One year ago, Connecticut experienced heart-wrenching seismic shifts to its transgender care landscape.
One of its largest providers shuttered its doors entirely, and the other was forced to stop providing gender-affirming medical care services to its patients. An extension of the federal war waged against transgender people, these institutions were threatened with persecution and a potential loss of funding through proposed changes in the Centers for Medicare and Medicaid Services’ (CMS) reimbursement rules.
To comply in advance, these institutions ended or limited their services, leaving trans youth and their families in a lurch. Forced to scramble for places to access necessary care, families weighed difficult decisions; healthcare costs grew as some families paid out of pocket for care, and others contemplated whether and how they might leave Connecticut for greener, often international, pastures where they might re-establish care.
The remaining Connecticut institutions were ill-equipped to deal with the deluge: their waitlists grew exponentially and still grow today—a sign there isn’t enough care to meet the demand. And, with clinics closing around the country and some insurance companies dropping coverage for gender-affirming health services, some families have little to no recourse for accessible and affordable care.
One year later, the threatened CMS rules still have not been passed.
I spent the last year documenting the impact of these changes in care on youth and their families. The largest lesson: Our leadership was not showing up for these trans kids. Their lives had been disrupted, their care had been abruptly withdrawn, and our leaders looked the other way as our healthcare facilities discriminated against transgender children by ending their very necessary care. And they are still absent now as families sift through the rubble to find anything that can help them rebuild their lives.
Now, as with most disasters, after the immediate outpouring of sympathy, people have started looking the other way. Our organizations remain inactive, and Connecticut’s leadership’s absence fuels frustration and a sense of abandonment among trans youth and their families.
Our trans youth deserve better.
As one parent of a trans youth put it, “I really was hoping that our politicians here in Connecticut would have spoken up in our defense, also like having our back, somebody having our back.” They lament that support and defense never came from our leaders: “That didn’t really happen, somebody having our back in an institutional way, people with power having our back.”
Sadly, this isn’t new, though. Transgender communities have had to show up for themselves for decades, often unable to count on sustainable support from society and its leaders. In the trans experience, leadership is often comprised of fair-weather friends in high-powered places, who come to pride events and who court transgender voters. But when the bonds of their allegiance are tested against the real, systemic hardships faced by trans people, these bonds are frequently easily broken, and transgender people are left standing alone.
So, one year later, trans youth and families continue to reel from the disruptions to their healthcare. Connecticut leaders supportive, on paper, of protecting transgender youth, have not (yet) concretized this support in meaningful ways that support the needs of transgender youth and their families for care and for protection against further federal assaults.
On this grim anniversary, we have this opportunity to reflect on our leaders’ actions and inactions and consider how the next year might be different and how those in power can help rebuild trans care in Connecticut. It begins with enforcing extant laws and holding Connecticut institutions accountable for providing the care to the populations they have supported for years.
Work with them to reinstate care.
Support them by extending shield laws so they can operate fearlessly and stand up for our transgender youth and their families.
Connecticut enjoys the laudable status of being one of the first states to enact shield laws in 2022 to protect the delivery of gender-affirming healthcare. In the current sociopolitical climate, Connecticut leadership is positioned to lead the charge in protecting trans youth in Connecticut and create a model of care and protection that can inspire other states and territories to do the same. Leadership must continue standing for trans youth by creating alternative sources of funding to rebuild and sustain transgender care so that any threat of the CMS rule is made innocuous.
Finally, private healthcare organizations remain more vulnerable to federal anti-trans attacks. Recognizing this, Connecticut leadership must create state-sponsored and/or state-directed avenues for transgender care that, as public entities and agencies, can wield the might of the Connecticut legislature and can be fully protected by our shield laws.
Connecticut, our trans youth are looking to you to have their back now more than ever. Will you show up for them?
SJ Job is a psychologist at Yale University. The opinions expressed here are their own.
