In 2015 and 2016, new anti-discrimination federal rules required insurance plans to cover preventive services for transgender and gender non-conforming youth, in addition to prohibiting plans from denying insurance and service coverage for transgender youth. The expansion and victories for transgender-based rights during this period were momentous, however recent national discussion to remove the anti-discrimination laws is worrisome.
The number of transgender children and youth is rising, as seen by the increase in individuals seeking care for gender dysphoria. Gender dysphoria is defined by the American Psychiatric Association as “a conflict between a person’s physical or assigned gender and the gender with which he/she/they identify,” which can often lead to feelings of strong discomfort and distress. Gender nonconformity (or gender expansiveness) is not the same thing as gender dysphoria, as gender nonconformity relates to “behaviors not matching the gender norms” of an individual’s gender assigned at birth.
Research shows how transgender-based youth are high at risk for self-harm, depression, anxiety, substance abuse, and other mental-health concerns, with many also facing harassment and discrimination in every-day life. Utilizing gender-affirming healthcare such as hormone therapy, puberty-blockers, or gender-reassignment surgery can minimize the challenges many children, youth, and adults face, providing a better quality of life. This fact is what makes recent policy shifts more troubling.
NPR recently featured an article about one particular youth who initially lost coverage for a gender-reassignment operation in Wisconsin, when the state’s Group Insurance Board voted to “exclude coverage for gender reassignment or sexual transformation” for state employees. The decision came during the recent national rhetoric of many socially conservative politicians calling the 2016 anti-discrimination rule “unlawful”. Although the youth was ultimately able to get her surgery by striking a deal with her hospital to pay about $20,000 upfront, many people may not be able to afford this privilege. There are more stories out there of children and youth facing difficulty with transgender-based insurance coverage and experiences in the healthcare setting. It is imperative that policymakers and local and national officials realize the negative consequences of discriminatory national discourse and policy changes for the mental, social, and physical health and wellbeing of transgender-based children and youth.