By Ramona Rose, Member of Southeast PA Healthcare Committee
If there is one thing that no one likes when it comes to scheduling doctors appointments, it is the concern of insurance standing in the way. Whether it’s with an NSI number just so you can see a specialist, or being told you cannot access a specific medication because it’s “not covered,” a firm denial of benefits when you need them most will always remain the hassle that it is: health insurance puts profits over people. To have the ability to make my own medical decisions should be clear and simple. When I know I am sick or when I know my loved ones are sick, I take care of my needs and their needs because I am present in the situation. An insurance company is not present. It is only present in-so-far as it will be paid for services that they are claiming to cover but then can choose on a whim to not cover at all. Why is this? Because if the insurance company is not making a profit to give to their shareholders, then the venture is not worth the cause. That leaves us – the everyday folks, the working class – the people who are most affected by these sudden whims to worry and stress over what to do. What is a common experience we all share? Having the insurance company swoop in and tell us what we deserve in our health care, and what THEY are willing to pay out for it. All in the name of a shareholder making extra money without putting in the work.
When I was a teenager, I had a lot of discomfort with my body as well as anxiety and depression. I did not like shaving; I did not always like my breasts; and don’t get me started on periods. I was diagnosed with Premenstrual Dysphoric Disorder (PMDD) due to my sudden changes in mood and overall dysphoria of my body during the time of my menstrual cycle. As a teenager I had an irrational fear of losing friends if I so much as shared my experiences regarding my diagnosis. But in order to protect myself, I had to hide my true feelings about the perception I had of my body which took a mental and emotional toll back then. It would not be until much later in my life that I would realize I was genderfluid and learn to accept myself.
I consider now what gender-affirming care might have looked like had it been an option when I was a teenager going through all those experiences. Since 2014, gender-affirming care has been covered under Medicaid. Being denied that ability to take care of myself played a pivotal role in my overall health. I felt unworthy of care. In reality, I know I am worthy of care but what does that mean for others who have similar feelings and experiences regarding their health? It hurts us when we are made to feel that we do not deserve access to healthcare when in dire need.
However, having the ability to make healthcare decisions for myself precludes that I have access to healthcare. It is still hard to obtain any kind of health care if you are poor, working class, or a person of color. A major obstacle that keeps us from obtaining healthcare is insurance benefit denials. Medicaid offers many kinds of services to people of various backgrounds and identities. When I was on Medicaid in 2018, it relieved me to know I would be able to obtain affordable medications and seek care when I needed it. However, insurance companies are only interested in for-profit needs. The money in the palm of the company’s hand holds more value than the mind and physical health of any given person. A patient and their care is considered to be a transaction of goods rather than a continuation of overall health. For example, a patient might have a conversation with a doctor about gender-affirming care and/or HRT and be ready to start the process. But insurance, acting as the middleman, can tell that patient the dosage for their HRT does not meet the guidelines and parameters set and enforced by the insurance company. All kinds of care are denied by insurance, not just gender-affirming care. A plan of care is firmly established between the patient and the doctor. Yet someone who has no experience in the medical field gets between the patient and their ability to obtain medication from the pharmacy or a procedure that might save their life. We know what we need to take care of ourselves. The doctor knows how to give patient care on the ground. Why must an insurance company have final say in this decision?
I can only imagine our country’s children becoming adults and having to navigate Medicaid and insurance for the first time. Insurance companies should not have the final say in our health care. It is not just trans youth and adults who are affected by this. EVERYONE is affected by this!. Keep in mind that even though I refer to my plight as a member of the trans community, there are so many examples within our communities that need healthcare as a whole. Men, women, and children in this country muddle through the same issues with insurance denials. If we had the right to healthcare, we would not be struck by the worries and constraints of this system. In order to do that we must organize across all these lines that divide us! We can puncture the bureaucracy. Our organization, Put People First PA, assists those affected by our burdening healthcare system. We have assisted with the reversal of medical bills. We helped community members fight insurance denial claims, and had them appealed! We can fight for our right to healthcare so no one will experience the pain of denial.