I quit my full-time job as a bank teller to become a full-time freelance journalist on April 20, 2017. I had never done anything so rash before. I was always the person who made reasonable decisions, going from safe job to safe job, trying to slowly build a better life for myself. But after successfully publishing a few scattered bylines in online outlets like Vice, I decided to jump off the career cliff into the great unknown of working for myself.
My access to that essential care is now being quietly threatened by the Trump administration.
And I couldn’t have done it without the Affordable Care Act and its coverage of gender-affirming care.
But my access to that essential care is now being quietly threatened by the Trump administration. Last week, the Department of Health and Human Services put out a proposed rule that would change a wide range of policies under the ACA — including shortening the open enrollment period by a full month, ending eligibility for ACA plans for DACA recipients and no longer requiring gender-affirming care coverage as an essential health benefit on all ACA individual and small group plans.
“This means that insurance plans would no longer be required to cover treatments related to gender transition, such as hormone therapy, puberty blockers, and surgeries,” Matthew Rose, senior public policy advocate at the Human Rights Campaign, told me in a statement. “As a result, many insurers may drop coverage for these services or shift the costs to individuals and states. If a state mandates coverage for gender-affirming care outside of the federal EHB requirements, it would have to pay for the coverage itself. This could make gender-affirming care more expensive or inaccessible for transgender individuals, particularly those with lower incomes.”
If this rule, which is open for public comment, gets implemented, I could lose coverage for vital hormone prescriptions and doctor’s appointments.
I’m not alone in worrying about this. According to available data, trans people are more likely to be uninsured than the average cisgender person, and though numbers are hard to come by, trans people appear much more likely to get insurance from a government-subsidized program like the ACA or Medicaid.
HHS estimates that more than 45 million people have ACA plan insurance. If you use the conservative estimate that 0.6% of the population is trans, rough math says that as many as 270,000 people could lose access to the gender-affirming care coverage that they’re currently paying for. The rule, if put into place, would go into effect starting next year, depending on the outcome of likely inevitable lawsuits.
The proposed rule change has gotten surprisingly little media attention so far, with few outlets reporting on it. The administration’s quiet rollout has seemingly worked, as the rule had received only about 5,400 public comments as of Tuesday morning.
Nevertheless, a ban of this nature on gender-affirming care would be unprecedented. This type of care has been consistently covered since 2016, including through the entirety of President Donald Trump’s first term.
And this proposed rule, more so than the passport nonsense outlined in the administration’s early executive orders, represents the most alarming government attack on my personal life since Trump took back the White House.
Conservatives have a track record of trying to cut funding for things they don’t like by claiming “my tax dollars shouldn’t fund that” — think, “my tax dollars shouldn’t fund abortions.” Now they’re doing the same thing here, claiming they should have personal veto power over tax dollars spent on trans people they have increasingly villainized in recent years.
But the conservative argument doesn’t work here, for several reasons. In my case, I don’t receive government subsidies for my ACA plan, meaning I pay the entire $500 premium every month myself, with my own money, out of my own pocket. Your tax dollars aren’t going toward my health insurance; it’s just that the government set up the marketplace I buy my plan on. This is like buying a car and then eight years later having the owner of the car dealership show up on your doorstep to tell you that you can’t drive it in Vermont anymore. We have afforded conservatives special rights to divest taxpayer dollars from whichever policy they find offensive. The second reason this argument doesn’t work is that no one else is given such deference in politics. When George W. Bush was in office, I couldn’t, as a liberal, stop the government from using my tax dollars to fund wars I opposed. I couldn’t stop the government from using my tax dollars to pay for the expansion of the surveillance state. Right now, I can’t demand that my tax dollars not enable whatever the heck DOGE is doing. (And all of these examples dwarf the amount of money the U.S. spends on abortions or transition care.) That’s not how politics works. And it’s weird that we have afforded conservatives special rights to divest taxpayer dollars from whichever policy they find offensive. When I made the jump to working for myself, someone else was able to take my position at the bank, helping to lower the unemployment rate. If my essential health care gets ripped away from the public marketplace, I’ll be forced to again compete for a job that someone else probably needs more than I do, simply so I can get the appropriate health care. Regardless of the politics of the moment, we shouldn’t be discouraging folks like the 2017 version of myself. I took a leap of faith, backed by a belief in my own abilities and confidence in a government-run insurance marketplace. If you agree, feel free to leave a public comment letting Trump know that this rule shouldn’t go through.
Katelyn Burns is a freelance journalist based in New England. 
