proposing USA Fed laws regarding transgender folks

[Kapalika]

It should happen! This is is my list of "probably should be federal laws" for the United States so that there isn't a ton of nonsensical variance state to state. Right now, you can go from some pretty good protections like in California, to worse than none, like in Texas.

In order of most to least important:

1. I think it should be illegal in any US state or territory for a transgender person to be fired, evicted, denied medical care or public accommodation ect ect based on their status as being transgender as the starting point.

2. This would also mean that every state's public healthcare would be required by law to cover therapy, hormone replacement therapy, any mastectomy, any other medication or surgery associated with transitioning such as a vaginoplasty or mastectomy. Since gender dysphoria is a medically recognized condition with decades of evidence and proof through clinical treatment backing it I see no reason why this shouldn't be the case. Such treatment should be as easy to obtain as any other similar care for similar types of issues (endocrine, hormonal, ect).

3. The medical coverage should also include the cost of medication and travel (for those who don't know medicaid covers travel costs for treatment so long as you have proof) to see specialists, and it should be possible to get doctors out of network to be paid on programs such as medicaid since in some rural areas (such as where I lived in West Virginia) there is little to no options for in state care. Refusing treatment on the basis of one being transgender should be illegal as it's discrimination. This is something I faced with doctors refusing to treat me so I know the harm of cases like that.

4. Likewise every state will be required to recognize the transitioned person's legally changed birth markers n their birth certificate and ID (in Texas for example they don't recognize either last I checked) and provide a non-gate keeping method by which one can change those markers. I also think that name changes should be approved without discrimination and without a requirement that the transgender person post their legal name change in the paper or any other public forum (as is the law with name changes in places like West Virginia). This can be accomplished by the fact that those states already provide certain exceptions to publishing the name changes in public papers and forums. This would be one such one.

5?. This need not be a law, but could be accomplished by one of the many regulating bodies, but similarly, and I know this since a lot of my family is/has been in the medical field, but doctors and nurses learn a ton about so many obscure diseases and ailments they will likely never see, but every doctor is going to have at least one, if not more transgender patients in their time. So there should be some way to ensure that there is at least, in medical school, retrainings or otherwise, a section on some type of recognized transgender standards of care. Again this need not be a "law" but could be accomplished by the many doctor's associations' guidelines that we have in this country.

6. Furthermore, I think it should be required in the eyes of the law to be a hate crime to attack any transgender person for using a sexed restroom or for being transgender. Before I moved I had more than one incident (one due to using the men's room at a mall, and one for using the women's room at work) that both almost resulted in an attack that I narrowly escaped both times (former due to quick thinking and latter due to intervention).

7. I also think that there should be protection against retaliation in employment, housing, public accommodation, ect ect of any transgender person trying to use the restroom that matches what they are transitioning or have transitioned to. This isn't to say that any specific place is *forced* to have a policy allowing them to use the restroom of their gender, just that if they try push the issue that they can't be retaliated against.

8. That said, I also think that if they have legally changed the gender marker on their ID and/or birth certificate or any other similar documentation that is used for identification, that the venue, workplace, public accommodation ect should be required to let them use the restroom that

9. A little bit of a tangent, but also any single occupancy restrooms anywhere in the country should follow California's example and have them by law be required to be unisex. I also think they should be required to be handicap accessible. This would make it easier for those not able to deal with sexed restrooms or in certain unsafe areas a better alternative. Many people prefer single occupancy anyway so people would likely not know.

I'm sure I could think of more, in which we are discriminated in ways that would be unthinkable (or illegal) if it was for our sex, race or religion ect. But in order from most important to least important, this is what I can think of.

 

[Stanyon]

I think #1 is already covered in anti-discrimination laws.

With #2 there seems to be a growing trend of surgery remorse (much like tattoo remorse) especially among male to female transgenders and some seek to be reassigned to their original sex. Do you think that transgenders be allowed to have as many gender reassignment surgeries as they want or do you think that since someone else is paying for it it is reasonable to limit it to one?

 

[Kapalika]

I think #1 is already covered in anti-discrimination laws.

With #2 there seems to be a growing trend of surgery remorse (much like tattoo remorse) especially among male to female transgenders and some seek to be reassigned to their original sex. Do you think that transgenders be allowed to have as many gender reassignment surgeries as they want or do you think that since someone else is paying for it it is reasonable to limit it to one?

1. isn't federally protected via any law (the most you can see is any rules the feds have for their own departments or for terms of giving funding to state schools or programs). State laws and even local laws vary wildly (which I saw first hand before and after moving to Cal).

