Save Obamacare: Open Letter from a Transgender Man

It’s been a while since the last time I wrote here. A lot has happened in my personal life, and also in my country, since my last blog post. In happy news, on June 4, 2016, I married my best friend and love of my life. I’ll write another time about how we planned our wedding ceremony and celebration to reflect our values, and how wonderful and empowering our wedding felt. In unhappy news, my country elected a president and vice-president who seem at the very least complicit in, and at the very worst actively committed to a roll-back of civil rights for transgender Americans like me. The first salvo in this fight is the proposed repeal of the Affordable Care Act, known to most as Obamacare. The ACA isn’t perfect, but it contains a myriad of provisions, including protections that make a real difference in transgender people’s lives.

Today is January 16th, 2017 — the day we celebrate civil rights legend Dr. Martin Luther King, Jr. In honor of Dr. King’s legacy of service and political activism, I have written an open letter to the United States Congress, urging them to halt the repeal of the ACA.

My story is singular; I am only one of millions of Americans who will be affected if the Affordable Care Act is repealed without preserving its essential benefits. I urge others to speak up with their stories. Write a letter or an email. Make a phone call. Attend a protest. Make your voice heard.

The text of my letter follows below. Here’s a link to the PDF version. Please feel free to share, or to use my letter as inspiration or a template to write your own. We must speak out.

Open Letter to the Congress of the United States of America:

Aiden James Kosciesza
Philadelphia, PA 19104

January 16, 2017

United States Congress
Capitol Building
East Capital St NE & First St SE
Washington, DC 20004

To the Honorable Congresspeople of the United States:

My name is Aiden Kosciesza, and I am writing to you today, on the Martin Luther King, Jr. Day of Service, in support of the Affordable Care Act, colloquially known as “Obamacare.” I am a millennial, a young professional, and a transgender man. The Affordable Care Act has provided real, enormous benefits to me and my family, and I am appalled that Congress is moving to repeal this program and take away all of the great things that the ACA brought to our country. I want to share my story with you, and implore you to do everything in your power to stop the repeal of the ACA, and preserve the key benefits that mean so much to millions of Americans like me.

I am a full-time, tenure-track college professor, but four years ago, I was still an adjunct instructor. At one point I taught six classes for three schools in two different states during the same semester. Since I was technically working part-time for each separate employer, none of them were required to provide health care coverage. For three precarious years I had no coverage at all, and avoided going to the doctor even when I really needed to. Without insurance, I just couldn’t risk the cost of a doctor’s visit. Only through the Affordable Care Act’s marketplace was I able to get insurance, and only through the ACA’s subsidies was I able to pay for it.

When I moved into a full-time position, I continued to see the benefits that the Affordable Care Act provided for my students, and for my friends and family. My younger brother was able to stay on our parents’ insurance while he looked for a job after graduation. My friends who were self-employed or still working part-time were able to afford insurance with the help of ACA subsidies. My godson, born in 2016 to a friend who is an adjunct professor, could only come into this world because of the ACA plan that covers his mother. So many people in my life are healthier because of the Affordable Care Act.

As for myself, even after moving to employer-provided health insurance, I still see great benefits from the ACA that I am loath to lose. The protections in the Affordable Care Act make it illegal for insurers to discriminate against me because of my gender identity. This has a huge economic impact on me as a transgender person. If an insurance company is allowed to make blanket exclusions of care for people like me, then I have to continue to pay out of pocket for medical expenses that my doctor has deemed necessary and essential. This puts a young family like mine in a precarious position.

Without the Affordable Care Act, I am left with the absurd choice: health or home? If I have to pay out of pocket for my health care, I can’t possibly afford to save up a down payment for a house, much less start a family with all of its attendant costs. I often hear older people criticize my generation, the millennials, asking why we aren’t participating in the economy at the levels they expect. How can we, when we’re forced to choose between paying for our health care or securing stable housing? If Congress goes through with the repeal of the ACA, millions of Americans will be right back where we started: a position of financial insecurity that makes us unable or unwilling to take on major life expenses. Make no mistake – this insecurity will have long-term effects on our economy and our nation.

This decision is about much more than politics. Prosperity begins with people, and the American people will suffer irreparable harm if their health is not protected. I do understand that the political line is “repeal and replace” – that a nebulous “something better” is waiting in the wings. If Congress really does want to pass a new health care bill that will preserve the great benefits of the Affordable Care Act while also fixing some of its problems, I will support those efforts. But to repeal any part of this law before a clear, concrete, complete replacement has been written, analyzed, tested, and passed through both the House and the Senate is partisan political theater that will literally cost American lives.

I urge you to stop this madness. Do not allow the essential benefits of the Affordable Care Act to be taken away from the Americans who need them. Your legacy is at stake – and so are our lives. We are counting on you to do the right thing.

