The Affordable Care Act said that federally funded health care could not discriminate on the basis of sex. More recent federal and state regulations made it clear this included transgender care. Yet the hope these changes brought has been shaken in recent months.

Between Republican attacks on the ACA, including the Graham-Cassidy bill, and the Trump administration’s avowed plans to gut some gender-discrimination rules, Santos and many other transgender people fear that treatment now considered medically necessary will again slip from their reach.

Santos, who lives on Supplemental Security Income, learned only about a year ago that Medicaid would pay for the surgeries and hormone therapy that could help her to live comfortably in her own body.

“I was flabbergasted,” said Santos, who fears that chance may be gone.

Physicians say they are seeing real anxiety in their transgender patients.

“I think it started literally the day after the [presidential] election,” said Allison Myers, a Penn family-medicine doctor who specializes in care of LGBT patients. “I remember a trans woman in the office quite frankly just distraught over what this meant for her – her access to hormones, her health care in general.”

Since then, Myers has heard from trans patients with many worries. Some have asked if they can get a year’s supply of hormones in case their coverage is yanked. Others ask for help with changing their gender on their passports.

“You can just sense a lot of fear. Fear that their rights are going to be slowly stripped away,” Myers said.

Ivona Percec, associate director for cosmetic surgery at Penn Medicine, says her trans patients are getting more urgent about gender reassignment surgery.

“I think some of them want to get this done as quickly as possible out of fear,” Percec said.

The number of gender reassignment surgeries in recent years has grown substantially, according to the American Society of Plastic Surgeons.

There were more than 3,200 such surgeries in 2016 – a nearly 20 percent spike from the year before. That was also the year of the Obama administration clarification – now under threat – that federally funded health programs must include transgender care. Pennsylvania and New Jersey have both since affirmed trans Medicaid coverage. Medicare, the government health program for seniors and the disabled, also covers trans care.

Many experts say that most trans people do not get surgeries, which are major medical procedures. Even some who could afford surgery decline, doctors say.

For those who want surgery, however, federally guaranteed benefits are the only way they could ever pay for it, or even less invasive treatments. Despite the fanfare of Caitlyn Jenner’s transition, many transgender people have limited incomes due to employment discrimination and other issues.

Read the full article at