Healthcare Access & Equity

The Challenge

America's healthcare system fails millions of people, but the failures are not evenly distributed. Transgender people face a uniquely hostile landscape: an escalating wave of state-level bans on gender-affirming care, persistent insurance exclusions for medically necessary treatments, and a severe shortage of providers with the training and willingness to serve trans patients. As of 2025, more than 24 states have enacted bans or severe restrictions on gender-affirming care for minors, and several have moved to restrict access for adults as well. These bans proceed despite the overwhelming consensus of mainstream medical organizations: the American Medical Association, the American Academy of Pediatrics, the Endocrine Society, and the American Psychological Association all support evidence-based gender-affirming care as medically necessary treatment. The evidence base spans decades of peer-reviewed research demonstrating that access to appropriate care dramatically reduces rates of depression, anxiety, and suicidality among transgender youth and adults.

Beyond the specific crisis in trans healthcare, the broader affordability crisis touches every community. Millions of Americans remain uninsured or underinsured, one medical emergency away from financial ruin. The cost of prescription drugs, the consolidation of hospital systems, and the erosion of public health infrastructure all contribute to a system that prioritizes profit over patients.

For marginalized communities—transgender people, people of color, immigrants, rural residents, people with disabilities—these systemic failures compound. The result is not just worse health outcomes but shorter lives.

Why This Matters

I know the cost of America's broken healthcare system from personal experience. During the COVID-19 pandemic, I was hospitalized and received a bill for $35,000—without insurance to cover it. That experience crystallized what I had already understood from years of policy work: the system is designed to extract wealth from the sick, and those with the least are asked to pay the most.

Through my work leading a coalition of 45 organizations advocating for healthcare policy reform, I have seen how the system's failures cascade. A trans person denied hormone therapy may face worsening depression. A family bankrupted by medical debt may lose their housing. A rural community that loses its hospital may see preventable deaths become routine.

The policy landscape is not entirely bleak. States like Oregon and Washington have demonstrated that Medicaid expansion can be a vehicle for health equity, with both states securing trans-inclusive coverage through their Medicaid programs. Section 1557 of the Affordable Care Act—the law's core nondiscrimination provision—prohibits discrimination on the basis of sex in federally funded healthcare programs, and federal courts have increasingly interpreted this to include gender identity. These protections matter enormously for the most economically vulnerable transgender people who depend on public insurance programs for their care.

Healthcare is not a privilege to be earned. It is a fundamental human right, and the policy choices that deny it to millions are exactly that—choices that can and must be reversed.

What I've Done

My healthcare advocacy has focused on both expanding access and protecting existing gains against rollback. Key accomplishments include:

• Securing trans-inclusive coverage in Washington's Apple Health (Medicaid) program, ensuring that gender-affirming care is available to low-income transgender residents as a covered medical benefit
• Building and leading a 45-organization coalition focused on healthcare policy, uniting providers, patients, advocates, and community organizations around shared goals
• Advocating for insurance reform to eliminate discriminatory exclusions that single out transgender-related care for denial
• Working with healthcare providers to improve cultural competency and clinical training around the needs of transgender and gender-diverse patients
• Engaging in legislative testimony and public education campaigns to counter misinformation about gender-affirming care
• Contributing to the successful effort to secure trans-inclusive coverage in Oregon's Medicaid program, complementing the parallel victory in Washington and establishing a regional model for other states
• Testifying before the Health Care Authority of Washington State to make the case—grounded in clinical evidence and fiscal analysis—for why covering gender-affirming care is both a medical imperative and a cost-effective investment in public health

These wins did not happen in isolation. Each required years of relationship-building with state agencies, provider networks, and patient advocates. The testimony before the Health Care Authority, for example, drew on data showing that covering gender-affirming care reduces emergency room utilization, mental health crisis interventions, and long-term disability claims—saving the state money while improving patient outcomes.

Where We Go From Here

The immediate priority is protecting the healthcare gains that are under active threat. As states move to ban gender-affirming care and insurers seek new ways to deny coverage, holding the line on existing protections is essential work.

But defense alone is not enough. The longer-term vision must include universal coverage that ensures every person—regardless of income, identity, or geography—can access the care they need. This requires both federal policy change and state-level innovation.

Provider training is another critical frontier. Even where coverage exists on paper, a shortage of knowledgeable, affirming providers creates practical barriers to care. Investing in medical education and clinical training pipelines is necessary to close this gap. The release of the World Professional Association for Transgender Health (WPATH) Standards of Care, Version 8, provides an updated, evidence-based clinical framework that should inform provider education and insurance coverage standards alike. Aligning state Medicaid programs and private insurance formularies with WPATH SOC8 guidelines would establish a clear, defensible standard of care that is harder for political actors to dismiss.

Equally important is the infrastructure for data collection and outcome tracking. Right now, we lack comprehensive national data on transgender health outcomes, insurance coverage rates, and the downstream effects of state-level care bans. Building that evidence base is not an academic exercise—it is essential for defending existing protections in court, making the case for expanded coverage in legislatures, and ensuring that clinical guidelines reflect the lived realities of transgender patients. Federal agencies, state health departments, and research institutions all have roles to play in closing this data gap.

Finally, the healthcare system must be reformed to prioritize prevention, community health, and patient outcomes over corporate profits. The coalitions built around trans healthcare access provide a model for the broader solidarity needed to achieve these systemic changes.