Berks County Medical Society Medical Record Fall 2017 - 13

I spoke to the Physician General of Pennsylvania, Dr. Rachel
Levine, about this issue. As a physician and as a transgender woman
she had a wealth of insight on the issue of transgender healthcare.
She categorizes transgender health into two spheres: specialty care
and primary care. Specialty care consists of a person's psychological
care, their transitional medical care, and surgical care. Until quite
recently, the nearest provider for specialty care for transgender
people in Berks County was the Mazzoni Center in Philadelphia, an
institution that has been providing healthcare to the LGBT (lesbian,
gay, bisexual, transgender) community since 1979. Recently, though,
the Reading Health System's Women's Health Center has opened a
clinic for transgender health care under the direction of Dr. Mark
Woodland.
The issues with primary care, Dr. Levine asserts, are more to
do with the personal biases of physicians. Primary and emergency
health care is widely available, but it can be difficult for a transgender
person to find doctors who will not turn them away. There are
instances of transgender patients being turned out of Emergency
Departments for their gender identity. Primary care physicians will
refuse treatment to transgender patients for many reasons, ranging
from disapproval of the person's gender identity, or because they
feel taking care of a transgender person is beyond their capabilities.
Not every medical need of a transgender person requires a specialist
in transgender health. Every doctor does not need to be an expert
in transgender health, but primary care physicians should have
enough knowledge to take care of the basic, day-to-day needs of their
transgender patients.
Putting laws in place to protect people makes it easier for them
to exist freely and without fear. Laws also validate communities of
people who have been historically marginalized and asserts their
right to exist as who they are in public spheres. It is important for
legislation to affirm transgender people as citizens who deserve to be
protected and cared for just as much as non-transgender people.
The Affordable Care Act has been the champion for transgender
health care rights on a federal level. However, there is a possibility
for change on that front. The Trump administration has announced
that it is planning to roll back an important ruling regarding Section
1557 of the Affordable Care Act, which protects transgender people
from discrimination in health care and insurance coverage. In
2016, the Department of Health and Human Services adopted a
rule clarifying that when Section 1557 prohibits sex discrimination
in health care, this includes anti-transgender discrimination. Also,
the Republican Healthcare proposals would result in skyrocketing
insurance premiums for people with higher health needs in states
that would allow stripped down policies to be sold. Transgender
people would be included in a higher risk pool and as a result,
insurance would become unaffordable for many.
Public policy on insurance coverage for mental health care
is also an issue that disproportionately affects the transgender
community. In the United States Transgender Survey, thirty-nine
percent of respondents experienced serious psychological distress in
the month before completing the survey, based on the Kessler Six
Psychological Distress Scale, compared with only five percent of the
U.S. population at large. Forty percent of transgender people have
attempted suicide at some point in their lifetime, which is nearly
nine times the rate in the U.S. population. In just the past year,
seven percent have attempted suicide - nearly twelve times the rate

of the U.S. population. The increased rate of mental illness in the
transgender community is often a result of constant discrimination
and violence motivated by bias. Many transgender individuals
require medication for mental illnesses. The ACA includes
mental health as an essential benefit that must be covered under
all insurance products. However, under the current Republican
replacement proposals, states would be able to apply for waivers to
remove mental health as an essential benefit. In such states, policies
that would include mental health coverage would be much more
expensive than under the ACA. An increase in the cost of mental
health coverage would disproportionately affect the transgender
community because twenty-nine percent of transgender people
are living in poverty, as opposed to fourteen percent in the U.S. at
large.
Despite recent progress, the transgender community still faces
many barriers in their quest for respectful and comprehensive
healthcare. There is relatively little any single person can do
about the scarcity of specialist care or difficulty with insurance
companies, but one thing anyone can do is to educate themselves.
The education that healthcare providers receive often does not fully
equip them to meet the needs of and interact respectfully with their
transgender patients. Currently, there is no standard curriculum on
transgender medical care included in undergraduate medical schools
or residency programs, though there are several schools striving
to develop one, such as the Perelman School of Medicine and the
Temple University School of Medicine.
continued on next page >

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Berks County Medical Society Medical Record Fall 2017

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