Open Enrollment: The Most (un)Wonderful Time of the Year
Tis the season for picking which corporation will profit from my health
This week it’s time for me to once again sign up for health insurance for next year through the Affordable Care Act. The process easily ranks high on my list of least favorite things to do every year. It’s a soul-sucking experience, deciding which corporation is going to profit from whether or not I get sick or injured in 2021.
The plans are all expensive, ranging from $200 to $500 a month just for me personally, and laughable deductibles larger than my savings account balance and credit card available balances combined. On the one hand, I’m thankful that such a marketplace exists, as it enables me to continue my career as a freelance journalist.
But the bigger issue for me personally is that none of the insurance plans ever work for me, despite recent trends toward eliminating trans exclusions in coverage plans.
In my state, transition care is still covered. I even had facial feminization surgery covered under a Maine plan several years ago. But insurance doesn’t typically cover my estrogen injections, tending to limit coverage to pills or patches. But I’ve found over the last five years that injections work better for me.
The same goes for my thyroid medication. Over a decade ago I was diagnosed with Grave’s Disease, triggered by a hyperactive thyroid and which can cause premature death. After eliminating thyroid function with radioactive iodine, I am now forced to take a pill daily to replicate the hormones my body no longer produces. For years that meant taking Levothyroxine, which is perhaps the most commonly prescribed medication for my condition. But I found that I was always cold and hungry when I was taking it.
Early last year, I switched to a more uncommon therapy for my thyroid, called Nature-throid. It’s a natural, if more inconsistent, dose which delivers a slightly different kind of thyroid hormone and it fixed the issues I had with my previous medication.
This too is not typically covered by the insurance plans offered on my state exchange. Nor was the pelvic floor physical therapy I needed after bottom surgery. With the exception of my transition-related surgeries, which still required tens of thousands of dollars to pay for auxiliary costs and travel, I can’t think of another product that I’ve paid hundreds of dollars a month for that I’ve gotten less value out of in my lifetime.
The system is fundamentally useless unless I get catastrophically sick or injured. It’s quite obvious that the US needs a public health system like Medicare-for-All, but that type of system also scares me as a trans person.
Last week in the UK, a nation with a true nationalized health system, a court-imposed the government’s will on transition care for minors, ruling that persons under 16 are unlikely to be able to consent to puberty-delaying medication.
Adolescents in the UK can still consent to virtually any other type of medical care, despite all sorts of permanent risks, but consenting to being trans was deemed legally unacceptable. Trans young people must now convince an untrained judge along with their parents and several medical professionals that they are in fact trans.
This shows the potential downside of government-run health care. In the US, government funding for abortion care has been banned since the mid-1970s thanks to the Hyde amendment. That means that low-income folks on Medicaid cannot receive basic reproductive health care because of politics.
There’s nothing stopping Republican regimes from instituting similar restrictions on a host of medical treatments they personally dislike, including transition care.
It’s a political problem that leftists advocating for Medicare-for-All must grapple with as they seek to do what’s right for the US health care system.