Doors Slamming Shut on Trans Care

A Preamble

So much has happened so quickly since the Trump inauguration, so much of it damaging to marginalized people, that it's difficult for folks to keep up with what is going on. That is clearly the intent of Trump puppeteer Steve Bannon, with his desire to produce shock and awe, stir up society like an anthill, and remake it in his nasty image.

With so much going on, it's important that we make and listen to reports from the many fields of struggle, which is why I'm writing this post. But I do want to preface my report with a call for unity. We've been set up, by this initiation of battles on many fronts via tweets and executive orders. Our opponents in Washington hope to divide us. They hope that we'll splinter into "interest groups," each demanding primacy and seeing calls for help and attention from other embattled groups as acts of betrayal. Remember, the concept of "divide and conquer" is as old as the hills. 

None of us can fight every battle--but we can support one another's efforts. We have to focus our individual efforts on what we can do best to resist in our local communities, with the skillsets we each have. But we also need to have one another's backs.

So: I make this small field report, not to distract people from protesting the ban on refugees and travelers from seven Muslim-majority nations, or from pushing their representatives in Washington to oppose the nominations of unqualified ideologues to head federal agencies, or whatever other actions people are engaging in. I make it because we must keep one another informed of all the negative changes that are taking place. That's what we need in order to keep taking positive steps to resist.

A Trans Report from the Midwest

I am an employee of the state of Wisconsin, teaching at a state university. About a decade ago, the University of Wisconsin system added to its nondiscrimination clause protections based on gender identity or expression. Yet the insurance plans offered to people working and learning at University of Wisconsin schools all banned coverage of "procedures, services, and supplies related to surgery and sex hormones associated with gender reassignment." I've been fighting that ban ever since.

Until the summer of 2016, I got nowhere. It was a strange battle, because at every turn, I encountered expressions of surprise and sympathy from colleagues and benefits staff and administrators in the University of Wisconsin system. Colleagues presumed transition care must be covered by our insurance, since our antidiscrimination policy bans discrimination based on gender identity, and that must mean what it says. Human resources staff presumed the denial of coverage in our insurance plans must have originated with the insurance companies, and be their national exclusion policy. Upper university administrators saw that the discriminatory medical exclusion came from on high--proclaimed for all state employees by an entity called the Employee Trust Fund. But they regretfully stated that the university system couldn't tell the state what to do. They promised to bring the exclusion up as an issue to be addressed at the state level should an opportunity arise.

And so, year after year, I'd repeat this process of approaching people at various levels, reporting on the ongoing discrimination and asking for their help. I'd speak to them personally, and tell them how my family was impacted. With two gender transitioners and two disabled people in the little family of three I support, we couldn't afford any uninsured surgical care, and the lack of coverage for our trans endocrinological care was costing us between $1000 and $2000 a year out of pocket. Between our other medical expenses and the big hit my take-home pay received when the state withdrew much of its benefits support, my family's savings disappeared, and we have been sinking further and further into debt. And not being able to access surgical transition care is not "just" some issue of psychological discomfort for my wife and myself. It means relying on antiandrogens for year after year, with side effects that can be cumulative. It means relying on the extended wearing of chest binders for year after year, with their restrictions on breathing, exercise, and risk of rib injury. It means if we fly, we regularly get stopped by airport security and detained due to our "anomalies."

And year after year, the people I contacted would express sympathy, but do nothing.

Then, in the summer of 2016, the U.S. Department of Health and Human Services posted the "Final Rule to Improve Health Equity under the Affordable Care Act." And one of the things this document said was that health insurance could not discriminate on the basis of gender identity or expression. Blanket exclusions of transition-related care were stated to be unacceptable discrimination.

And lo! Based on this federal guidance, the Employee Trust Fund, the entity declaring policy for state benefits programs, instructed all the health insurers providing insurance to state of Wisconsin employees to remove the ban on trans care.

In the fall of 2016, my family received a letter from our insurer stating that the ban on coverage for transition-related medical expenses would be lifted on December 1, 2017. We put the letter up on the fridge and celebrated.

And then Trump won the election.

