Plume recognizes that we are living in very challenging times that have put our community on high alert, and we are all feeling the pressure and uncertainty as a result of the current political climate in the United States. All of your feelings are entirely valid, and we want to assure you that we are committed to supporting bodily autonomy for all trans people, and are here to support you to the best of our ability! We are here to be a resource to you and will continue to work to increase access to gender-affirming care for all trans people in the United States. Plume is paying close attention to what is happening and will be keeping you informed if we hear of any specific changes to legislation that could affect your access to gender-affirming care.
TABLE OF CONTENTS
- My state has proposed anti-gender affirming healthcare legislation. How does this impact my Care with Plume?
- What if my state finalizes anti-gender affirming healthcare legislation?
- I live in a conservative state and am concerned about being able to access GAHT (sometimes known as “HRT”). Are there ways I can prepare for potentially losing access to medication?
- How does Roe v. Wade affect potential future judicial decisions related to accessing gender affirming care?
- How can I keep track of what is going on with gender affirming healthcare in my state?
- What is Plume doing to support and advocate for access to gender affirming care? Can I get involved?
My state has proposed anti-gender affirming healthcare legislation. How does this impact my Care with Plume?
We are closely monitoring any legislation directed towards restricting access to gender affirming healthcare for adults. While we certainly understand having any transphobic legislation on the table is worrisome, there are no laws that have been finalized that would impact any Plume member’s Care at this time. Any legislation directed towards individuals under the age of 18 will not impact care with Plume since it is required to be 18 or older to receive our services.
What if my state finalizes anti-gender affirming healthcare legislation?
We are required to abide by the individual state’s law for all Plume active states. Unfortunately, telehealth does not circumvent any local laws changing or restricting access to gender affirming care and we would be required to follow the law. In the scenario a Plume active state finalizes a ban on gender affirming healthcare, we would immediately contact any potential members impacted by such legislation to come up with a contingency plan on how to move forward together and offer as much support as possible. We would provide a timeline when care might end, share any resources available for you, provide alternatives to care if they are available, and answer any questions or concerns you may have.
For example, when the Alabama Ban for trans youth healthcare occurred, we monitored the situation closely and and remained in contact with all of our impacted patients. You can learn more about the ban, steps we took, and how you can support trans people in Alabama here.
At this time, there are no laws that have been finalized that would impact any Plume member’s Care at this time.
I live in a conservative state and am concerned about being able to access GAHT (sometimes known as “HRT”). Are there ways I can prepare for potentially losing access to medication?
Some things you can do are plan ahead when possible by doing the following:
keeping a minimum of 3-4 doses of medication on hand
Ask your provider to see if a 90 day prescription can be given. If you are using insurance to pay for your medication, sometimes companies may reject or require a prior authorization for a 90 day prescription depending on your plan. Your provider can also write the prescription and go from there. If cost is a barrier, explore medication coupons from GoodRX to assist in lowering your medication cost.
If you inject, keep extra syringes, needles, alcohol swabs, and bandaids on hand
Injection supplies such as alcohol swabs and bandages can be purchased online or at your local pharmacy. Needles and syringes can be purchased at pharmacies and online from bulk medical supply stores.
Some states may require you to have a prescription to order injection supplies online, and some states may limit the amount of syringes/needles you are able to obtain over-the-counter without a prescription.
Your provider can write you a prescription for a larger quantity of syringes and needles.
Sometimes the pharmacy may be limited in what they can give you, or you may need to try switching sizes if you have no other options. Luckily, planning ahead should give you a buffer so that you’re not put in the position of having to improvise.
Some pharmacies will give you an extended supply if you ask. Most will give you a refill 5-7 days before the end of your prescription. You can work with your Plume team to learn more about your options, and talk to the pharmacist about your needs.
Storing your medications safely will ensure that in the event of a delay in care, you can maximize your current supply. All your medications should be stored in childproof, labeled containers inside a waterproof, sealed bag. Get a printed copy of your prescriptions and keep it in the bag too. You should also have a list of every medication you take that includes each drug’s name, strength, dosage form, and how often you take it. You can also include a photocopy of your prescription and medical cards, so you have that information if you lose the originals.