2. meta point on 2; i should of clarified that it isn't just identifying as transgender that gets one medical coverage, it's a diagnosis of gender dysphoria. Anyone can claim the former, but the latter requires a clinical professional.

As to what you brought up, I think a lot of the issue with male to male or female to female is people rushing in and then getting no support ect. . At least for mtf there are two distinct groups statistically speaking, those who realize they are trans as kids and those as older teens or adults. People who regret transition are always in the latter group.

IIRC "standards of care" is that you see a decent therapist with specialty or knowledge in gender issues about it to help make sure you really are trans and it's not just some other issue (does happen sometimes)

Unfortunately this can create gate keeping but I don't have a good solution. There might be a rise due to the fact that it's easier to get care and there is no one set "way" that doctors are required to follow before giving a referral for SRS. At this point (at least in the USA) it's basically up to whatever the hell they want to require.

On the subpoint you brought up, I can't imagine how the hell that would work reversing reassignment surgery if it was something like a vaginoplasty or mastectomy. I guess it would be a lot easier with something like facial surgery.

If someone were to undergo all the normal standards of care, get on hormones, then get some surgeries, then try to reverse it THEN want to go back again... I don't think that should be covered because clearly something way different is going on in their brain. The diagnosis of gender dysphoria would become void basically as a mistake.

 

[wellwisher]

We have the right to bear arms, but this does not mean that the state has to pay if someone wants a gun. The right to bear arms only gives one the option to own a gun. However, you are expected to act like an adult and cover your own tab. You also have to jump through hoops to show you are sincere. This should be the model for all rights such as abortion and sex change.

I believe in the pursuit of happiness but many of these choices are serious choices and should require an adult in the drivers seat and enough personal responsibility to pay for one's choice of happiness.

One also needs to be careful in a Capitalist society, since business benefits by selling goods and services and will disguise this intend using compassionate marketing. If we changed the 2nd Amendment to have the state pay for guns, the gun suppliers will push everyone to have at least one gun, since this adds to their bottom line. They will come up with compassionate bull as a marketing tool to sell more guns and ammo. The same is true for lucrative medical angles like abortion and sex change. This is why rights, like bearing arms, try to insulated culture from a free ride mentality, since it will prompt business to oversell by distorting reality.

In a logical sense, if transgender is natural, and not a disease, than all the medical need is cosmetic and not for the treatment of a sickness. What is called natural is being born one sex biological and another sex psychologically. Changing this with artificial additives makes it unnatural. If unnatural is your choice for happiness, one needs to be an adult and pay for your own cosmetic changes since this is how pursuit of happiness works. If transsexual was a sickness or disease than treatment would have medical value. But in that case, other treatment options would open up and medical industries would need to compete. You can't have it both ways or else this will give the impression of one being unable to make a sound judgement for something so serious. One will not give an irrational person a legal gun.

 

[Twilight Hue]

I think a transgender/sexual ought to be protected from phyiscal harm, but not accommodation past the basics.

 

[Stanyon]

1. isn't federally protected via any law (the most you can see is any rules the feds have for their own departments or for terms of giving funding to state schools or programs). State laws and even local laws vary wildly (which I saw first hand before and after moving to Cal).

2. meta point on 2; i should of clarified that it isn't just identifying as transgender that gets one medical coverage, it's a diagnosis of gender dysphoria. Anyone can claim the former, but the latter requires a clinical professional.

As to what you brought up, I think a lot of the issue with male to male or female to female is people rushing in and then getting no support ect. . At least for mtf there are two distinct groups statistically speaking, those who realize they are trans as kids and those as older teens or adults. People who regret transition are always in the latter group.

IIRC "standards of care" is that you see a decent therapist with specialty or knowledge in gender issues about it to help make sure you really are trans and it's not just some other issue (does happen sometimes)

Unfortunately this can create gate keeping but I don't have a good solution. There might be a rise due to the fact that it's easier to get care and there is no one set "way" that doctors are required to follow before giving a referral for SRS. At this point (at least in the USA) it's basically up to whatever the hell they want to require.

On the subpoint you brought up, I can't imagine how the hell that would work reversing reassignment surgery if it was something like a vaginoplasty or mastectomy. I guess it would be a lot easier with something like facial surgery.

If someone were to undergo all the normal standards of care, get on hormones, then get some surgeries, then try to reverse it THEN want to go back again... I don't think that should be covered because clearly something way different is going on in their brain. The diagnosis of gender dysphoria would become void basically as a mistake.

What is the estimated cost with everything included and why should others pay for it?

 

[YmirGF]

What is the estimated cost with everything included and why should others pay for it?

