Pondering HB2: Bathrooms Important, Healthcare Essential

By Elizabeth Kunreuther, MSW, LCSWA

Credit: Liz Highleyman via Flickr (used with permission)

OccuPride, San Francisco, 6/24/12

Credit: Liz Highleyman via Flickr (used with permission)

NC House Bill 2 has raised quite a commotion and well it should. It blatantly discriminates and is a desperate reaction to the increased level of acceptance that the rest of our state and the country have adopted.

Yet I can’t help but wonder if this bill is simply a distraction. When I step back, it seems HB2 could be a ploy to keep us focused on bathrooms rather than other and potentially more egregious though less overtly visual forms of discrimination. For instance, why didn’t we all rally, boycott, mail letters and storm the legislature when our Governor decided not to expand Medicaid? Medicaid expansion would not only have significantly improved the lives of transgender individuals but also countless other disenfranchised members of our state denied the right to basic healthcare services.

How could Medicaid expansion impact the transgender community? As many of us already know, The Kaiser family foundation found that sexual and gender minorities experience worse physical and mental health outcomes compared to their heterosexual and non-transgender counterparts. A 2015 KFF report states:

The transgender population is much more likely to live in poverty and less likely to have health insurance than the general population. Research reflects the impact of these barriers. In one survey of transgender individuals, nearly half (48%) of respondents postponed or went without care when they were sick because they could not afford it. In addition, many health plans include transgender-specific exclusions that deny transgender individuals coverage of services provided to non-transgender individuals, such as surgical treatment related to gender transition, mental health services, and hormone therapy.

If Medicaid had been expanded, individuals who identify as transgender would have access to basic health care and treatment—access that would not only significantly improve their lives but, by enabling them to access healthcare, would give the medical community the opportunity to get to know this misunderstood and mistreated population. As Gary Gates, an expert on transgender policy from the Williams Institute notes: “We see health disparities and socioeconomic disparities that are likely related to stigma and discrimination…” More access to healthcare could lead to de-stigmatization.

The health statistics for the transgender population are shocking. According to the CDC, approximately 1 in 4 transgender women is HIV positive. Transgender people, particularly transgender women and transgender people of color, are at a high risk for physical violence. A nationwide study found a reported 41% prevalence of suicide attempts among the transgender population. Expanding Medicaid would offer HIV and mental health treatments as well as services specific to the transgender population such as hormone therapy.

Though having access to the appropriate bathroom is indeed important, allowing transgender individuals access to healthcare should be a rallying cry too. Up to 39% of transgender people have faced some type of harassment or discrimination when seeking routine health care, and many report being denied care outright or encountering violence in health care settings. Allowing access not just to a restroom of choice but to a hospital or doctor or clinic of choice can save lives as well as erase stigma.

Elizabeth is a LCSWA working for the Carolina Institute for Developmental Disabilities' research registries.


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