by Mike Andrew - SGN Staff Writer

The Republican health care bill passed by the House of Representatives - labeled the American Health Care Act (ACHA, or Trumpcare) - could be a 'death sentence for many in the [Trans] community,' according to a leading expert.

Kris Hayashi, executive director of the Transgender Law Center, issued the warning in a statement soon after the bill passed the House by a mere four votes.

'For transgender people who experience dramatic rates of discrimination in all areas of life, these attacks on our health care are absolutely attacks on our survival,' he wrote.

'The Transgender Law Center's 'Positively Trans' survey, for example, found a clear link between access to health care and viral suppression for transgender people living with HIV.'

According to the Williams Institute, Trans people are five times more likely to be HIV positive than cisgender people.

'It is no surprise that the South, where most states have not expanded Medicaid under the Affordable Care Act, has the most alarming numbers for both insurance coverage - with 30% of our respondents uninsured - and lack of viral suppression,' Hayashi continued.

'The actions of this administration are a death sentence for many in our community.'

Hayashi also worried about the one-two punch of Trumpcare plus the new administration's anti-immigrant rhetoric.

It could 'have a devastating impact on transgender and gender-nonconforming immigrants who already live at the margins,' Hayashi pointed out. 'Practically, religiously affiliated nonprofit agencies serving immigrant communities may feel emboldened to stop providing services to transgender and gender-nonconforming immigrants.'

One of the most dangerous provisions of Trumpcare is the continuous-coverage waiver that the Republican plan would allow state governments to exercise. Simply put, the waiver would allow insurance companies to charge much more to cover people with pre-existing conditions than healthy people.

Gender dysphoria, the diagnosis for which most Trans people receive treatments to help them match their physical bodies to their gender identity, is explicitly listed as a pre-existing condition for which states could waive coverage.

Under the GOP plan, states would be required to set up so-called 'high-risk pools' to cover people with pre-existing conditions, but people in those pools would still have to pay much higher insurance premiums - so high that many would not be able to afford to keep their coverage.

Trumpcare would also do away with Section 1557 of the Affordable Care Act (ACA, or Obamacare), a provision that bars health care providers getting federal funds from discriminating on the basis of gender identity.

For example, a patient who identifies as female can't be denied a gender-specific treatment she may still need, like prostate cancer treatment. Also, an insurance company can't deny coverage of a transition-based service if it's covered for other patients. If hormone therapy is used to treat menopause, hormones should also be covered for Trans patients. These protections would go away under Trumpcare.

Simply the stress of being in a marginalized minority community may lead to negative health outcomes for Trans people, according to Dr. Jody Herman of the Williams Institute.

'Minority stress is the result of experiences of stigma and discrimination, and it can have an impact on mental and physical health,' she said. 'We view health disparities are largely caused by minority stress.'

A 2014 study published by the National Institutes for Health (NIH) showed that Transgender adults were more likely to experience poor overall health and more days suffering from mental or physical health problems. They are also less likely to have insurance than their cisgender peers, despite the fact that the number of LGB people without insurance dropped from 21.7% to 11.1% as a result of Obamacare.

Trans people also suffer health disparities because much of US health insurance is employer provided, and Trans people to not enjoy the same employment opportunities their cisgender neighbors have. According to the Williams Institute, Trans people are twice as likely to be unemployed as the average American.

They are also four times more likely to have a household income less than $10,000 per year - not enough to afford insurance even under Obamacare, much less after Trumpcare makes it more expensive.

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