Transgender Advocacy for an Inclusive Universal Health Care System
Universal healthcare is a vision for a society where every person has access to the care they need, free from discrimination or financial hardship. Transgender advocacy is central to this vision, not only because transgender people face some of the most severe health disparities, but also because their fight for patient-specific care challenges the healthcare system to become more equitable, evidence-based, and affirming for everyone.
June marks the start of Pride Month in the United States and across the world. Pride Month is a time to celebrate and advocate for LGBTQ+ people across the world and ensure a safer, more just society for LGBTQ+ people in all aspects of life. Pride Month takes its roots from the 1969 New York City Stonewall Uprising where LGBTQ+ advocates, many of whom were black trans women, violently clashed with the police and kicked off the modern LGBTQ+ rights movement. Today, we know the experience of being a non-white, non-gender-conforming person in America challenges the vision of those within the most powerful positions in national government. As we discuss the importance, the attack of, and universal benefits of inclusion of trans healthcare, it is important to think of and advocate for those who are harmed most by a lack of healthcare access.
Why Gender-Affirming Care Matters
Gender-affirming care includes a range of services such as hormone therapy, mental health support, and gender-confirming surgeries. For transgender people, these services are essential. Research shows that gender-affirming care significantly improves mental health outcomes, reduces suicide risk, and enhances quality of life for trans individuals.
In fact, a study published in the American Journal of Public Health emphasized that expanding access to gender-affirming care leads to long-term mental and physical health improvements, particularly when it is integrated into systems of universal healthcare(1). The study found that including such care improves patient coordination and reduces discrimination in health settings. These two outcomes benefit both transgender and cisgender patients alike by promoting respectful, consistent treatment from providers.
The Benefits Go Beyond the Trans Community
When gender-affirming care is included in universal healthcare, the ripple effects benefit all:
● Improved Health System Responsiveness: Integrating the needs of marginalized populations strengthens provider training, care coordination, and trust. These are traits that are essential for any successful healthcare system.
● A More Inclusive Patient Model: Much of the current healthcare data and corresponding healthcare practices were designed with cis-gendered white males in mind. Knowing that only a fraction of the US population make up this demographic, a patient model which takes into account the diversity of gender identities, sexualities, racial and ethnic backgrounds, national origin, religious practices, ability/disability, and socio-economic statuses is desperately needed.
● Cost Efficiency: Early and appropriate care reduces crisis interventions and mental health emergencies, which are both expensive and avoidable.
● Health Equity: Prioritizing care for those historically left out ensures the system works for everyone, not just the majority.
The Danger of Political Interference
Despite overwhelming medical consensus, gender-affirming care remains under political attack. A recent report from the U.S. Department of Health and Human Services under the Trump administration attempted to discredit gender-affirming care by promoting discredited pseudoscience and even suggesting conversion therapy for transgender youth, a practice widely condemned by major medical associations(2).
As journalist and trans advocate Erin Reed reported, the HHS review misrepresented scientific data, used non-medical criteria like “employability” to assess care outcomes, and lacked transparency in authorship and peer review(2). These attacks are an example of cultural politics superseding practiced health strategies with significant health consequences. When ideology overrides science in healthcare policy, everyone loses.
Perhaps most frustrating is the fact that the medical community is unified in support of the care trans people are asking for. Over 30 leading medical organizations, including the American Medical Association, American Academy of Pediatrics, and World Health Organization, have confirmed that gender-affirming care is safe, effective, and often lifesaving(3). These organizations consistently oppose legislation that seeks to ban or restrict access to such care, noting that these efforts are not grounded in science and put patients’ well-being at risk.
Oregon’s Inclusive Approach
Through the Oregon Health Plan (OHP), the state offers one of the most comprehensive Medicaid programs for transgender and gender-diverse individuals in the country.
As of January 2024, OHP covers a wide range of gender-affirming services deemed medically necessary under the World Professional Association for Transgender Health’s Standards of Care4. These include hormone therapy, mental health support, speech therapy, hair removal, voice surgery, facial reconstruction, chest surgeries, and more(4).
Importantly, this coverage is available to all OHP members, including trans women, trans men, nonbinary, and two-spirit individuals. The program explicitly aims to remove barriers to care and protect against discrimination in treatment access. Complementing this, Oregon’s House Bill 2002 ensures that no health insurer operating in the state may deny coverage for medically necessary gender-affirming care or misclassify it as “cosmetic.”(5)
Oregon’s approach offers a clear model for how other states can successfully integrate gender-affirming care into public health programs. It illustrates that inclusive care not only meets the specific needs of trans individuals but also promotes a stronger, more just health system for all.
If universal healthcare is to live up to its name, it must include care for all people, including transgender individuals. Access to gender-affirming care could be seen as a test for whether a system truly serves the people. The inclusion of this care strengthens healthcare for everyone by demanding a more just, compassionate, and scientifically sound foundation.
The push for universal healthcare and transgender rights are not separate struggles. When we support the right to gender-affirming care, we’re fighting for a healthcare system that serves us all.
Achieving Health Equity for Transgender People Through Universal Health Coverage. https://doi.org/10.2105/AJPH.2023.307523
Fact Check: Trump's HHS Review On Trans Care Filled With Pseudoscience, Pushes Conversion Therapy https://www.erininthemorning.com/p/fact-check-trumps-hhs-review-on-trans
Medical Association Statements in Support of Health Care for Transgender People and Youth. https://glaad.org/medical-association-statements-supporting-trans-youth-healthcare-and-against-discriminatory/
Gender-Affirming Care and OHP. https://www.oregon.gov/oha/HSD/OHP/Pages/gender-affirming-care.aspx
Gender-Affirming Care Protections under HB 2002. https://dfr.oregon.gov/insure/health/pages/gender-affirming-care.aspx