Trans-lating the health divide 

Report documents transgender disparities in Colorado, despite Affordable Care Act's aid

Shari Zabel was in the right place at the right time — and that's saying something for a transgender woman.

In the past few years, the 49-year-old has ended a career with the Air Force, where she was a major; gotten a divorce; and finally come out as who she really is. And though she says she's known on some level that she was different since she was 3 years old, her decision to live honestly came at an opportune moment.

Transgender people need specific kinds of health care, and had Zabel come out a few years earlier, she would have had a hard time finding it under military health coverage. But in 2011, the Department of Veterans Affairs system began covering trans-related health care, which Zabel can access because she's a partially disabled vet. Zabel notes that she also has TRICARE, but that didn't cover her needs.

After a few doctors rejected her, Zabel was able to get the help she needed to make her transition. Now she has everything from hormones to help her develop breasts and lose body and facial hair to a VA support group with other trans people that meets once a month.

"I'm lucky," she says. "It's very easy to try to hide in plain sight and not say anything because there's too much discrimination and problems that can happen."

Zabel says she knows that other trans people struggle with getting the care they need, which is why she's working with One Colorado.

The LGBTQ-advocacy group recently completed "Transparent: The State of Transgender Health in Colorado" (tinyurl.com/o36ulg2), the nation's first statewide survey on transgender health needs and issues. Most public health research doesn't ask about gender identity, let alone its effects on health outcomes. This report was based on a survey of 400 transgender Coloradans, as well as earlier research by the group. The main findings:

• The Affordable Care Act has "drastically increased coverage" for transgender Coloradans, especially because of the expansion of Medicaid. (Nineteen percent of respondents were on Medicaid.) But costs associated with health care and fear of discrimination still dissuade many from seeking the care they need. (Forty percent said they delayed accessing health care, compared to 16 percent of all Coloradans.)

• Survey participants were much more likely to have a college degree (61 percent) than Coloradans as a whole (33 percent), but were also much more likely to be unemployed (13 percent compared to 7 percent) or low-income (with 42 percent making less than $25,000 annually, compared with 24 percent of all Coloradans).

• Transgender Coloradans have much higher rates of depression (44 percent), suicidal thoughts (36 percent for the past year), and suicide attempts (10 percent for the past year) than the general population.

• In multiple questions, survey respondents said access to a trans-friendly health care provider hugely impacted their health and well-being.

Leo Kattari, One Colorado's health policy manager, appreciates the positives in the report. He notes that not only has the ACA allowed for coverage of many more trans people, a nondiscrimination directive from the Colorado Division of Insurance has ensured that most insurance plans have to cover trans-specific measures if a doctor orders them.

Kattari adds that many of the negatives could be combated by reducing discrimination that trans people face, especially in doctors' offices. He says One Colorado plans to reach out to the trans community to help its members better navigate the health care system and advocate for their needs. The organization also keeps a list of trans-friendly health care providers.

And One Colorado plans to help doctors grow their understanding of transgender patients. Kattari says, the organization is encouraging physicians to take a free online class provided by the Colorado Medical Society that offers information about trans-specific health care.

Staff at the Colorado Department of Health and the Environment confirm plans to include gender-identity questions in upcoming health surveys. And Kattari is hearing from organizations in other states that want to conduct surveys like this. "The data is very popular," he says.

Zabel says she's happy to see some progress being made. When she was first coming out, she had bottled up so many emotions that her poor mental health had spilled over into her physical health, causing her to have what looked like epileptic seizures. She sought help from several doctors before she stumbled across the right one. She recalls vividly the first doctor she visited, who put his hand out at her in a "stop" position while she was mid-sentence, and said, "We don't do that."

"Getting a doctor that actually understands the transgender issues," she says with a sigh, "is very difficult."


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