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A History of
In the United States
Although gender-diverse people continue to suffer civil rights abuses and discrimination, slow but noticeable progress has been made in access to legal advocacy and the right to receive affirming medical care. As research now clearly demonstrates the efficacy of medical interventions, numerous professional associations have voiced support for access to health care (including the American Medical Association, the American Psychiatric Association, and the American Public Health Association) and insurance companies have been challenged to cover transgender health services. In 2014, Medicare removed its reflexive denial of coverage for trans health, and over the subsequent years, other private and public insurance have followed suit. This chapter traces the evolution of state and federal protections for transgender health in the United states. It includes the evolution of insurance coverage (regulations which vary by state), and protections under the ACA. Janice Raymond and others worked against insurance coverage for transgender people, and these efforts are reviewed. Medico-legal advocacy is an important service offered by many gender clinics across the country, and this chapter includes descriptions of these services and explain why they are crucial to affirmative care.