The high cost of being a transgender person in Las Cruces

June 21--LAS CRUCES -- While Caitlyn Jenner's widely-publicized transition was unquestionably courageous, the former-Olympian's finances allowed her to avoid one significant obstacle faced by many in the Las Cruces transgender community -- the costs. Presumably, Jenner didn't struggle to find a doctor who would administer care, or wrangle with insurance companies to provide payment. These are constant challenges faced by transgender people in towns and cities across the nation, including Las Cruces.

Overwhelming cost

"It's been really hard. It's been a lot of work," said Eusabia Gilbert, a transgender male-to-female, who continues to deal with the financial burden of her transition. "The out-of-pocket expense has been tremendous. And I've looked around to find insurance coverage, but haven't been able to find a policy that meets my needs."

Gilbert said that the cost of hormone therapy is burdensome -- currently costing about $300 each month -- and that the final surgery she needs will cost nearly $25,000.

"There is also the cost of a therapist, which is often necessary before a doctor will agree to do the sex reassignment surgery," Gilbert said. "In my case, I had a nose job and breast augmentation. But even the simpler things, like the cost of laser hair removal, can be overwhelming. The legal costs of changing your name and gender marker can run into the thousands."

J.T. Perez, a Las Cruces resident transitioning from female to male, said that he too has struggled to bear the financial burden.

"I haven't gone through the steps yet, with surgery, because I'm waiting for something to progress," Perez said. "And progress is being made, even as we speak, in terms of Medicaid and Medicare coverage. I used to work in the insurance field, and I know that it will have to change. A lot of people have been fighting that fight for a long time, but when it happens, there will be a domino effect."

Perez -- who receives disability benefits due to major depression, the result of a lifetime of dealing with gender-identity issues and the complexities involved -- receives some assistance for hormone therapy.

Virtually every major health-related professional organization has called upon public and private insurers to recognize transgender care as medically necessary -- including the American Medical Association, the American Psychiatric Association, the American Academy of Family Physicians, the American Psychological Association and the American College of Obstetricians and Gynecologists, to name a few. Despite this, most insurance companies don't.

Loopholes abound

"In general, if a person has health insurance, it's unlikely that it will cover trans-related care, even if it's deemed medically necessary," said lore dickey, vice president of the Jim Collins Foundation, a New York City-based nonprofit organization which advocates for transgender rights. "And even if plans cover it -- whether it's hormones or surgery -- insurance companies put up additional hurdles to avoid paying."

Many doctors will only provide services through private pay, rather than fighting with the insurance companies over payment, said dickey, who intentionally spells his name lowercase. As a result -- without the insurance companies negotiating the price on their behalf -- patients end up paying more.

The Jim Collins Foundation offers two or three grants each year to transgender applicants, to pay for "gender-confirming surgeries" related to their transitions. However, the foundation can only meet the need of a tiny percentage of applicants nationwide.

Progress is slow

The Affordable Care Act moved the ball forward, if only by a half-measure, by explicitly prohibiting sex discrimination if a hospital receives federal funding, according to the National Center for Transgender Equality.

"To me, what has really begun to shift the landscape around funding is the decision about Medicare, which updated the rules so that transgender care is determined on a case-by-case basis," dickey said. "For decades, they categorically refused all trans-related care, calling the hormones and surgeries 'experimental.' There are now six states where Medicaid will cover hormones and surgeries. Things are beginning to change, but it's slow moving. The problem is that people's lives are at stake here."

Gilbert, who recently moved back to Las Cruces from Phoenix, said that she and her husband may be forced to move back to Arizona if she isn't able to receive coverage here.

"We nearly moved back to Arizona recently, because I was able to receive more affordable care in Phoenix," Gilbert said. "I went in to see my doctor -- who is really good, and has worked so hard to get the insurance to cover my treatment -- but she told me that, despite her best efforts, they were refusing to cover my medication and hormones."

A reason for hope

Gilbert said that she's hopeful that a resolution may be reached, and there's reason to believe that her hope isn't misplaced.

According to Perez, Equality New Mexico, working with the American Civil Liberties Union of New Mexico, has made some progress in the realm of Medicaid coverage within the past few weeks.

The managed care organizations, which are contracted through the state to provide Medicaid, have agreed to take steps to better serve transgender patients. While it's unclear how this will play out with the MCOs -- which include Blue Cross Blue Shield, Presbyterian and Molina -- it's believed that the agreement reached will make it easier for transgender patients to receive services that are medically necessary, and not considered to be cosmetic.

EQNM and the ACLU-NM could not be reached for comment.

A need for doctors

"The continued shift in what's happening with insurance is important," dickey said. "But no matter how good my insurance is, it doesn't do me an ounce of good if I can't find competent physicians. We absolutely have to be training our physicians to be culturally competent with all of their patients."

Perez and Gilbert said it's a problem they experience in Las Cruces, too.

"We need more doctors here," Perez said. "We need therapists, we need endocrinologists, we need surgeons. I know of one transgender person who went to her regular doctor, and was turned away and told, 'We're not going to see you because of the way that you look.' So she had to go to St. Luke's. We still face discrimination."

Even the cost of traveling to a larger city, like Albuquerque, Santa Fe or Tucson for treatment can begin to add up.

"I wouldn't want to have to go to Albuquerque every week, just to see a therapist who is familiar with trans issues," Perez said. "Thankfully, right now I don't. But it's not outside the realm of possibility that one day I might. But it's such an important part of this that I would if I had to."

Already marginalized

Perez said that transgender people often have trouble finding work.

"There's still a lot of discrimination based on being transgender. It's not like we're going to get the best jobs, or be considered for that big promotion, because of the way we look," he said. "If I'm looking for a job, I'm going to try to look at state-run programs in the healthcare field, or maybe a nonprofit that deals with equality issues. It's very difficult, and the options are extremely limited."

While New Mexico is one of 19 states (plus the District of Columbia) in which nondiscrimination law covers gender identity, the nationwide statistics on transgender unemployment are staggering. According to statistics from the Human Rights Campaign and the Center for American Progress, transgender workers report unemployment at twice the rate of the general population -- 14 percent versus 7 percent, at the time the survey was conducted. Forty-four percent of transgender people currently working are underemployed, and transgender workers are nearly four times more likely to have a household income of less than $10,000.

Education and understanding

For transgender people, discrimination is a common occurrence.

"For transgender people, it's an uphill battle they're having to fight in order to survive," dickey said. "Most have had struggles in their home life, they're unable to get an keep a good job. It can lead to a whole lot of bad things -- depression, addiction, suicide. I have to believe that the everyday stressors contribute to that."

Gilbert and Perez both said that raising awareness is the first step toward ending discrimination.

"People compare us to rapists, murderers and pedophiles," Perez said. "That's what gay people used to be compared to; that's what they said about alcoholics. It's a complete misunderstanding of what other people are like -- and we're the 'others.' I think that the Caitlyn Jenner announcement can make an impact, and it could be a lasting impact, but it's going to take some time to change some minds."

Gilbert said that she feels it's critical for people to educate themselves if they feel they don't understand gender identity.

"I hope that the conversation around Caitlyn Jenner is more than a fad, and that people will actually educate themselves," Gilbert said. "I hope that it leads to a better understanding of people like myself. If this can lead people to stop killing people like me -- and for people like me to stop killing themselves -- then we'll really see some progress. We'll really move the conversation forward."

Damien Willis can be reached at 575-541-5468.

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