Medicare for All

With all the threats facing our country – climate change, a predatory economy, corporations buying our elections, and the overt move towards fascism among the far right – you would think that politicians would be laser-focused on the existential crises descending upon us. But instead, politicians in the US are devoting a considerable amount of their energy these days to an all-out assault on the rights of transgender people. Although the war on trans people has taken many forms, from bathroom bills to restricting school curricula, one of the most chilling is the denial of basic gender-affirming healthcare. Now, in places like Texas, elected officials have gone even further by targeting healthcare access for the most vulnerable trans folks – trans kids. In this episode, we’re joined by one El Paso family and a local gender-affirming care doctor who are fighting back!

Our guest today is Lori Edwards. Lori is the Director of the Intergenerational Rainbow Link at Borderland Rainbow Center in El Paso, Texas, an organization that provides a number of services to queer people in their community. Lori is a mama bear to her two trans/gender fluid teens, as well as any person who finds themselves in need of a mama bear nearby. She has a BSNS from Purdue Global, is a certified Mental Health Peer Specialist and pulls from backgrounds in both emergency medicine and education to function as a Jane of all trades who’s ready to tackle the unexpected. As an El Paso native, Lori returned to the borderland with her husband to raise their children close to family.

Liana, who is Lori’s daughter, is a 16-year-old trans girl who loves gaming, singing (rapping in particular) and is a student athletic trainer at her high school. She is also a Girl Scout and local advocate for LGBTQ rights in her city. Along with helping the family foster for a local pug rescue, she loves spending time with her 2 cats, 2 pugs, and 4 fish.

Dr. Toni Marie Ramírez is a family medicine physician with several years of experience in gender-affirming care. She received her undergraduate and medical school degree from Brown University and trained in family medicine at the Santa Rosa/UCSF family medicine residency in Northern California. She was born and raised in Socorro and moved back to El Paso in 2020 to be with family. Her work is strongly grounded in social justice and equity, valuing the power of community empowerment.

As a family medicine physician and gender-affirming care provider, Toni shares that those entering the medical field with the intention to provide and contribute to the health and well-being of a community, quickly realize that the healthcare system is not set up for this. We pathologize what is outside the norm in this colonized world and the medical community ignores the healthcare disparities of the trans community. Her 10-year experience in providing care has shown that it is astonishing how little medical providers know about gender-affirming care.

Gender-affirming care is not part of the curriculum in medical school, let alone residency. This allows medical providers to uphold this gender binary in medicine. Starting from the very beginning, our socialized aspects infiltrate the way medicine is practiced and taught. When it comes to the access aspect that comes from that, physicians are already not educated enough to provide such care. We live in a world that is very binary and the reason why there are so many disparities is not because of anything innate to trans or gender-diverse folks, but because of the transphobia that exists in the world and the transphobia that exists in medicine.

Sometimes people don’t access care because of a fear of discrimination or outright denial of care. Even in a progressive area of California, where Toni practiced, there are so many barriers to accessing care: (1) for feeling safe, (2) there was only one gender-affirming clinic in the entire county, (3) the insurance companies and the cost of seeking care. In California, there’s a law that insurance companies must cover gender-affirming care. That being said, there are loopholes around this and Toni spent a lot of her time talking with insurance companies and explaining to them the operations were medically necessary. Even in the most progressive places, we’re seeing constant barriers to access to care.

Transphobia in the marketplace from employers prevents trans folks and queer folks from getting good jobs that have good benefits and insurance coverage. Any transphobia we see in hiring just in the economy translates into discrimination against trans and queer folks.

On June 2 (just in time for Pride month), Texas Governor Greg Abbott signed a bill into law that would ban gender-affirming care for trans youth. Without some kind of judicial intervention (which I know we are all hoping and praying for), the law will go into effect on September 1. For Lori and Liana, the worries about the law started in February of last year, when Gov. Abbott and Ken Paxton put out their opinion letter telling CPS to investigate her and her husband. They specifically wanted to call them unfit parents and that they were abusing Liana.

Liana was very young when everything first started happening and we were rolling out of COVID. Liana slowly started thinking “Wow, I don’t have a future”. To look at kiddos who have that thought process makes everything impossible including setting goals. As a mother, looking at your kid and saying “Hey, we’re gonna get through it” when the internal monologue is “Texas doesn’t want me to get through it”, it is very hard to maintain grades and social relationships and to set goals. S.B. 14 was the biggest slap to their face and wanted to testify in Austin as soon as they found out.

Toni shared that the law has impacted adult patients she sees even though it does not directly affect their care. They are fearful and appropriately paranoid about what the next steps will be for them in Texas. Kids could just be the first line of attack because they are more vulnerable than adults. There are several bills that may directly impact gender-affirming care for all ages in the future if they pass.

At Healthcare NOW, we train our activists who have been impacted by the healthcare system how to tell their story publicly, which is 100% needed if we want to win social change but can be very challenging, and emotional labor, and you can put a target on your back for criticism.
Liana and Lori have both been really brave and vocal about defending trans kids. Liana spoke out for the first time publicly at an El Paso Matters interview, where it felt awkward for her at first but after she realized that a lot of people would look up to her words and use them for guidance or information it became easier.

We have been fighting for many years to make sure that if we were to win Medicare for All, healthcare for trans folks wouldn’t be left behind. This year, the Medicare for All bills were reintroduced in the House and Senate, and for the first time, we were able to get explicit language into the bill that would guarantee access to gender-affirming care at the national level and make sure those services are covered for everyone, regardless of income or zip code.

Lori explains that this kind of change would be life-changing for her family. If M4A were to pass it wouldn’t be an issue of where she lives or how much she makes because she would be able to
Provide for her daughter. It would be amazing not just for Liana but for the entire community and to be able to see her 16-year-old not have to carry the weight on her shoulders and worry about insurance.

Toni shares that M4A would be life-saving for so many people. If she could change anything about our healthcare system it would be (1) our food systems and (2) having universal coverage and M4A is the best way to do that. M4A means safety and equity because when gender-affirming care is denied or thought of as cosmetic and is not included very specifically in these aspects it allows the narrative that it’s wrong, dangerous, or questionable to continue. Coverage is a validation that gender-affirming care is medically necessary.

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