverage. Not both. Not in the states.

/end-late-night-rant

Calling the WHAAAAmbulance now- XD


~Brooke~

[SophieD]

In the end- I just wish that coverage determination was based on medical necessity between the patient and their provider. I would love a healthcare system who's primary coverage was not tied to an employer. I think it's really this aspect that screws people over.

I'm noticing that even Republican figures (e.g., Charles Krauthammer) are seeing an inevitable trend toward a single payer health care system.  Maybe the current mess will get sorted out in a way that improves our system after all, once (or if?) we get through this ugly period of political reaction and grudge-settling.

[AnneK]

As for lowering costs. Health insurance works by pooling healthy people with some sick people. You can either have cheaper coverage or better access to coverage. Not both. Not in the states.

In Canada, we have health insurance that's paid for with tax dollars.  In Ontario, we used to pay premiums, either directly, by employers or both.  However, several years ago, those premiums were discontinued, with health care paid for entirely out of taxes.  Many have complained about the large amount going to pay for it.  There might be a better way.  We also have something here called "non-refundable tax credits", where everyone is given a tax credit for something, but as your income increases, that credit is gradually consumed, until high income earners have exhausted those credits.  This system provides maximum benefit to low income earners, compared to tax deductions, which benefit the higher earners.  So, if that system was used to cover the premiums, low income people would get free health care and those earning more would cover more of the premiums, some higher income earners paying the full amount of the premiums.  This system would provide health care for all and reduce the load on taxes in general.

[Barb99]

What we need is a single payer system run by a non profit entity (maybe the government maybe not). The system we have now, with hundreds of for profit insurance companies, hundreds of CEO's, thousands of VP's and who knows how many share holders, all making a profit and pulling money out of the system will never be able to provide fair and affordable health care to anyone let alone everyone. Our system is setup to make money, not to provide the best health care.