D'Angelo Alexa B, Dearolf Michelle, Restar Arjee, Tsui Emma K, Zewde Naomi, Grov Christian
CUNY Institute for Implementation Science in Population Health, New York, USA; CUNY Graduate School of Public Health and Health Policy, New York, USA.
Departments of Epidemiology and Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA; Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA.
Soc Sci Med. 2025 Feb;366:117666. doi: 10.1016/j.socscimed.2024.117666. Epub 2024 Dec 30.
Over the past decade, access to and insurance coverage for gender-affirming medical and surgical treatment for transgender (trans) individuals in the U.S. has improved. Despite this, trans individuals continue to experience insurance-related barriers to gender-affirming care (GAC)-and in particular, transmasculine individuals may face gender-specific barriers resulting from regulations on masculinizing hormones. In this study, we interviewed transmasculine individuals from across the U.S. about their gender-affirming care experiences with a focus on insurance, payment and policy-related barriers to care. Interviews were conducted via video-conferencing software, analyzed using a codebook approach to thematic analysis, and contextualized within a broader analysis of the policy landscape dictating coverage for gender-affirming care. Participants reported insurance denials for gender-affirming care, as well as challenges with prior-authorization requirements, letter requirements, restrictive formulary lists and other challenges that complicated and/or barred access to care. Many discussed adaptive strategies to these challenges, which included utilizing community resources and knowledge, as well as receiving material support from family, friends, and partners, and developing technical and interpersonal savvy skills in response to insurance challenges. Participants expressed a range of emotional responses with regard to payment and related challenges, from annoyance and frustration to hopelessness. Our findings illuminate the persisting challenges that transmasculine individuals face when attempting to access and pay for gender-affirming care, despite improvements in insurance coverage and legal protections in recent years resulting from the Bostock ruling by the Supreme Court and the expansion of the ACA's Section 1557.
在过去十年中，美国跨性别者获得性别肯定性医疗和手术治疗的机会以及保险覆盖范围有所改善。尽管如此，跨性别者在获得性别肯定性护理（GAC）方面仍继续面临与保险相关的障碍，特别是跨性别男性可能会因男性化激素法规而面临特定性别的障碍。在本研究中，我们采访了来自美国各地的跨性别男性，了解他们在性别肯定性护理方面的经历，重点关注保险、支付和与政策相关的护理障碍。访谈通过视频会议软件进行，采用编码本主题分析方法进行分析，并在对决定性别肯定性护理覆盖范围的政策环境的更广泛分析中进行背景化。参与者报告了性别肯定性护理的保险拒绝情况，以及在预先授权要求、信件要求、限制性处方清单和其他使获得护理变得复杂和/或受阻的挑战方面遇到的问题。许多人讨论了应对这些挑战的适应性策略，包括利用社区资源和知识，以及从家人、朋友和伴侣那里获得物质支持，以及为应对保险挑战而培养技术和人际交往方面的机智技能。参与者对支付和相关挑战表达了一系列情绪反应，从恼怒和沮丧到绝望。我们的研究结果揭示了跨性别男性在试图获得和支付性别肯定性护理时仍然面临的挑战，尽管近年来由于最高法院的博斯托克裁决和《平价医疗法案》第1557条的扩大，保险覆盖范围和法律保护有所改善。