I wrote a social media post a few days after the election saying to watch out, because I bet that trans medical care coverage would disappear for people in red states soon after his inauguration in January. A batch of people replied in comments saying that of course things were uncertain, but that I shouldn't be so alarmist. Once rights are granted, they are very hard to take back, they said. Insurers wouldn't want to look bad. If insurers did try to put back blanket bans, they'd face years of lawsuits. And anyway, Trump said he was ok with Caitlyn Jenner using the women's bathroom in Trump Tower.

Who was right? Well, it seems under the Trump administration there is no such thing as an alarmist progressive worry.

What followed Trump's election in Wisconsin was an immediate flurry of activity in the state health insurance regulatory world. Insurers, who a couple of months ago had sent out sunny letters about how they did not discriminate and offered wonderful health care coverage to all, regardless of gender identity, had private conversations with the ETF. Soon, Governor Scott Walker and our anti-LGBT activist state Attorney General, Brad Schimel, were voicing their opinions that the federal bullies who had forced the state to offer trans medical care had no more influence, and the state should reassert its noble, sovereign right to discriminate. The ETF asked the Group Insurance Board for a ruling on whether a "rescission of coverage" would amount to a "breach of duty" to the employees of the state of Wisconsin. The GIB basically ruled, "No, go for it, once Trump is inaugurated."

The very first executive order Trump signed after his inauguration was one stating that Trump intended that Obamacare be repealed, and that meanwhile, all possible actions should be taken "to minimize the unwarrented economic and regulatory burdens" of Obamacare, and give the states "more flexibility and control."

And so, in the name of freedom, states rights, and economic security, the ETF acted. On February 1st, they issued a statement saying that "the exclusion of services related to gender reassignment is reinstated as of today."

One month. That's how long trans medical care needs were acknowledged to be valid in the state of Wisconsin. I didn't even get to have a single refill of my testosterone covered, because of a backorder at my pharmacy.

Hold the Doors

This is a moment where doors are swinging shut all over America. Due to racial and religious bigotry, they are being slammed shut at the national level in the faces of refugees who are fleeing the horrors of war. We must fight for the refugees and immigrants whose lives and livelihoods are endangered by anti-immigrant sentiments and actions. 

But we should also notice and help resist the other doors slamming shut on the smaller levels of state and local action. And the Wisconsin re-adoption of trans discrimination in health care for state employees is one of those actions.

So, can you do anything to help? Well, if you are actually a University of Wisconsin employee, especially an administrator, now is the time to stand up against transphobic discrimination and speak out. Perhaps you didn't know there was a ban on trans medical care coverage before. Perhaps you knew it existed, but thought that was true across the U.S.. Perhaps you knew it was an ETF policy, but thought of it as a sort of ancient fossil, some passive, unconsidered barrier. But now you know. The ETF has pulled the rug out from under your co-workers who are transgender, or have spouses or children who are trans. Coverage is clearly possible, since for one brief month it was offered. It is being denied in a blatant case of discrimination.

I realize that nobody at the University made this decision to reinstate the discriminatory policy. I know that it comes from the state, and that if you are an employee in the benefits office, you don't want to hand out discriminatory plans. University staff supervising and hiring individuals who are trans or have trans dependents don't want them to face unfair financial burdens and negative health and safety outcomes. You are just part of a large system.

But when you hear yourself saying, "I am a cog in a huge machine. I am just following orders," I hope that this makes you shiver, then shake yourself, and do something to resist. This is a habit that we need to develop or redevelop in these times, when talk of creeping fascism is not hyperbole.

Most readers, of course, aren't Wisconsin state employees. But you can help as well. You can contact state legislators via phone or fax. You can make a donation to a trans advocacy organization or the Wisconsin ACLU or other group. Most of all, what you can do is be aware of what is happening here as an example of what is happening in many states and localities now. Find out what is happening with regard to trans health care discrimination in the localities and states you live in or have connections to. Help raise awareness of the issue. There is so much to fight, now: xenophobia, racism, religious discrimination, misogyny. . . I'm not asking people to put transmisogyny and transphobia at the top of some list of deserving causes. I'm asking people to focus on the work they are best at, but when it comes to the list of issues they are not concentrating their personal work on, to make that an inclusive list. We need to have one another's backs, and help one another out where we can, though none of us can effectively take everything on. This is what I am trying me best to do.