Respectfully,

Aiden James Kosciesza
Philadelphia, PA 19104

Inclusive bathroom sign

Transgender Rights PSA

Yesterday I received an email from a high school student working on a final project for her English class: a public service announcement. She chose transgender rights and public restrooms as her subject, and she wrote to me to ask if I could answer some questions for her. I was glad to help — and since I thought those same answers might be useful to others, I’ve copied my letter to her below.


Hi [Name],

I’m glad to hear that you’re interested in transgender rights. I think it’s a great topic for your PSA project! I am happy to answer your questions, but I would like you to do something for me in return. When you finish your project, would you send me a copy, or a link to an online version? I’d like to see the results! If you are willing to do that for me, then please feel free to use my answers in your project.

You asked me three questions:

My questions are:

What was going through your mind when you made the change?

Do you have any thing to say to other transgenders?

What do you want people to understand?

In order to answer your questions, I first have to explain a couple of things. In your first question, you asked me about when I “made the change.” I think that what you mean is my medical transition, but this wording is problematic for a few reasons.

First of all, saying “the change” makes it sound like there is just one change, and it is something that all transgender people do. That’s not the case. Being transgender doesn’t always mean having surgery or taking hormones; it’s an identity, not an action.

Many transgender people do want to make changes in their lives — changes that feel right to them, or changes that signal to other people that the trans person wants to be addressed a certain way (for example, with male pronouns instead of female pronouns). We call this process “transition.” There are three basic types of transition: social transition, legal transition, and medical transition.

Social transition is when trans people change the way they interact with other people (society), usually to express a different gender than the sex they were assigned at birth. This could include changing one’s name and/or pronouns, wearing different clothes, walking or talking differently, or taking part in different activities or social spaces.

Legal transition is when trans people get new documents to reflect their gender identity (remember, gender identity is one’s own internal sense of one’s own gender; it’s not necessarily the same as the sex that one was assigned at birth). This could include legally changing one’s name and gender marker on documents like a driver’s license, social security card, passport, birth certificate, or bank accounts. In the US, these processes vary by state, and sometimes it’s difficult or even impossible for trans people to change their documentation.

Medical transition is when trans people change their bodies to bring them more in line with the trans person’s gender identity and sense of self. Medical transition could include hormone treatment or a number of different surgical options. Trans people may do all of these things, some, or none.

The most important thing to remember about medical transition is that it is not the only way to be trans. Many transgender people either don’t have access to this kind of medical treatment, or don’t want it at all — and even for those who do have medical treatment, it’s not a single event. There’s no such thing as “the change.”

It’s very invasive to ask transgender people about their hormones, surgery, or other medical procedures. That’s no one’s business except the trans person and their doctor, and many trans people will be offended if you ask. In my case, though, I’m very open about my medical history, because I’m a transgender educator. You probably learned from my website that I visit schools, hospitals, and organizations to talk about transgender identities and to answer questions. So let me tell you about my medical transition.

I started taking injections of testosterone about five years ago, in January of 2011. That is the extent of my medical transition. I haven’t had any surgeries or other procedures; the way I look and sound has only been affected by hormone therapy. I plan to have chest surgery in the future, but I currently have no plans for genital surgery. That is because the current medical procedures can’t achieve the results that I want.

What this means is that there was no moment in my trans life that can be described as “the change.” There have been important milestones, like the summer when I first realized I was trans, or the time I cut off my long hair, or the day I took my first hormone injection, but my process of transition is ongoing. And if you think about it, isn’t that the same for cisgender (non-transgender) people, too? We all change over the course of our lives. My aspiration is that the changes I make in my life, whether they’re related to my gender transition or not, will all help me to explore and express my authentic self.

In fact, this is also my answer to your third question, where you asked me what I want people to understand. I want people to understand that transgender people are not defined by their transition process, or lack thereof. No transgender person is “more” or “less” trans than another. Just as every artist has a unique form of creative expression, every transgender person (and indeed, every cisgender person!) has a unique form of gender expression. Although medical transition is an integral part of many trans people’s journeys, it is never the whole story.

Your second question — which I am answering last — also contains some problematic wording. You asked me if I have anything to say to other “transgenders.” This is grammatically incorrect, and using this word to describe transgender people is offensive. The root of this mistake — and it’s a mistake that many people make, believe me! — is a misunderstanding of the word “transgender.” Transgender is an adjective, not a noun. This is why “transgendered” is not a word — we tend to add the -ed suffix onto words that we want to turn into adjectives, but transgender is already an adjective, so it doesn’t need any help. Of course, you can’t call a person, place, or thing an adjective without adding a noun. It would be like saying “a smooth” instead of “a smooth plate.” Transgender is an adjective used to describe people, so you must say “transgender people,” not “transgenders.”

So, let me return to your question: do I have anything to say to other transgender people?

This is a very difficult question, because trans people are living in a difficult time. In the wake of the US Supreme Court’s marriage equality decision, it seems like opponents of LGBT civil rights have turned their attention to transgender people, a population that is already vulnerable (as studies have shown — you can read more here). Across the nation, states have proposed or have actually passed laws specifically written to discriminate against trans folks.

