New York, along with 23 other states, has announced that it will expand Medicaid, which will greatly widen the number of people eligible for health coverage under the Affordable Care Act.
This expansion, set for implementation in 2014, will now cover people whom insurance companies previously deemed "too sick" or "not sick enough" for coverage, eliminating harmful policies that required "proof of a disability" or an official AIDS and/or HIV diagnosis and an opportunistic infection before being eligible for coverage. According to recent estimates, an additional 811,000 adults will be eligible for Medicaid coverage under New York's expansion.
While this is great news for populations that frequently live on the margins, particularly people living with HIV/AIDS, people of color, homeless people, and those living in poverty, it remains to be seen how this expansion will affect, or include, transgender New Yorkers.
You see, in the state of New York, it is still legal for doctors or hospitals to refuse medical treatment to someone because of their gender identity or expression. That's right: A doctor can refuse to administer life-saving services because he or she does not want to treat a transgender or gender-nonconforming person. Unfortunately, because New York has yet to pass the Gender Expression Non-Discrimination Act (GENDA), transgender and gender-nonconforming individuals have no legal recourse to challenge this outright discrimination.
This denial of medical care because of an individual's gender identity is not only unethical but extremely dangerous. Many transgender individuals have high rates of chronic conditions that require medical attention, and in fact, the transgender population has an HIV/AIDS rate much greater than the cisgender population, which suggests that this population needs medical care just as much as the general population. Yet despite this profound need, transgender individuals face extremely high rates of discrimination in health care settings when they seek treatment.
Not surprisingly, these experiences of discrimination have worked to discourage many transgender individuals from seeking routine or even emergency health care. Indeed, one client in Housing Works' Transgender Evening Program recently told me that her friends would rather fend for themselves than seek professional care at a hospital, because of the name calling, finger pointing, and public humiliation they have faced. As she succinctly stated, "People go to hospitals to heal, not to be hurt."
Interestingly, many of our older clients have noted that these struggles that our transgender clients face in health care settings are eerily similar to the struggles that people with HIV/AIDS experienced during the early years of the AIDS pandemic.
Think about it. During the '80s and into the early '90s, many people living with the disease discovered that doctors and nurses in reputable, metropolitan hospitals refused to treat them, letting fear and misinformation guide their professional choices. In a 1987 New York Times article, one Milwaukee hospital's chief heart surgeon brazenly defended his refusal to treat people with HIV/AIDS by stating, "I've got to be selfish. I've got to think about myself; I've got to think about my family. That responsibility is greater than to the patient."
Thankfully, we all know that such refusals to treat people living with HIV/AIDS have since become illegal, and that by instituting law, it worked to normalized -- and humanize -- the treatment of people living with the disease.
I believe the same must be done to help transgender and gender-nonconforming individuals. By passing GENDA, all hospitals in the state of New York will legally be required to provide medical care for transgender and gender-nonconforming individuals, which would greatly equalize their ability to live healthy and successful lives. With tens of thousands of transgender New Yorkers newly eligible for Medicaid, we must ensure that they are able to access hospitals and are empowered to take control over their health.
I know that GENDA is often perceived as a transgender-only issue, and that there isn't the same community urgency behind GENDA as there was for marriage equality, for instance. But as social justice advocates and activists, we must remember that campaigns, movements, and calls for equality do not -- and should not -- end with identities or our own identifications, however we choose to express, blur, queer, or refuse these demarcations altogether.
Supporting equal access and opportunities for transgender and gender-nonconforming New Yorkers in education, employment, credit, housing, and public accommodations is simply the right thing to do.
This year Housing Works has spearheaded a campaign urging the New York Senate to vote on GENDA in 2013. Please visit the Housing Works passgendanow.org webpage to sign the Change.org petition, share it through your social media networks, and encourage your friends and family to do the same.