And now you know one way to have my back. 

Transphobia, Racism, and Segregation

I want to talk about some contemporary issues, and how they relate to American history. The exclusion of trans people from facilities and organizations is not often framed as segregation, but that is exactly what it is, and I want to illustrate that. This will be a rather “heavy” post, but it's important to talk about recurrent patterns in American social history, so that we can learn lessons from our collective past. I'll be discussing patterns and parallels, not equivalences. Racial segregation in the U.S. came into being in the aftermath of racial slavery, the most extreme form of oppression our nation has seen, and one that, as a white man, I cannot claim fully to comprehend. Transphobic segregation does not have this terrible history directly behind it, for which I am grateful. That said, trans people suffer from segregation every day, and to understand the problem, and gain insight into solutions, we have to examine patterns of the justification of segregation across history.

Sometimes, as a trans person, it seems like every day brings another news story about some transphobic incident or initiative. At times there's a ray of light, but often it's followed by a dark cloud of backlash. I have two situations of this sort on my mind right now, both having to do with segregation. These situations illuminate a common thread in American history: the enactment of bigotry through segregation policies that are justified as somehow “protecting the innocent” by oppressing a minority group.

The first of these situations relates to an incident in which a trans woman was shopping at Macy's. When she took some items to a dressing room to try them on, she was denied access by a sales clerk. The customer went to the manager, who told the clerk to let her in to try on her items. The clerk refused, shouting that God doesn't recognize “transgendereds” and that the customer was thus just a man in a dress, about to violate a private women's space. Embarrassed by the scene and by the employee's noncompliance, the manager fired her. The clerk soon acquired a circle of religious advocates demanding her reinstatement, but Macy's actually quietly refused. (See here.)

The day that I read about Macy's asserting a nondiscrimination policy, I was pleasantly surprised. The store would not put up a symbolic “Cis Women Only” sign above the changing room. But, sadly and predictably, a lot of backlash followed. In just one of the actions taken in retaliation, Rep. Richard Floyd, a Tennessee republican, introduced a state measure prohibiting transgender people from using public bathrooms or dressing rooms that conflict with the sex listed on their birth certificates. (Tennessee, by the way, does not permit people to change the sex on their birth certificates when they gender transition.) What uproar this would have led to when bearded Tennessee-born trans men dutifully entered ladies' rooms, one fortunately has only to imagine, as the state sponsor of the bill chose to withdraw it as distracting the legislature from pressing economic issues. While the withdrawal brought me a sigh of relief, I keep hearing the words that Rep. Floyd spoke when introducing the bill:

“I believe if I was standing at a dressing room and my wife or one of my daughters was in the dressing room and a man tried to go in there — I don’t care if he thinks he’s a woman and tries on clothes with them in there — I’d just try to stomp a mudhole in him and then stomp him dry. Don’t ask me to adjust to their perverted way of thinking and put my family at risk. We cannot continue to let these people dominate how society acts and reacts.” (See here.)

Floyd's words follow a time-worn groove in the politics of bigotry in America. A minority group is framed as posing some imaginary threat to privileged innocents, and segregation and violence against that minority are thus framed as justified. The U.S. saw such violent “logic” on a vast scale after the end of the Civil War and the manumission of all who were enslaved. Here are the words of Sen. Benjamin Tillman of South Carolina, speaking on the U.S. Senate floor in March of 1900 in favor of racial segregation and against voting by African Americans: “As to the Negro's 'rights,'— I will not discuss them now. We of the South have never recognized the right of the Negro to govern white men, and we never will. We have never believed him to be equal to the white man, and we will not submit to his gratifying his lust on our wives and daughters without lynching him.” (See here.)

The wave of racist violence against African Americans in the wake of Reconstruction took place on an appalling scale. Between 1889 and 1940, 3800 lynchings of African American men and women were reported—and doubtless, many more went unreported. There was a claim that most of these were in retaliation for black men raping white women in what was termed the “New Crime,” supposedly caused by black men reverting to a “savage type” once the “civilizing influence” of slavery was removed. In fact, as activist and author Ida B. Wells found in her research on 728 lynchings, the majority of lynching victims were not even accused of rape, but of crimes such as “quarreling with Whites” and “incendiarism.”

