Apr 1 2013

Missing the Bigger Picture on Transgender Healthcare

When appropriate care depends on your school or job

The New York Times (2/13/13) reported that in the last few years, several elite U.S. universities have begun to cover sex reassignment surgery and/or hormones for trans-gender students.

On the one hand, it’s great that they’re reporting news like this. After years of extremely disrespectful coverage of transgender issues (Extra!, 11/07), it feels like a victory that the story’s “balance” is limited to noting that “the idea still seems radical to plenty of people.” On the other hand, not a single trans-identified person is quoted.

But what is most striking about this kind of article is how it utterly fails to connect some really big dots, leaving readers with a very narrow picture of reality. 

This story as framed by the Times is, of course, extremely important to the students who will take advantage of these 61 universities’ policy changes (a population that, the Times emphasized, is “tiny”). The paper told readers that the bigger story behind the shift is that such coverage “sends a signal to the much larger number of students for whom the rights of transgender people have taken a place alongside gay rights as a cause that matters.” And the paper points out that universities “may be lagging behind the corporate world,” where a quarter of Fortune 500 companies cover sex reassignment surgery.

No doubt that’s all true enough. But the bigger-picture story that the Times obscured is about how economic disparities get magnified in our society: Only those transgender youth privileged enough to get into one of these big-name, four-year universities like Stanford, Brown and the University of California system will have access to full health coverage that will enable them to align their gender presentation with their gender identity —which can have important reverberations down the line for their job and life prospects.

Transgender people and allies fight for healthcare for everyone, not just university students. (photo crediit: Liz Highleyman)

Transgender people and allies fight for healthcare for everyone, not just university students. (photo credit: Liz Highleyman)

But most will never get there, given the discrimination young transgender people face and their resulting disproportionate rates of poverty, homelessness and dropout rates (Sylvia Rivera Law Project, 8/12). (Interestingly, the Times noted that only 20 of these universities also cover such healthcare for their employees; the remaining 41 apparently aren’t as concerned about the signal they’re sending to potential hires.)

Not all transgender people want to take hormones or undergo surgery, but for many it is a medical necessity—something both the American Medical Association and the American Psychiatric Association have recognized. Access to such healthcare improves their mental health while decreasing substance abuse (SRLP, 2011). It typically makes it easier for them to get ID that reflects their gender identity (Seattle Journal for Social Justice, 2010), which in turn helps them get and keep jobs and avoid harassment; trans people who don’t “pass” are more vulnerable to employment discrimination, which is still legal in many parts of the country (National Center for Transgender Equality, 2012).

Without access to appropriate healthcare, many trans people go into debt or criminalized activities like sex work in order to access hormones or surgery (Seattle Journal for Social Justice, 2010), and self-administer hormones and silicone, which can put them at increased risk of HIV, hepatitis, liver problems and other serious health complications (SRLP, 2011).

The real story here is that so many transgender people—those with-out access to elite higher education or certain Fortune 500 jobs—face serious healthcare discrimination that puts them at an even greater disadvantage than they already face. If we had a single-payer healthcare system, where your health insurance didn’t depend on where you go to school or whether you have a certain kind of job, it would still be a struggle to get these things covered, no doubt. But it would be one unified struggle, instead of thousands of disparate ones.

And it would mean those economic and health disparities wouldn’t be exacerbated. That’s a story that is extremely important not just to the transgender students at elite universities, but to all transgender people in this country.

But don’t hold your breath waiting for the New York Times to provide that kind of analysis.