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Notes

In 2011, the National Gay and Lesbian Task Force and the National Center for Transgender Equality published the National Transgender Discrimination Survey. The survey's findings highlight the discrimination transgender and gender non-conforming people are facing in all aspects of their daily lives, including in medical and health care settings. The survey reported that 19% of respondents stated that they had been refused healthcare by a doctor or other provider because they identified as transgender or gender non-conforming. Trans people of color were more likely to have been refused healthcare. The survey found that 36% of American Indian and 27% of multi-racial respondents had been refused healthcare, compared to 17% of white respondents. In addition, the survey found that 28% said they had been verbally harassed in a healthcare setting and 2% of respondents reported being physically attacked in a doctor's office. Transgender people particularly vulnerable to being assaulted in a doctor's office were those who identify as African-Americans (6%), those who engaged in sex work, drug sales or other underground work (6%), those who transitioned before they were 18 (5%), and those who identified as undocumented or non-citizens (4%).

Although they are not the only uninsured population in the U.S., transgender people are less likely than cisgender people to have access to health insurance. The National Transgender Discrimination Survey reported that 19% of survey respondents stated that they had no health insurance compared to 15% of the general population. They were also less likely to be insured by an employer. Undocumented non-citizens had particularly high rates of non-coverage (36%) as well as African-Americans (31%), compared to white respondents (17%).

While a majority of U.S. insurance policies expressly exclude coverage for transgender care, regulations are shifting in favor of expanded coverage of transgender care. A number of private insurance carriers cover transgender-related health care under the rubric of “transgender services,” “medical and surgical treatment of gender identity disorder,” and “gender reassignment surgery.” Nine states (California, Colorado, Connecticut, Illinois, Massachusetts, New York, Oregon, Vermont, and Washington) and the District of Colombia require that most private insurance plans cover medically necessary health care for transgender patients.

Access to public health care is also shifting. Medicaid leaves the regulation of the coverage of gender-confirming health care up to each state. While forty states do not fund sex reassignment surgery through Medicaid, several, like New York and Oregon now require Medicaid to cover (most) transgender care.