As the nation deals with the fallout of losing Roe, many folks are discussing what can be done in order to keep abortions safe and accessible. This often includes making sure people seeking abortions are able to cross state lines in order to get the care they need. A number of companies have come forward and pledged to cover travel for employees who seek abortions but can’t access the care within their home states. This point itself is pretty nuanced (one’s employer shouldn’t need to know you’re getting an abortion, for example) but also opens up a point often overlooked in mainstream media: Trans folks are facing similar challenges in accessing gender-affirming care, too.
For example, in a recent study published in JAMA Surgery, as highlighted over at them, 49% of trans patients who received genital gender-affirming surgeries traveled outside of their home states in order to receive the care. In this study, surgeries include vaginoplasties and phalloplasties.
According to this data, people didn’t only have to travel far for the care they needed—they also had to cough up a lot more money.
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Oregon Health and Science University researchers gathered data from 771 openly trans patients. They found that patients who had to leave their states to access said surgery ended up paying close to 50% more in out-of-pocket costs. In-state patients paid around $1,800 out-of-pocket, and out-of-state patients averaged out at close to $2,650. These costs refer to expenses the patients submitted to their insurance providers for reimbursements. It includes private insurers, but not Medicaid or Medicare.
“We already knew that traveling for health care requires patients to take time off work and pay for travel and lodging on their own,” explained researcher Jae Downing, Ph.D., in a press release. “And that it can make receiving follow-up care from qualified providers who are familiar with each patient’s unique needs challenging.”
What’s new about this data, according to Downing, is we can plainly see traveling out of one’s state considerably increases out-of-pocket costs, even though the cost of the surgery itself is roughly the same.
Researchers found that patients who live in the South travel out of state in pursuit of gender-affirming care more often than patients who live in other parts of the country. Patients who live in the West are one-third less likely to leave their home state in pursuit of care than their peers in the South, for example.
Study researchers note that there were about 1,800 gender-affirming genital surgeries covered by commercial health insurance providers in 2019. Put another way, that’s about 1 in 100,000 patients.
Trans folks face an incredible number of barriers when it comes to accessing safe, affordable, and age-appropriate gender-affirming health care. Trans folks report facing discrimination in health care settings in general, including having to educate providers on their gender identity. Thanks to Republicans pushing vicious anti-trans health care bills, it’s only getting harder for people to access the life-saving care they need.
Restrictive anti-trans measures pushed by conservatives are likely to impact trans people differently. For example, a white trans person seeking medical care might have a more positive experience than a trans person of color, as the white person isn’t going to be impacted by racism or racial micro aggressions.
In terms of traveling outside of one’s state for care, low-income trans folks may face the most significant barrier, as travel, lodging, and time off work may be harder, if not impossible, to manage. Trans people who are parents may face additional obstacles in terms of finding child care. And given that we’re still in a global pandemic, trans folks with chronic illnesses or certain disabilities might have to choose between traveling for gender-affirming care and staying home where it might be safer to avoid getting COVID-19.
It’s also important to point out that we also need more physicians (and in this case, surgeons, specifically) who are qualified to do this kind of work. This means not only educating doctors on trans issues and trans inclusion but also working to make medical school (and the subsequent training) inclusive and accessible for diverse populations, including trans folks.
Everyone deserves safe, affordable, and accessible health care. We can’t leave trans folks behind when it comes to necessary, life-saving care.