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Perspective: How Obamacare allowed me to become my real self

Perspective: How Obamacare allowed me to become my real self

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Women rally in favor of the ACA

Under an Obamacare insurance plan, freelance writer and web designer Amy Krakar, 47, is transitioning to the male gender. For about $400 a month, Krakar receives a Kaiser plan, which provides access to the hormone therapy and surgery necessary to live in that chosen gender role, as well as mental health care for transitioning issues. Now, Krakar is scared about the future access to these benefits. In this edited essay, Krakar shares the experience.

I’ve known I was trans since I was a young child, although I did not have the words to articulate how I felt until I was in high school, except to tell people that I felt like I was a boy and my body felt wrong. I spent many years suffering in silence, feeling very depressed, and sometimes suicidal. It wasn’t a vague level of discomfort; it was all encompassing.

I got some help from a counselor after I dropped out of high school due to being bullied, but she discouraged me from seeking medical intervention, and my mom was so upset when she found out that the counselor had given me information about what was then referred to as “gender identity disorder” that I felt compelled to go into hiding. As an adult, the one time I tried to talk to a psychiatrist about my gender dysphoria in the 90s, he told me he couldn’t write down my condition in my chart because my insurance would not cover counseling for it. I got the message that I needed to remain as invisible as possible.

With the insurance coverage available under the ACA, and the general cultural climate, it seemed like a good time to begin living and to start transitioning. I’ve been taking testosterone for about six months now, and am “out” to most of my friends.  Psychologically, it’s felt very good. My voice and my appearance, more and more, make me feel good rather than feeling hopeless and like no one can see the real me. I feel like I’m part of the world, whereas before I felt like I was on the outside looking in and just waiting for my life to be over.

To have this lifeline and feeling of really being alive and happy possibly taken away again feels like more than I can bear. There’s no way I would want to go back to where I was a year ago.

I had hoped that the incoming administration would work on fine-tuning the ACA and finding ways to bring costs down for more people rather than scrapping most of the coverage and the federal assistance for the exchanges. 

I’m worried that the incoming administration will get rid of protection and services for transgender patients altogether. If insurers are no longer required to cover services for transgender individuals, will I continue to have access to lab tests, hormones, and other services? I’m scared because I need to have access to hormones to live in my chosen gender role, and for my own mental health. Likewise, the right to coverage for transgender surgery and hormone therapy seems like it may be endangered. I feel overwhelmed knowing that I must rush this process.

While the ACA experiment is not perfect, I think that throwing away the concept and returning to a system where only the wealthy can afford continuous insurance coverage is a big step backwards. I worry that the expanded rights for trans people in the ACA, also a work in progress, will be taken away, leaving trans people in a precarious situation in their jobs, society, and their personal worlds.

I spent the first week after the election feeling very hopeless, but I’m coming to terms with my fears and I’ve realized that I need to be brave, live my life with conviction, and stand up for the rights of all Americans. 


Other posts in this series:

Perspective: Obamacare isn't working for middle-class American families like mine

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