A new frontier: States must champion trans visibility and care

As we stand at the crossroads of history, trans voices are more critical than ever. We face a time when some trans rights opponents are calling for the eradication of “transgenderism.” Meanwhile, organizations like The New York Times that are meant to inform the public have been criticized for promoting fear against the transgender community. It is a moment that demands we rise to the challenge to protect the rights and freedoms of all our citizens.

States like Massachusetts, Minnesota and California must understand their vital role as bastions of freedom for the many people who otherwise lack access to essential care. Some pioneering states have done great work but must now invest further to enhance their gender-affirming care protections and access and ensure others in less-progressive states can find safe haven. They are the beachhead against this invasion of liberty.

These states and others can take the following bold steps to secure access to lifesaving care:

1. Create an access program for gender-affirming care. Inspired by the Massachusetts Child Psychiatry Access Program, this initiative would make psychiatric services more accessible to primary care providers, ensuring quicker access to consultations and ongoing behavioral health care.
2. Ease insurance company prior authorization requirements. Massachusetts has proposed a bill (“an Act relative to trans-inclusive health care access”) to address the convoluted prior authorization insurance requirements for gender-affirming care. By simplifying these processes, we can expand access to care and ease the burden on health care providers.
3. Eliminate cost-sharing. Cost-sharing for gender-affirming primary care and mental health care is a barrier to access to many essential services. By removing copays and deductibles for gender-affirming care, we can make it more accessible to those underserved who need it most.
4. Eliminate prior authorization requirements — specifically on GnRH analogues, hormones and gender-affirming primary care. Taking a cue from states such as Massachusetts, which has lifted restrictions on prior authorization for tobacco use cessation products, we can remove unnecessary barriers to critical care.

States must also work to expand access to patients from other states where politicians are actively targeting trans individuals and seeking to reduce or eliminate access to gender-affirming care. States can and should take these steps:

1. Pass provider protection laws that allow the provision of gender-affirming care regardless of the patient’s location, enabling providers to care for those outside their state without fear of retribution.
2. Create budgetary protections for gender-affirming care, such as indemnity funds, offering added security for providers who care for patients from other states.
3. Establish clear pathways to protect health care workers, especially those providing gender-affirming and reproductive care, from threats and abuse. Allocate resources to safeguard providers, nurses, aides and other frontline workers and collaborate with these groups to address their needs.
4. Launch investigations on behalf of their attorney general’s office into cyberstalking and networked harassment, working directly with victims and training law enforcement to focus on these issues. This will help protect the ability of all citizens to engage in civic life.

Securing the well-being and dignity of trans individuals is a moral and social imperative. By upholding these actions, states not only demonstrate compassion but also reaffirm the principles of freedom and equality upon which our nation was founded.

As we mark the Trans Day of Visibility, let’s remember that the pursuit of liberty, health and happiness is the birthright of every American, transcending the boundaries of politics and state lines. We must not allow fear or prejudice to dictate the course of our nation’s progress. The challenge before us now is to ensure that all our citizens, regardless of their identity, have the freedom to choose their own care and chart their own destinies.

The progressive states that have already stepped forward must continue to forge new paths, to be the vanguard of change and the voice for the voiceless. They must provide a sanctuary to provide vital health care to those in states where politics have attacked our shared values. It is our duty, our privilege and our solemn responsibility to create a future where every individual, regardless of where they live or who they are, can access the care they need to lead a life of dignity and fulfillment. 

Let us not falter in our pursuit of justice, for it is our shared humanity that compels us to act. In doing so, we will not only secure the blessings of liberty for ourselves but for generations yet to come.

Dallas Ducar is founding chief executive officer and president of Transhealth. Follow her on Twitter and Instagram: @DallasDucar