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Trans Health Care is Health Care

As expanding access to health care becomes one of the leading priorities of the 2019 legislative session, gender identity, a less discussed determinant of access, deserves attention. Trans people are fighting to receive quality health care in North Carolina.

Trans people have been targeted by legislation in North Carolina in the past. One powerful instance was HB2, known as the “bathroom bill,” which restricted public bathroom use for people who were not cis men or women. Another part of this bill that was vastly overlooked made it clear that employees are able to discriminate against a person based on gender identity.

At the close of 2016, newly elected Republican treasurer Dale Folwell announced a goal to “reduce the state health plan’s 32 billion dollar debt, provide a more affordable family premium especially for our lowest paid employees and provide transparency to the taxpayers.” In 2017 Folwell announced the state health plan would no longer cover gender-affirming care for trans state employees as part of his cost-saving effort. This cut continues to undermine the well-being of trans people in North Carolina and advances a path to sanction the denial of rights of key constituents. At 2018’s open, hormone therapy- a method of gender affirmation and one utilized treatment for gender dysphoria- was cut from the state health plan. In 2019, this health plan will come under scrutiny by the legislature as they create NC’s overall budget- and it is in need of some serious changes.

Folwell’s justification reinforces the toxic narrative that trans health is a fringe issue. The writers of our statewide budget like Folwell, are largely white, male, and Republican, get to make unilateral decisions about people whose health care needs they do not understand. This skewed power dynamic positions trans people as scapegoats for inadequate funding. 

Understanding of what health care for trans people looks like has intermittently expanded beyond gender-affirming surgeries, which isn’t even a specific surgery and rather an umbrella term for surgeries done for the sake of affirming someone’s gender identity. Additionally, there are other forms of health care many officials haven’t considered, including treatment for chronic illnesses, managing disabilities, obtaining medication prescriptions, getting regular checkups, and access to therapy. There is complete overlap between this list and the list of health care needs of other North Carolinians. Trans health care looks like “regular” health care services because they are regular health care services.

The exclusion of trans people from an updated state health plan sets a dangerous precedent for state-sanctioned discrimination. Health care in North Carolina is a basic right and in 2019, lawmakers should expand access to all North Carolinians rather than use it as an effort to ostracize and shame people.