On March 18, Palliative Neglect, an interdisciplinary collective that looks at health issues for LGBTQ people, hosted a trans health and healthcare forum at University of Illinois at Chicago's School of Public Health (SPH). The forum was designed to answer the community's questions about the new Affordable Care Act (ACA) and resources. The event was held in conjunction with Pride At Work, SEIU Lavender Caucus, Transgender Law Center, Center for American Progress and the National Center for Transgender Equality.
Panelists included a mix of activists and healthcare professionals. They were Alexis Martinez, of the Trans Oral History Project; Laura Goring, River Rock Therapy; Channyn Parker, Trans Life Center & Chicago House; Dr. Margo Bell, Stroger Hospital; Jen Richards, of We Happy Trans; Lisa Kuhns, Lurie Children's Hospital and UIC SPH and John Peller of AIDS Foundation of Chicago. Rebecca Kling served as the moderator and Hale Thompson, a Ph.D. student in the School of Public Health, delivered introductory remarks.
Thompson spoke about March as a "Transgender Month of Action," an ongoing campaign among labor unions as well as trans and LGBTQ groups designed to bring awareness about healthcare disparities faced by trans people. Health care has historically been complicated for trans people because vital elements of trans health, such as hormone therapy and surgery, are often denied to those who seek them on grounds that they reflect "pre-existing conditions."
Peller spoke at length about the ACA, saying that it meant "good news for trans people," and that it was a "critical step in the right direction for access to healthcare." According to him, two important elements of the ACA were that insurance companies will not be able to ban people because of pre-existing conditions and that people will be able to buy more affordable health insurance.
Kling stopped Peller as he continued to discuss the virtues of the ACA, and asked what she said were the biggest questions for people in the room: Would it provide for surgery and would it provide for hormones? The response from Peller was, "We don't know yet. In most cases, hormones will be covered. Surgery will be a heavier lift." He also added that "the Obama Administration has stated that non-discrimination provisions apply to trans and LGBQ populations."
As the discussion moved to the rest of the panel and opened up to include the many attendees in the room, it became clear that both economic and social issues were pressing matters for many people.
For many, like Richards, simply getting health insurance has been impossible, even after protracted correspondence with providers who eventually told her, "We cannot appropriately price for someone in your condition." Richards said she took that to mean, "We cannot charge you enough money." Alexis Martinez spoke of having difficulty with healthcare even though she has had insurance in nearly all of her workplaces, because of the lack of cultural competency on the part of providers. For instance, her revealing that she is on hormones will lead to doctors insisting that those are the cause of any unrelated medical conditions.
Bell spoke of her work with trans youth of color, and that for them even getting transportation to get to the hospital for hormone therapy can be an economic burden and, as a result, "most youth buy street hormones" and this "can be tough on adolescents' growth and development."
Kuhns spoke of similar issues and talked about ongoing research at Lurie. One study, on more than 100 trans women, showed, among other findings, that 38 percent had no insurance of any kind, 44 percent had no personal doctor, and 37 percent needed to see a doctor in the past 12 months but could not because of the cost.
The relationship between social stigma and health was especially clear for many. Channyn Parker pointed out that providers, social workers, and the community needed to understand what it was like to be trans and even step out of the house to get to an appointment. For someone who does not "pass" according to societal norms, every minute of the trip to a hospital, from taking a bus to sitting in a waiting room clearly designed for cisgender women, means becoming the subject of intrusive stares or harassment.
Goring spoke about how trans patients are not helped even by having insurance because they're faced with a medical field which pathologizes them and sees them incapable of making rational decisions. But, she emphasised, mental health issues for trans people are not the result of their internal problems: "You need therapy because everybody else has issues, but you feel like you have the problem—not because you're trans. You should be able to get care where you're at."
Goring also spoke about how many trans people are subject to the idea that they must conform to binary expectations of gender, and this was echoed amongst several audience members who spoke of the need to acknowledge that "trans" could also mean a more fluid existence, and one not regulated by medical or hormonal therapy. There were also questions about studies on the long-term effects of hormonal and surgical treatments, and on what was being done to ensure better training for medical personnel on cultural competency.
At the time of this writing, the event's Facebook page is still being used as a provisional resource for further questions. See https://www.facebook.com/events/262589797205013.