The so-called bathroom bills are sexist, discriminatory, and dangerous. They start out as image policing. In the time of the Stonewall Riots, men and women could be arrested if they were not wearing at least three pieces of “gender-specific” clothing. Now people — transgender and cisgender people alike — are being harassed in public bathrooms if they don’t fit the arbitrary image of masculinity or femininity that onlookers might have. Lawmakers are using scare tactics to demonize transgender people, and the media coverage they are afforded gives their views an air of legitimacy, even when they don’t have a shred of evidence to back up their claims. This leads members of the public — some motivated by bias, and some simply by ignorance — to dislike and distrust transgender people, and then the publicity emboldens them to air these views. Transgender people have already been targets for harassment and violence, and the current political climate is only making things worse.

As a trans person myself, sometimes, I feel despair. It seems unbelievable that the United States, a nation that is supposed to stand for freedom, justice, and equality, could be so backward when it comes to transgender rights — especially with other countries providing a progressive model. Didn’t we learn anything from the Civil Rights Movement of the 1960s? Haven’t we come farther than this?

Yet when I travel and give presentations about transgender identities, I am heartened and inspired by the people I meet. There are good people out there, lots of them, who want to be allies — who want to learn about transgender people, and learn how best to support us in our struggle. Allies are out there. They might not be as loud as our enemies, but their ranks are growing. Meeting these allies gives me hope, and hope gives me the strength to keep fighting. What I want to say to other trans people is: don’t give up hope. We’ll need it.

I hope these answers help you to learn a little more about transgender people — and of course, I hope they help you with your project! Please don’t forget to send me a copy when you finish. I’m really looking forward to seeing your work.

Very truly yours,

Aiden K.

Health Care Or Home Purchase? The Transgender Dilemma

Today I completed the US Trans Survey, a comprehensive study gathering information that will be used to inform public policy towards transgender people in the United States. Trans, genderqueer, and non-binary folks: if you haven’t taken the survey yet, please do so now! Our data is urgently needed.

On paper, my answers to the survey questions are encouraging. I have never been assaulted or harassed due to my gender identity. I have never been fired from a job or made to feel uncomfortable at work as a result of my trans status. I have had positive personal relationships, and I have not experienced homelessness. My answers, of course, are only a tiny fraction of the trans experience, but they are mostly good news. Unfortunately, they don’t quite tell the whole story. At the conclusion of the survey, participants are asked to share a personal story of either acceptance or discrimination to help round out the picture of their experiences. I’d like to share here a selection from what I wrote:

In many ways, I have been very fortunate as a trans man in the United States. I have a supportive immediate family, a wonderful fiancee, and a full-time job. However, although my salary is enough to support me, I am struck by the difficult choices I’ve had to make because of my trans status and my inability to get comprehensive transgender health care.

I began my medical transition four years ago with hormone therapy, but my health insurance has never paid for any of my trans-related treatment. Because I am fortunate enough to be employed, I have been able to pay for my hormones out of pocket, and I felt secure in the idea that I would be able to continue doing this indefinitely. However, I was recently shocked to learn that my usual, trans-friendly pharmacy has been barred from issuing my normal hormone prescription, and that the only replacement available would be twice the cost. Because of this capricious regulatory setback, I’ve been unable to get my regular medication, and this puts my health in a precarious and unexpected place, at least for the short term.

This short-term situation is frustrating and difficult, but it doesn’t even compare to the long-term anguish of having to choose between chest surgery and the normal life expenses of a young professional. Although I do have health insurance through my employer, all of the plans available to me specifically exclude coverage for any type of transgender care; thus, I would have to pay out of pocket for gender-affirming chest surgery, even though my doctor would affirm that such surgery is medically necessary for my health and well-being.

The practical upshot of these policies is that I must continually choose between my own health and well-being and my ability to afford the purchases and milestones that will contribute to my long-term livelihood and stability, and that will help me to contribute to my family and community. I am getting married next year, but I can’t possibly afford a wedding alongside a surgical procedure, so I’ve delayed my surgery. After the wedding, I’ll need a down payment for a house — there’s another delay. Once my housing is settled, perhaps I’ll want to raise children with my partner. Will I have to choose between top surgery and infant expenses? I’m sure that I’m not the only transgender millennial being held back by tough choices between medical care and participation in the so-called “American Dream.”

The refusal of American health insurance companies to cover transgender-related care — and the failure of our legislators to require them to do so — is a national embarrassment that could have far-reaching economic consequences.  Just as housing, employment, and other forms of discrimination have created a wealth gap between white and non-white households, I have no doubt that the denial of comprehensive medical care for trans folks will likewise affect our incomes, stability, and earning power.

To force transgender people to choose between medical care and major life purchases is to hamstring the economic potential of an entire class of people in the United States. These discriminatory policies are hurting us as a nation in both moral and practical terms. Allies, please urge your legislators to step up and ensure that all insurance policies provide comprehensive health care for transgender people!