PURPOSE: Access to gender-affirming surgery (GAS), has been historically limited. For transgender people of color (TPOC), these barriers are exacerbated. While previous research has demonstrated the general impact of legislation, specifically the Affordable Care Act, on access to GAS, data on disparate effects on TOPC is limited.
METHODS: The National Inpatient Sample database was queried from 2013-2019 utilizing ICD diagnosis and procedure codes to identify patients diagnosed with transsexualism or gender identity disorder who underwent GAS. Utilization was stratified based on race (white versus non-white) and payer type. Given the underlying racial distribution of patients, payment method was converted into a percentage of total GAS performed by race to facilitate comparison. This percentage was averaged across pre-policy (2013-2014) and post-policy years (2015-2019) for both cohorts. Proportional change was evaluated using a 2-sample proportional Z-score test.
RESULTS: 1,585 transgender patients undergoing GAS were identified. On average, there was an overall four-fold increase in GAS following ACA implementation in 2014. There was no significant difference in rates of Medicaid-covered GAS before the policy change between cohorts. Post-implementation, however, there was a significant decrease in self-pay among both groups (p < 0.0001) and an increase in proportional utilization of Medicaid among TPOC (p < 0.0001).
CONCLUSION: Expansion of publicly funded insurance in terms of coverage and eligibility is associated with improved access to GAS, especially for TPOC.
