Tag Archive for: health care

Save Obamacare: Open Letter from a Transgender Man

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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My story is singular; I am only one of millions of Americans who will be affected if the Affordable Care Act is repealed without preserving its essential benefits.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

Health Care Or Home Purchase? The Transgender Dilemma

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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!

#Transhealthfail Exposes the Need for Transgender-Specific Training in Healthcare

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When you experience discrimination, it’s easy to feel like you’re alone. The very nature of discrimination is isolating: the minority is singled out for insults, ridicule, or poor treatment from the majority, and for transgender people, the numerical difference between majority and minority is huge. A 2011 study put the U.S. transgender population at an estimated 0.3 percent. Although a definitive count has never been performed, that estimate gives a sense of scale to trans people’s experiences as they fight for recognition and respect.

One of the most daunting and pervasive forums for anti-trans discrimination is the health care system. The landmark 2011 transgender discrimination study Injustice at Every Turn reported that 19% of trans people studied had been refused care due to their gender identity, 28% had postponed care due to discrimination, and a staggering 50% wound up educating their own doctors about trans issues. Yet it’s easy for individual trans patients to feel like they’re the only ones being treated this way.

Enter social media. The hashtag #transhealthfail was started by @MyTransHealth, an upcoming website that is building a database of transgender-friendly health professionals. (Their Kickstarter is here – and Philadelphia coverage is among their stretch goals!) The first tweets invited trans folks to share their negative experiences with healthcare providers, and the hashtag quickly exploded.

These posts reveal a daunting, often hostile environment for transgender patients. Some were misgendered, outed, or ridiculed in public:

Others were questioned or dismissed by doctors with narrow-minded or uneducated views of trans people:  

 

And still others highlighted the serious failings of insurance coverage for transgender people in the U.S.:  

The tweets go on – and to date, they show no sign of stopping. Although it’s terrible to see so many horror stories, the attention #transhealthfail is getting is encouraging. It is my hope that all of these tweets, shares, articles, and replies will spark support not only for political action – the passage of laws that ban discrimination and ensure health care access for all trans and non-binary people – but for transgender-specific training for health providers.

I got involved in healthcare training in 2013, just two years after I started my medical transition. I had previously spoken to college students and activists about transgender identities, but had never thought about addressing the medical community until I was asked to give a workshop at Good Shepherd Penn Partners, a physical rehab center in Philadelphia. They had recently served a transgender patient and were looking for ways to improve future care. I agreed, but the night before the presentation, I was getting nervous. Medical professionals go through years of school and training, I told myself. What could I tell these doctors and nurses that they didn’t already know?

It turned out that I had a lot to offer. The professionals I spoke with were all at the top of their field, yet many of them had never been trained in transgender issues. Every one of these doctors and nurses wanted to do their best for patients of all genders – they just didn’t have a lot of experience with the terminology, the range of identities, and the personal stories of trans people.

After the session, the organizer walked me to my car, and it was clear that the workshop had made a difference for her. “We just never talked about this back in medical school,” she explained to me. “I mean, for a lot of us, our training was ten or twenty years ago. They weren’t discussing these types of issues back then. Just having a vocabulary reference, knowing what to say and what not to – that’s huge!”

As I continued speaking at hospitals and clinics, I quickly realized the difference that a training session could make for both providers and patients. While there are certainly doctors who discriminate against trans patients out of bigotry and fear, I believe there are many more who want to be allies to the LGBTQ community – but they need the tools to do so.

We must champion comprehensive training and professional development for medical professionals – training that prepares them to treat transgender patients with compassion and respect. Of course, this training must start in medical school, but it must also extend beyond the classroom so that we can reach professionals who are already working in the field, and so that providers can keep up to date with best practices.

The best way to avoid a #transhealthfail is to teach our doctors, social workers, receptionists, nurses, security personnel, therapists, and everyone involved in patient care about transgender identities. This is not the job of the patient. It is the responsibility of the institution to seek out knowledge and to better serve the trans community.

Healthcare providers: Please step up and ensure that your staff have the knowledge they need to provide transgender patients with the highest standard of care. Let’s put the #transhealthfail hashtag out of commission for good.