There is a difference of scale in the level of violence faced by African Americans after Reconstruction and by trans people today. But contemporary transphobic policies and violence follow this historic pattern of blaming the true victim. Rather than owning their bigotry, legislators, street thugs and shop clerks claim that the trans people they exclude or assault “started it.” We don't enter a restroom to use the toilet, they claim: we come in to sexually assault those in the women's room or challenge those in the men's room, so segregating us and/or assaulting us is justified. Any violence against us is framed as merely self-defense, or as defending the honor of women and children. The fact, of course, is that trans people are the victims, and our “offense” is not attacking the “helpless,” but challenging the worldview of an angry, privileged, insecure group.

And so we see our first theme: the projection of violence onto the victims of bigotry.

Justifications for both racial segregation and the segregation of cis and trans people are unfortunately often based on religious worldviews—as the sales clerk justified her actions at Macy's. Many religious organizations are firmly in favor of trans people's rights. But in the U.S., transphobes often present their ideologies as dictated by the Bible. The standard claim of contemporary transphobic Christians is that gender transition violates God's plan:

“Most basic to our understanding оf sex іѕ that God created twо (and оnly two) genders: “male аnd female He created them” (Genesis 1:27). All the modern-day speculation abоut numerous genders—or еven а gender “continuum” wіth unlimited genders—is unbiblical. . . God’s creation оf еаch individual muѕt surely include His designation оf gender/sex. His wonderful work leaves no room for mistakes; nо оnе іѕ born with the 'wrong body'. . . In the Law, transvestism / transvestitism wаѕ specifically forbidden: 'A woman muѕt not wear men’s clothing, nor а man wear women’s clothing, for the Lord your God detests аnyone whо dоes this' (Deuteronomy 22:5). . . Transgenderism іs not genetically based, аnd іt is nоt simply a psychological disorder; it iѕ rebellion аgainѕt God’s plan.” (See here.)

(The fact that sex is indeed a spectrum, which is something that as an intersex person I am aware of every day, raises a problem for this worldview. I once asked an evangelical leader how he could reconcile his claim of divinely-created gender dyadism with my intersex birth status, and the prevalence of intersexuality in all species. He responded that God did not intend for me to be intersex, but that in a world of sin birth defects occurred, and that in the world to come there would be no “errors” like me. . . which conflicts with the simultaneous claim that “His wonderful work leaves no room for mistakes; nо оnе іѕ born with the 'wrong body'.” There is a great illogic in claiming that people born with intersex bodies that bother the majority have defects that must be medically corrected, but nonintersex trans people cannot seek these same medical services because God makes no mistakes.)

Transphobic Christians see in gender transition more than a case of “individual sin;” they see a danger to society as a whole. The entire LGBT community is framed as sexually perverse, polluting society with the belief that sexuality need not be limited to the confines of a marriage between one person who was assigned male at birth and one person who was assigned female. Trans visibility is seen as carrying a further seductive and contagious danger: the idea that both physical sex and gender roles are mutable, which will spread to children and confuse them about their “true” sexes, making them rebellious. In questioning their sexes, they believe, their children will question God's plan as manifested in human bodies since the creation of Adam, and Eve from Adam's rib. Children who question their sex also question Adam's superiority and Eve's submission to him. Thus, trans people threaten the “proper” order of all gender relations in society.

This framing of a persecuted minority as posing a threat to the plan God made manifest in the body also has a long history in the U.S.. Consider this editorial published in a Madison, Wisconsin newspaper, the Daily Argus and Democrat, on September 11, 1857. The editorial advocates in favor of racial segregation, and bases its argument on the idea that segregation will prevent interracial relationships, which are against God's plan:

“Our Creator clearly never intended these two widely dissimilar races to fraternize; if he had wanted them to be one, he would have so made them—but he has placed, with his own finger, a mark , in color, intellect, physiognomy, and other strongly marked characteristics. Whenever these lines of demarkation are endeavored to be obliterated by amalgamation, the white race has been degenerated, enfeebled, and degraded, as a natural consequence.”