I will admit I am a bit leery of that clause too. I have no problem having a means test in order to get a reduced rate, but outright free is a tiny but unrealistic an expectation.

Aside from that, the list given by @Kapalika is somewhat reasonable, but would take a Herculean effort to bring about any time soon, but unfortunately, these issues affect relatively few people and so there isn't the political will to see these things through at this time. It's just in the math.

 

[Shad]

I think #1 is already covered in anti-discrimination laws.

Not really. What is covered is discrimination against a sex which does not follow the social standards and beliefs about sex. So a male dressed like a woman can not be discriminated against. This does not require said male to identify as a woman thus is not unique to TG itself.

Toss in Trump is looking at these very laws to get some sort of standard regarding the application of sex.

 

[Shad]

I don't think that should be covered because clearly something way different is going on in their brain. The diagnosis of gender dysphoria would become void basically as a mistake.

A problem is this could be grounds for malpractice thus seen as something the government must correct to make the person "whole" by the law. After all coverage means the procedures are not elective thus government bares part of the responsibility for the whole system involved. Certification of diagnosis procedures, treatments, etc.

 

[Kapalika]

What is the estimated cost with everything included and why should others pay for it?

A lot less than you would think, especially when you consider how few people are transgender. Hormone costs, blood work and doctor visits are as low as $2,000 a year out of pocket (the first year is bit' more expensive just due to more doctor visits). Facial surgery (which most don't get) is below $5,000. SRS surgery's high end is never rarely than $20,000

I think we should pay for this when it's not elective and medically necessary (we got a process for this in California already as an example, not just anyone can get it covered because they claim to be transgender) and I think we should pay that because it's been deemed medically necessary and not much more than anything else most Americans are willing to pay for such as diabetes

Cost of diabetes:

"According to the American Diabetes Association's Economic Costs of Diabetes in the U.S. in 2017, the average medical expenditure for people with diagnosed diabetes is about $16,750 per year, of which about $9,600 is due to diabetes."

Calculate What Diabetes Costs Your Business | Diabetes at Work | NDEP | CDC

Taking it even further, I think because we should move towards universal healthcare (like the rest of the developed world) but absent of that, for the above reasons.

Oh, a relevant quote from an article I wrote, the cost it would of been for the military (in the military trans people represent a larger percentage than the general population... not sure why guess it's some draw we have to the military):

We actually already had a Defense Department study on the efficiency of transfolk in the military and as many other sources here pointed out the cost is minuscule… 2.4 to 8.4 million a year. The impact on combat efficiency wouldn’t even register.

I actually think Beck’s words (in one of her articles linked earlier) sum it up nicely:

“We could buy one wheel for [Lockheed Martin’s] Joint Strike Fighter for the same price as everyone’s surgeries,” said Beck. “And the thing is not everyone who is transgender is going to get surgery. I’ve had zero surgeries. It cost the taxpayers zero.”

So again, the cost is pretty much negligible. On the flip side @YmirGF is kind of right when he says:

but unfortunately, these issues affect relatively few people and so there isn't the political will to see these things through at this time. It's just in the math.

So how realistic this is to all come true I don't know, it likely would probably be part of some larger reform to healthcare I'd imagine when it does happen.

A problem is this could be grounds for malpractice thus seen as something the government must correct to make the person "whole" by the law. After all coverage means the procedures are not elective thus government bares part of the responsibility for the whole system involved. Certification of diagnosis procedures, treatments, etc.

Well ideally no one that isn't transgender would get the surgeries. I can't imagine anyone getting the surgery, going back on it, then wanting it again I've never even heard of that. It sounds insane basically considering how hard the process is on you either way.

I will admit I am a bit leery of that clause too. I have no problem having a means test in order to get a reduced rate, but outright free is a tiny but unrealistic an expectation.

It should be at least as free as any other healthcare. I was coming from the angle that normally state run medicaid programs for example don't have copays and such.

 

[tytlyf]

There are more chromosomes than xx or xy. People can't help being born with a different set.

 

[Kapalika]

There are more chromosomes than xx or xy. People can't help being born with a different set.

Sure, we can put intersex under these protections as well, makes sense and would give it more reason to become a thing. Intersex'ed peoples identities don't always fit with how they might look to people anyway and quite a few need hormone therapy no matter what direction they go.

However in my experience an intersex person is more likely to get coverage than a transgender person without issues, or face discrimination. Apparently it being caused by an extra chromozone or androgen insensitivity disorder in more valid some people's eyes, even though being transgendwer has a definite biological link as well (even though science isn't 100% sure what the reason is, although the evidence is clearly there that there are biological differences).

