Administration is trying to gut health care for trans folks: It will take all of us to stop them

I started physically transitioning in the 1980s, decades before trans folks had health care protections under the Affordable Care Act (ACA). Back then, I bought hormones off the street, or from doctors who performed back-alley injections without follow up. Formal education on hormone replacement therapy didn’t exist, so I relied on anecdotal stories from other trans women. My friends and I bought birth control pills from Vietnam or purchased unregulated hormones on the black market. The risk of taking altered substances was worth it to affirm our identities.

Before I was associate director of St. John’s Well Child & Family Center Transgender Health Program, I was a patient, first walking through their doors in 2015. I’d never experienced trans-affirming, competent health care, so this opened my eyes to a world of possibilities. My gender identity and journey were not only affirmed by my doctors -- I felt that my health and well-being were important.

Everyone deserves to feel validated when they access the health care system. I can say firsthand that the protections and accessibility to trans competent health care provided by the ACA saves countless trans lives every day. In fact, St. John’s Transgender Health Services, a pioneering program that serves over 2,100 people was able to grow rapidly largely due to funding and policies provided by the ACA. Now, this could all change because the ACA is under attack.


Section 1557 of the ACA explicitly protects against discrimination in health coverage and care based on race, color, national origin, sex, age and disability in programs and facilities that receive federal funding. In other words, Section 1557 is essential to the wellbeing of transgender individuals and other marginalized groups. Recently, the Trump administration has made moves to gut it. As a first step, we can fight to protect it by submitting a public comment before Aug. 13.

The attempt to roll back Section 1557 is yet another attack on the trans community in lock-step with Trump’s campaign to erase us. From the trans military ban, to attempting to compromise trans students’ rights, to allowing shelters to discriminate on the basis of gender identity -- the transgender community continues to be used by the right as a scapegoat and distraction from issues most Americans actually care about, like health care, jobs and education.

In reality, this attack isn’t actually about trans people -- it’s a testing ground for this administration to undo protections for many Americans -- most notably for women and folks who need access to reproductive health care, including abortion. Further still, this reversal lays groundwork for the Trump administration to cut services to other populations, including folks with pre-existing conditions, those seeking reproductive care, individuals with HIV, and people whose first language is not English. Undoing Section 1557 is a clear attempt to prioritize white, wealthy, able-bodied, cisgender, heterosexual, English speaking men. 

I was lucky to finally access the care I always needed. But, I’ve seen firsthand what happens when trans folks don’t have access to gender affirming health care. I’m terrified of returning to the dangerous days when we sourced our own hormones without medical supervision.

Lives are at stake if Section 1557 is gutted. With even less access to gender-affirming surgeries, there will be a resurgence of people -- particularly transgender women of color -- injecting their bodies with low grade silicone or oil as an alternative to surgery. This will also exacerbate dysphoria for countless transgender people, likely increasing our community’s already staggering rates of suicide.


Further, gutting Section 1557 would take away protections for trans people to be seen for basic medical services. Without the explicit protections around gender identity, any provider could refuse to see us on the basis of gender identity alone -- even if whatever health issue we were facing has nothing to do with our transness. That means that in an emergency, a doctor could refuse to treat a trans patient under the basis of religious exemption, and allow them to die. It also means that for trans folks in rural areas, the one doctor within hundreds of miles would be allowed to deprive them of medical care arbitrarily, leaving them with zero ability to treat illness, obtain medication, or generally take care of their bodies in the way we all deserve.

We’ve also already come so far in affirming care for gender non-conforming and non-binary individuals who have always faced misunderstanding and difficulty -- even within the trans community. We can’t let the attempt to undo protections stop our progress now. We must be able to continue to learn from and grow with the gender non-conforming community, and further innovate around affirming all of our gender identities through health care.

Transgender people like myself deserve the right to access health care in a dignified manner. At the end of the day, trans rights are human rights -- that’s why I urge anyone reading this to stand with us by submitting a public comment before Aug. 13, 2019.

Kazumi Yamaguchi is associate director of Transgender Health Services at St. John’s Well Child & Family Centers.