Trans Rights by State Lines


In 2014, Time magazine declared that the US had reached The Transgender Tipping Point. Beside a confident, glamorous Laverne Cox, the cover announced “America’s new civil rights frontier.”

They were right, if optimistic. The lightning-speed rise in trans visibility has resulted in a profusion of legislation and policy. More legislation has passed about trans people in the past decade than in the preceding century. While some of these policies attempt to address pressing needs, others try to erase trans existence or push trans people out of the public sphere.

Medicaid coverage of gender-affirming healthcare, including hormone therapy and surgeries, is a great example of the massive state-to-state variation in trans-specific policies. Medicaid covers gender-affirming care in 18 states, but included services still vary by state. On the other end of the spectrum, twelve states have banned coverage for gender-affirming care altogether. The other twenty states refuse to take a policy stance and decide coverage on a case-by-case basis.

Tamar Goldenberg and team used data from a national survey of over 27,000 people in the US to investigate how a state’s policy landscape shaped trans people’s health. They investigated anti-discrimination, health insurance, and identity document policies to answer two questions: Do pro-trans policies promote healthcare use? Do anti-trans policies restrict it?

Trans people in states with protective policies were more likely to seek healthcare than people in states with restrictive policies. However, no single policy significantly affected healthcare use. In nearly all states, trans people of color reported avoiding healthcare at higher rates than white trans people because of fear of mistreatment.

Trans rights are human rights, and human rights shouldn’t vary by state. Consistency requires federal legislation to protect and promote trans health, especially for trans people of color.

Databyte via Goldenberg, T., Reisner, S. L., Harper, G. W., Gamarel, K. E., & Stephenson, R. (2020). State Policies and Healthcare Use Among Transgender People in the U.S. American Journal of Preventive Medicine, 59(2), 247-259.