 

[Stanyon]

If the cost is miniscule and it is not a life threatening condition then it shouldn't be a problem for someone to pay for their own treatment and surgery, it all comes off as "I want someone else to pay for my unnecessary surgery"

 

[Kapalika]

If the cost is miniscule and it is not a life threatening condition then it shouldn't be a problem for someone to pay for their own treatment and surgery, it all comes off as "I want someone else to pay for my unnecessary surgery"

1. Most people who have gender dysphoria have issues with employment until they get on hormones. I had to go the dangerous route and not go through a doctor to even get to the mental state to hold any job at all.

2. Not everyone can pay the out of pocket expense. I was working and making only $12,000 a year. I would of needed to pay about $400 just for the office visit alone, a few hundred more for the blood tests on top of the actual cost of the hormones. This isn't accounting for travel costs when access isn't in one's area. I said that hormones can be as low as $2,000 but the first year is at least double that if you want to go through a doctor out of pocket.

For some electrolysis or other surgeries may be needed again ranging from $5,000 to $20,000+ each. It just depends on each case. The only people I know who make enough to allocate to that tend to work in advanced fields, and when in some states the higher education levels are as low as 25% only some of those make enough.

The cost is minuscule in the scale at which the government spends money, not for individuals who may have trouble with employment.

3. It is necessary to get treatment if one suffers gender dysphoria. There is decades of clinical evidence behind helping the transgender person experiencing dysphoria to transition. That is the standard of care and the only effective treatment in most cases.

It can be life threatening both due to dysphoria and how society treats us, and is why the international rate of attempted suicide is as high as 32-50%. Passing as our gender does an amazing amount to make our lives bearable.

I kinda also get the feeling that if it was a lot more expensive, you would claim it was too much cost.

 

[Stanyon]

The cost is minuscule in the scale at which the government spends money

How the government spends taxpayers money.

"In Pennsylvania, the Philadelphia Center for Transgender Surgery posts cost estimates for different procedures. Its price list mentions estimates of $140,450 to transition from male to female, and $124,400 to transition from female to male. This list, unlike many others, includes potential costs for things such as anesthesia, hospital stay and each of the potential surgeries that someone transitioning from one gender to the other may want or require. These numbers are based on one surgery center though, and will change depending on factors such as insurance, the hospital that is attended or if someone is using a different surgery center altogether."
The high cost of being transgender - CNN

Not everyone can pay the out of pocket expense.

Not everyone can afford their light or gas bill either

It can be life threatening both due to dysphoria and how society treats us, and is why the international rate of attempted suicide is as high as 32-50%. Passing as our gender does an amazing amount to make our lives bearable.

Not interested in the International rate, we are talking about the U.S. and why United States citizens should pay for transgender surgery and follow ups whether through insurance premiums or federal taxes. International rates should not be in this discussion because there are some countries that would give you the death sentence for it. As far as suicide, I am sure there are a lot of factors involved so it would be a stretch to blame suicide solely on gender dysphoria and society. Here are some statistics on suicide from the American Foundation for Suicide Prevention:
Suicide Statistics — AFSP

 

[Shad]

Well ideally no one that isn't transgender would get the surgeries. I can't imagine anyone getting the surgery, going back on it, then wanting it again I've never even heard of that. It sounds insane basically considering how hard the process is on you either way.

Ideally TG treatment should never be based on religious concept ergo Iran's example is a farce

 

[DustyFeet]

this is a toughie...
for children who's gender was chosen for them at birth or at some point later by their parents or at some point later based on medicine, then yes, i think your list is spot on.

how to determine / document that a person is included in the category above, i don't know

edit: #6 and #7 should be "no brainers" for everyone no matter who or why they are the way they are

 

[columbus]

What is the estimated cost with everything included and why should others pay for it?

You know, elimination of prenatal and pregnancy care would save a ton more money for us queer folks than transfolks cost.
And as a gay male non-parent, should I resent the huge chunk of my property taxes that pay for a school system that I have never been enrolled in or enrolled a child in?

Tom

 

[Shadow Wolf]

If unnatural is your choice for happiness,

My very unnatural glasses make me very happy because I can clearly see things.

 

[Shadow Wolf]

If the cost is miniscule and it is not a life threatening condition then it shouldn't be a problem for someone to pay for their own treatment and surgery, it all comes off as "I want someone else to pay for my unnecessary surgery"

The cost is definitely not minuscule and it is life threatening as there is an alarming rate of suicide and attempted suicide rate especially within those who are pre-transition or who can't for some reason or another transition at all (very typically this is related to social fears, harassment, and potential risks).