Though written a century later, the 1959 order of the trial court in the case of Loving vs. Virginia uses quite similar language. (It would eventually be overturned by the Supreme Court, putting an end to bans on interracial marriage in the U.S.) In sentencing Mildred and Richard Loving to jail under Virgina's Racial Integrity Act of 1924 for having married out of state and returned to Virginia, the trial court wrote: "Almighty God created the races white, black, yellow, malay and red, and he placed them on separate continents. And but for the interference with his arrangement there would be no cause for such marriages. The fact that he separated the races shows that he did not intend for the races to mix."

So we see another recurrent theme: a claim that bigoted civil policies follow God's plan as made clear in the color and shape of the flesh.

I want to examine one more theme—the way that gender and sexuality play out in enforcing marginalization. To do this, I want to turn to another story in the news: that of a 7-year-old Colorado trans girl, whose application to a Girl Scout troop was first denied, then accepted, leading again to lots of backlash. I've already noted that LGBT communities are framed as sexually perverse by bigots. Now, trans people are a gender minority, not a sexual minority. Gender transition does affect sexuality (a person who had been perceived as a straight man is categorized as a lesbian after transitioning, for example), but this is epiphenomenal rather than the cause of gender transition. We gender transition based on our gender identity, not for sexual reasons. Still, gender transgression is so linked in the popular imagination with “homosexuality” that it may seem inevitable that trans people would be viewed by bigots through a sexual lens. But the evocation of sexuality in American bigotry predates LGBT rights movements, and plays out even when sexuality should be deemed a nonissue.

Trans women have been slandered as men costuming themselves as women in order to gain access to women's private spaces to peep upon and sexually assault them by all sorts of groups. Excluding trans women from women's bathrooms, locker rooms, and other “safe spaces” is justified through a familiar Western system of sex/gender ideologies which frames “good women” as fragile sexual victims, to be put on a pedestal in a gilded cage. This same belief system frames even good men as sexual aggressors, able to control themselves around chaste good women, but naturally and excusably provoked by the actions of bad women to take sexual advantage of what is “offered.” Trans women suffer the doubly-negative fate of being framed as sexually aggressive men when in a woman's space, and as bad women who are “asking for it” in a men's space.

But Bobbie Montoya, Girl Scout aspirant, is seven years old. We contemporary Americans should see her as asexual, an innocent child. And yet the rhetoric deployed against her is remarkably unaltered from that directed at adult trans women. First of all, she's trying to enter a girl's space, so she's constantly being framed as a boy. The large majority of news reports blare “Boy Wants to be a Girl Scout,” or something similar. (See, e.g., this.) More importantly, she's framed as posing some sort of ominous threat by transphobic organizations. Three Louisiana Girl Scout troops that disbanded to protest the Colorado troop's action described the admission of trans gender children as not only “extremely confusing” for “normal” children, but as posing a danger to girls. (Here.) In a viral video calling for people to boycott Girl Scout cookies over the trans girl's admission, a 14-year-old Girl Scout says not only that the “radical homosexual agenda” of gender transition can't be permitted and that the trans girl is a boy, but that her presence endangers the other girls' safety. (Here.)

Bobbie Montoya is a button-eyed tot, not even four feet tall, living under extreme scrutiny. She poses no risk to anyone. And yet those fighting against allowing her to desegregate a cis gender Girl Scout troop continually evoke some sexual risk, some nameless dread. What this makes clear is that the justification of segregation as self-defense against a sexual risk has no relation to reality. It is a strategic claim, a trope. The fact that it emerges in the case of trans kids just makes this more obvious.

The gendered nature of the claim of sexual risk means that the bigotry faced by trans people differs a lot by gender. Trans women get the short end of the stick, attacked as victimizers when framed by the prejudiced as men, and sexually victimized when framed as women. Trans men suffer too, but not quite as dramatically. When framed as men, we can be attacked as victimizers, but when framed as women (as we often are by transphobes), though sometimes we are sexually victimized as “bad girls” who are “asking for it,” often we are put in the less physically dangerous (if unpleasant) position of being treated by bigots as pitiful and ugly self-mutilators who must be protected from ourselves.