How does Roe v. Wade affect potential future judicial decisions related to accessing gender affirming care?
Although the reversal of Roe v. Wade does not directly impact access to gender affirming care, a growing number of legal scholars, LGBTQ+ activists, and public health experts have reason to believe it sets the precedent to impact access to gender affirming care in the future. The following have been identified as key indicators to this possibility:
Studies show that 23% of all non-hospital U.S. clinics that offer abortion services also provide gender affirming healthcare services. There is concern that jeopardizing the future of these facilities will also inherently further restrict access to gender affirming care for the patients currently engaged with services in those facilities.
Another concern is the potential continuation of the Supreme Court of the United States rolling back rights that were previously federally protected by the 9th and 14th amendment. Doing so would leave these rights up to individual states to determine if they want to protect them at the state-level which allows local lawmakers the ability to ban or restrict access to gender affirming care without any federal protections to intervene. Just days after the ruling, the Alabama attorney general borrowed language from the Roe v. Wade reversal arguing that the fundamental right to gender affirming care is not “deeply rooted’ nor ‘implicit in the concept of ordered liberty,” and that the state should be able to ban gender-affirming care for transgender youth.
Angela K. Perone, JD, MSW identified the Obergefell vs. Hodges marriage equality decision to have created new terrain for LGBTQ+ people regarding access to appropriate healthcare, particularly when it comes to employer-backed health coverage and Medicaid/Medicare. Following the reversal of Roe V. Wade, Justice Clarence Thomas was quoted in a concurring opinion that the SCOTUS “should reconsider all of this Court’s substantive due process precedents, including Griswold, Lawrence, and Obergefell.”
Trans Equality cites Federal and state laws that prohibit discrimination against transgender and nonbinary people as being part of the community's fundamental healthcare rights, extending to Medicare and Medicaid. There is concern that weakening federal protections for vulnerable populations compounded with state lawmakers having the final say in retraining these protections will result in further restriction of access to gender affirming care.
While we are actively involved in advocating for access to gender affirming care, we are not policy experts and recommend following Transgender Legal Defense and Education Fund (TLDEF), Transgender Law Center (TLC), Department of Health and Human Services (HHS), American Civil Liberties Union (ACLU), and National Center for Transgender Equality (NCTE) to stay up to date on the evolving landscape.
How can I keep track of what is going on with gender affirming healthcare in my state?
We have compiled a few resources that we have found helpful in tracking anti-LGBT legislation.
The ACLU also has their own map and tracks the status of anti-LGBT legislation with regular updates.
Foley has provided a legal guide for practitioners, policymakers, and telemedicine companies which includes more detail on the law and how it specifically impacts controlled substances
There is a 30 day commenting period for a proposed rule that would impact individuals receiving testosterone via telehealth. You may read more and comment here “Telemedicine Prescribing of Controlled Substances When the Practitioner and the Patient Have Not Had a Prior In-Person Medical Evaluation” to voice your opinion and concerns on this announcement.
Join the Keep The PHE campaign by People’s CDC to support accessible telehealth.
What is Plume doing to support and advocate for access to gender affirming care? Can I get involved?
We challenge all laws that aim to restrict trans people’s rights to healthcare and support all transgender people’s right to lifesaving, medically necessary medical care. In addition to providing healthcare to many trans people, we are also working at the national level on policies to protect and affirm the rights of trans people to access gender-affirming care, including meeting with Admiral Rachel L. Levine, MD, the Assistant Secretary for Health for the U.S. Department of Health and Human Services (HHS), to discuss the importance of securing access to gender affirming care for all trans people.
Some things you can do to get involved are:
Donate to the ACLU or give directly to transgender people or LGBTQ+ organizations, particularly ones within “trigger states”
Keep an eye on anti-transgender legislation. Contact your elected officials and let them know that any law compromising the rights, well-being, and access to gender affirming care for trans people is unacceptable. Let them know how important gender-affirming care is and your support of trans people.
It is our vision to transform healthcare for every trans life. Plume is committed to continuing to provide our members with the affirming and accessible healthcare they deserve, and we stand with the transgender community as we navigate this rapidly challenging political climate together.