Here's What Imperiled Trans Health Care Looks Like

Transgender Americans’ access to health care is being jeopardized by the current presidency—but, today, an NPR article shows just what that looks like.

Wren Vetens was about to start her Ph.D. program at at the University of Wisconsin, and was eyeing a reputable doctor’s waitlist in the summer of 2016. State officials had just decided to allow transgender public employees, including graduate students working as teaching assistants like herself, to obtain coverage for hormone therapy and surgery. (Not out of the goodness of their hearts, mind you, but rather to adhere to the Obama administration’s rule barring health care providers from gender-based discrimination.) Vetens hoped to have gender confirmation surgery as soon as the summer of 2017.

Then Trump happened. As NPR reports:

… policy took a U-turn, changing the landscape for trans Americans. A new group of socially conservative government officials peeled back several new protections one by one, with legal challenges and non-enforcement. The Obama administration’s rule shielding trans patients from discrimination is expected to be formally eliminated this summer.

Amid this sea-change, NPR explains, “Wisconsin officials decided they did not have to offer coverage for transition-related hormones and procedures after all.” So Vetens, who had previously been picking a surgery date, was now suddenly questioning whether she would be able to afford the surgery without insurance coverage.

Vetens did her research, finding that the procedure should cost between $19,000 to $25,000. She purchased an insurance plan that would cover up to $25,000, found a doctor, scheduled the procedure, and got preapproval from her new insurer.

Then, roughly two months before the surgery, she was notified by a hospital billing representative that the procedure would cost $100,000. Minus her insurance plan’s coverage, she would have to pay up to $75,000. (As a teaching assistant, Vetens makes around $20,000 a year.) “Both hospital and insurer blamed the wide divergence in estimates on the fact that they had little experience in billing for a penile inversion vaginoplasty and didn’t know how much it should cost,” says NPR.

A week before her scheduled surgery, the hospital offered the option to forgo insurance and pay $20,080 out of pocket—and Vetens accepted. “What’s another $20,000 of debt for me being the person that I am?” Vetens told NPR. “If that’s the price that I have to pay to be myself, then so be it.” That is not an option for many—perhaps most—people. And, as NPR points out, it took a whole lot of “fortitude and resources” just to get to Veten’s $20K compromise. In other words, five-figure debt is, sadly, a better-case scenario.