This Pride month, it is important to not only celebrate the victories and mourn the losses of the LGBTQ+ community, but to look at the big picture of how to improve the wellbeing of LGBTQ+ people all year. Both as a trans and queer person and as the client advocate at Mabel Wadsworth Center, I am deeply familiar with how health care disparities rooted in stigma and discrimination impact my community.
The importance of access to quality health care is something that almost everyone can agree on. Whether the need for access is acute, such as getting a broken arm put in a cast, managing a chronic condition such as diabetes, or preventative care such as an annual physical, health care access impacts all of our lives.
Unfortunately, that access still isn’t equal. Members of the LGBTQ+ community face high rates of health disparities that stem from stigma and discrimination. In some cases, this can look like outright refusal of care, which the National Transgender Discrimination Survey found has been expereinced by 19 percent of transgender people across the country, with higher numbers for trans people of color.
In other cases, health disparities can be rooted in a health care provider’s misunderstanding of their patient’s health needs and/or risk factors that a patient may have. Lesbians live at the intersection of this risk with an increased risk of both breast and gynecological cancers. This is due in part to higher rates of tobacco use and misinformed health care providers who believe their lesbian patients don’t need preventative screenings like pap smears or breast exams.
Insurance companies also create barriers that prevent people from getting the care they need. Along with the typical trials and tribulations that most people deal with when it comes to insurance coverage, members of the transgender community experience extra barriers on top of that. Oftentimes, insurance will deny coverage for gynecological care for transgender men or prostate care for transgender women, as their outdated systems fail to account for the needs of anyone who is not cisgender.
Furthermore, if an insurance company refuses to cover transition-related care, a practice no longer allowed in Maine, a trans patient may find that their routine care like an annual checkup is denied with the excuse of the insurance not covering transition-related care. Of course, these denials are a violation of the law, but fighting with an insurance company is not something that most people, patients or providers, have time for.
One recent change to insurance barriers that we can celebrate here in Maine is an update to MaineCare policy. Previously, MaineCare policy stated that transition-related surgeries were considered to be non-covered procedures, which was not in line with the law. On June 18, 2019, the Maine Department of Health and Human Services announced an emergency rule to remove this policy. This change not only allows for an increase in the health and wellbeing of transgender people in Maine, but also reflects a cultural shift towards valuing trans individuals by both working to improve health and removing outdated language from MaineCare policy.
It is in large part because of these barriers with insurance that I’m in my career field. As the client advocate at Mabel Wadsworth Center, the biggest part of my role is helping our trans patients get the care that they need covered by their insurance. Additionally, I help people of all identities in navigating their insurance and finding the care they need from a provider they trust. In this work, I witness firsthand the difference that patient-centered, competent care makes in reducing health disparities experienced by the LGBTQ+ community.
All health care providers have the opportunity to fight against these disparities by seeking further education on how to meet the needs of their LGBTQ+ patients and learning how to become better, more effective advocates. This Pride month, we should all make it a goal to fight against health disparities year-round.
Aspen Ruhlin is the client advocate at the Mabel Wadsworth Center in Bangor.