Transgender patients worry about HHS push to overturn ACA provision

Among moves designed to reduce "regulatory or economic burdens," HHS Secretary Tom Price seeks to overturn a provision of the ACA that requires Medicaid coverage for transgender care.

A provision of the Affordable Care Act requires Medicaid coverage for transgender care. With the Trump administration working to overturn that rule, transgender patients fear a return to the days of high costs, red tape and hostile treatment.

While congressional efforts to overturn the ACA completely have stalled, a targeted push to overturn a provision requiring states to cover transgender care via Medicaid has come under fire, according to an article in STAT. HHS Secretary Tom Price’s unwillingness to enforce the rule reportedly stems from a desire to reduce “regulatory or economic burdens,” per the article. The administration’s ban on transgender individuals in the military, which rests on similar logic regarding cost of care, has come under fire from groups such as the American Medical Association.

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Transgender patients have taken notice, according to Emmi Monsour, a health plan case manager with L.A. Care, who describes calls from panicked individuals fearful they will lose their insurance benefits. “Their anxiety is at a fever pitch,” she told the publication. That anxiety has translated into an urgency to get care as quickly as possible. The backlog of patients for whom Monsour works currently extends through 2019, per the article.

For those who saw a glimmer of progress in the ACA provision, the potential backslide also brings fears of a general public backlash against trans people, Johanna Olson-Kennedy, M.D., medical director of the Center for Transyouth Health and Development at Children’s Hospital in Los Angeles, told STAT.

That backlash manifests itself in medical settings, as well. Laura Arrowsmith, D.O., a physician based in Tulsa, Oklahoma, describes in Health Affairs being told to “go back to California” when she went to a local emergency center because of a postsurgical complication. Rachel Levine, M.D., Pennsylvania’s physician general, has also described the ways in which transgender patients skip or avoid care out of fear or difficulty in finding a doctor they trust.