Why Transgender Health Care Needs Are Not A Laughing Matter

In a recent opinion piece for the New York Times, Lori Gottlieb — a self-confessed Obamacare skeptic — expresses her dismay about the Affordable Care Act by joking that under the law, while she can’t stay with the doctor she likes, “if I need a sex change operation, I’d be covered.” She does admit to feeling squeamish about making jokes at the expense of people dealing with cancer, but “sex changes” are nothing but a laugh.

Any humor that trades off the experiences of people grappling with serious health challenges is likely to be in pretty bad taste. But jokes that encourage casual disregard for transgender people by reducing their real health care needs to a cheap punch line, especially just a few days before the Transgender Day of Remembrance, are very poor taste indeed.

The Transgender Day of Remembrance, which falls on November 20, is an annual observance when we commemorate the hundreds of transgender people who are murdered every year. As the transgender scholar Susan Stryker puts it, people frequently have difficulty recognizing the humanity of another person if they cannot understand that person’s gender, and transgender people across the United States and around the world consequently encounter extreme prejudice, harassment, and even murderous violence based simply on who they are.


The patterns of anti-transgender discrimination and violence are not random. The overwhelming majority of the lost transgender lives honored on the Day of Remembrance are transgender women of color. Some were immigrants or asylum seekers. Most struggled to make a living with few protections against being the last hired and the first fired. Many were attacked on the street for the so-called crime of “walking while trans.”

In addition to violence, transgender people routinely confront discrimination in areas of everyday life such as health care, housing, employment, and education. Anti-transgender discrimination in health care is particularly cruel, since many transgender people need health care services such as hormone therapy to live authentic lives. In fact, few things put transgender people at more risk of violence in their everyday lives than the inability to get the health care services they need to fully embody their true selves and to be recognized by others as the gender they know they are inside.

Even while seeking the same basic health care that anyone might need to fix a broken bone or treat the flu, transgender people frequently encounter biased and inadequate treatment from health care providers and denials of financial support from health insurance companies — if they’re lucky enough to have insurance coverage at all.

Unlike the California Anthem Blue Cross plan that Ms. Gottlieb cites, the vast majority of insurance plans in the United States specifically avoid insuring transgender people and exclude coverage for the health care services that transgender people need, even when those services are covered for other subscribers, like mammograms and prostate exams.

Fortunately, advocates are working in states across the country, including California, to remove transgender exclusions from health insurance plans. These efforts dovetail with the reforms that the Affordable Care Act introduces to eliminate the worst abuses of insurers and open access to higher-quality coverage for millions of uninsured and underinsured Americans.


Transgender people are real people with legitimate health care needs — not the punchline to a joke. People should feel free to argue about the merits of the Affordable Care Act, but demeaning transgender people as a cheap attempt to critique the law does nothing to move the conversation forward about how to ensure that health reform actually works for the people who need it most.