Barriers to healthcare in the U.S. for transgender individuals
Discrimination within the healthcare system affects many marginalized communities. People who identify as LGBTQIA+, historically and currently experience challenges with accessing and receiving appropriate care, particularly individuals who identify as non-binary or transgender. Commonly reported issues from people who identify as transgender, when seeking or receiving care, include verbal harassment or refusal of treatment because of their gender identity.
Challenges, Care, and Cultural Competency
It is reported that transgender individuals struggle with receiving transitioning healthcare services, as well as primary care. They also experience a high prevalence of mental health conditions, victimization and suicide rates. Transgender individuals also encounter higher rates of discrimination from providers and are often denied access to transition care. Along with being denied access to care, transgender individuals are less likely to have health insurance, but even those with insurance face challenges with coverage for transition-related care and routine care. Unfortunately, there is proposed legislation at the state level that hinders or prevents transgender individuals from receiving adequate healthcare.
Legislators in states have been sponsoring legislation that would allow healthcare providers to deny care to LGBTQIA+ patients. Legislation in Illinois, Ohio, Arkansas, Mississippi, Alabama, and Tennessee allows providers to deny care based on religious exemptions. Twelve states exclude transition care from state employee health benefits, ten states explicitly exclude care for transgender people by the state’s Medicaid program, Arkansas has a ban on medical care for transgender youth and allows insurers to refuse transition-related care.
Despite attempts to limit or deny care in certain regions, there are parts of the country that have enacted legal protections for LGBTQIA+ patients. The District of Columbia requires healthcare providers to complete cultural competency training about LGBTQ health. A minimum of 2 hours of LGBTQ cultural competency training is required in order for providers to renew their license. This training highlights appropriate terminology, risk factors for patients who identify as LGBTQ, and addresses underlying cultural biases. Whitman-Walker, a D.C. based federally qualified health center is one resource that offers this training to providers to meet their licensing requirement.
The lack of healthcare services received by transgender people and their heightened risk for various health conditions leads to poorer health outcomes for this population. However, organizations across the U.S. have created resources to provide guidance on where to access appropriate, timely, and compassionate care. Whitman-Walker provides health care services to LGBTQIA+ individuals, as well as conducting research and advocating for health equity. The Fenway Institute focuses on research, training, advocacy, and policy development. They also house the National LGBTQIA+ Health Education Center which provides cultural competency training. In addition, CenterLink, a member-based coalition, provides a directory of local resources and community centers that offer healthcare services, counseling and support groups to LGBTQIA+ individuals. The support and resources provided by the aforementioned organizations allows for more people to receive appropriate and respectful health care. However, these organizations can be expanded on as the need for accessible care remains crucial for members of the transgender community.