This pattern of gender differences echoes the dangers faced by African American women and men after Reconstruction. Black men faced a great risk of being physically attacked by racists because they were framed as the most dangerous of male sexual aggressors. White fantasies about black male size and sexual violence were quite potent. For example, one white man who joined a mob of people flocking to look at the body of a lynching victim wrote that “the crowds from here that went over to see [the victim] for themselves said he was so large he could not assault her until he took his knife and cut her, and also had either cut or bit one of her breast off.” (Here.) In fact, stories like these were urban (or rural) legends, fantasies with no relationship to the actual cause of the lynchings, which were usually retaliation against the victim acting in a nondeferent manner, challenging a white man, rather than some accusation of rape. But these violent stories allowed white mobs to feel justified in torturing victims before lynching them, and in mutilating their bodies afterwards.

African American women in the period after the Civil War were the group that actually suffered from an epidemic of transracial rape, in a reality that was an inversion of the myth of the “New Crime.” Evidence of this lies in the marked increase in the proportion of mixed-race children born to African American mothers in the period after the war.

What we see in the case of racial violence after the Civil War is a series of projections, in which a bigoted white majority reversed the positions of victim and attacker. This pattern is echoed by transphobic assaults today in the “trans panic” defense. A cis man who encounters a trans woman and finds her sexually attractive is viewed by bigots as justified in assaulting her for “tricking him” into finding her alluring, her very status as trans woman inviting violence. A cis man who kills a trans woman and claims she initiated a sexual encounter with him, after which he discovered her trans status, routinely walks away with little or no jail time—even if that claim seems patently implausible (see, e.g., this). Conversely, trans men are at risk of becoming victims of “corrective rape” by transphobic straight cis men who find them attractive, their trans status being seen as a provocation, with the chances of prosecution being slim.

It becomes clear when examining the way that gender and sexuality are filtered through bias that those who are the victims of segregation are also the victims of sexual assaults and sexual myths. And yet segregation is justified in the name of protecting the “innocent” majority from a supposedly dangerous, deviant minority group.

What lessons can we draw from the parallels we've seen? In enacting segregationist policies, whether in the case of race or gender identity, there are two bases commonly drawn upon. The first is a claim that the marginalized group represents a sexualized threat to the majority—a claim that is inversely related to actual victimization. The second is a religious claim that God has written an intent that the minority be discriminated against in the flesh—in the color of the skin, or the shape of the body—and that religious order demands enforcement of discriminatory policies. The first claim can be opposed by marshalling the facts to point out empirical reality. The second can be countered by noting both the diversity of religious opinion and the constitutional separation of church and state in America.

The lessons of history show that fighting segregationist policies requires social movements, not just logical arguments. It took many marches and sit-ins and protests to bring about racial desegregation. Furthermore, ending segregation at law doesn't end it in practice. The results of racial desegregation in the U.S. have included the gradual defunding of integrated public transportation, white flight from integrated neighborhoods, and the ongoing de facto segregation of schools by neighborhood. Today, I live in the most racially segregated major metropolitan area in the U.S., so this reality is clear to me. The suburb next door, a former segregated “sundown town,” is now under 2% African American, while African Americans make up about 35% of the total area population. (Map.) So I don't want to come across as implying that ending formal segregation is a sufficient solution to the problem. It isn't. But we live in a time of great flux for the rights of trans people, with nondiscrimination policies and discriminatory policies both being added to the books around the country. I do believe that if advocates for trans people can make clear the continuity between regulations excluding us from facilities and organizations, and the laws that enacted racial segregation in the U.S., it would affect the way some people see us. It's not a panacea, a magical solution, any more than ending legal racial segregation has solved the problem of racial inequality—but it is something worth doing.

So, please, if you have a discussion about discrimination against trans people, use the term “segregation” to refer to our exclusion from schools, public facilities, and organizations. Because segregation is exactly what it is. And point out that the supposed sexual risk posed by integration is a myth—as is abundantly clear in the case of letting a little trans girl into the Girl Scouts. We're not out to “get” cis people. We just want to be able to use the bathroom like anyone else.