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For transgender people in the U.S., obtaining gender-affirming health care can be a long and arduous struggle against insurance companies and politicians alike — and according to a study released this week, the costs can grow even steeper when patients must travel to access this life-saving care.
In a study published on Wednesday in the journal JAMA Surgery, researchers at Oregon Health and Science University looked at insurance data from 771 transgender patients who had received either vaginoplasty or phalloplasty to determine out-of-pocket and total costs for gender-affirming surgeries. The team found that 49% of those who receive genital surgery traveled out of their home state for the procedures — and paid around 50% more in out-of-pocket costs as a result.
“Traveling a long distance for a major procedure such as gender-affirming genital surgery places a large burden on patients,” said Dr. Jae Downing, one of the study’s lead authors, in a statement. In addition to the known complications in receiving follow-up care or missing work, Downing explained, “our study shows that traveling out of state also increases out-of-pocket medical expenses for trans and gender-diverse patients — even though their surgery’s total cost is largely the same.”
According to researchers, out-of-state patients were burdened with an average of $2,645 in out-of-pocket expenses, while in-state patients paid $1,781. (This only includes allowable expenses for which the patients submitted an insurance reimbursement form; the true costs could be still higher.) The study’s authors recommend “[i]mproving geographic access and understanding patient preferences for surgical care” to decrease the financial burden.
“Transgender and nonbinary patients experience enormous barriers to accessing gender-affirming surgery, with one barrier being the lack of local, qualified surgeons and dedicated support teams to help patients navigate this care,” said Dr. Geolani Dy, the study’s corresponding author. “[T]this study helps quantify how severely we need more gender-affirming surgeons.”
While Dy is indisputably correct, the recent rash of bills attempting to outlaw gender-affirming care has made increasing the number of trans-qualified doctors and surgeons a difficult prospect. Indeed, it may be trans people and their families who are forced to become “in-state,” as many contemplate the necessity of fleeing their homes in states like Texas and Alabama where government-sponsored hostility towards gender deviance is quickly escalating, even — or especially — towards young people who seek puberty blockers or hormone therapy.
And while California Democrats are currently pushing to pass SB107, which would establish the state as a legal refuge for those fleeing anti-trans laws in other jurisdictions, California still has one of the highest costs of living in the U.S., meaning trans folks in transphobic regions are caught between two very expensive choices.
“It’s ungodly expensive to move across the country,” one parent of a trans child in the process of relocating told Them. “Every single day there’s something else I’ve got to arrange. We’re barely in the process of moving, and we’ve already spent more than $15,000. And we’ve only got the one kid.”
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