For 35-year-old Emma McFadden, the decision to empty her retirement account was simple.
She could continue occupying a body she didn't experience as her own and live with the feelings that led to multiple suicide attempts and genital mutilation. Or she could pay $20,000 out of pocket for a surgery that might finally make those feelings disappear, perhaps permanently.
"This whole transition is a life-or-death thing for me," explains McFadden, a transgender woman who is hoping to have gender-reassignment surgery in September. "If I don't do it, there's no point in having a 401(k) because I probably wouldn't live to see it."
Though McFadden has health insurance that covers the hormones she takes, it won't cover the surgery that will help complete her transition. But under a measure recently introduced by Philadelphia state Rep. Mark Cohen, insurers would be required to cover transition-related medical procedures — including surgery.
House Bill 304, known as the Transgender Health Benefits Act, would "require coverage of transition-related care, including hormone therapy, mental health, and surgery in all private, public and Medicaid plans."
That bill was introduced with a companion (HB 303) that would require schools to allow transgender students to participate in programs and use accommodations in accordance with their gender identity, not the gender that was assigned at birth.
"To my knowledge, [these] were the first transgender-rights bills ever introduced in Pennsylvania," Cohen says, noting that he introduced them for the first time last year. "It's just part of the gradual process of establishing the rights and dignity of all people."
If the bills pass, Pennsylvania would become one of only four states (plus the District of Columbia) that have full transgender health coverage, according to a memo attached to the legislation.
But in a legislature that has failed to secure basic nondiscrimination protections in employment and public accommodations for LGBT Pennsylvanians, the bill's authors, sponsors and advocates aren't holding their breath.
"Barring a tsunami, it will be an uphill battle to get these bills passed," says Jordan Gwendolyn Davis, a trans activist from Philadelphia who helped draft the legislation and has since moved to California because the state's Medicaid program will cover her transition-related health-care costs. "The religious right is going to throw a huge shit fit over it."
Still, Davis pushed for the bills for a reason: She's hoping they prompt a public discussion that lets transgender people explain — on their own terms — how current policies affect them.
And for trans people like McFadden, who have spent their lives scrapping and finagling their way through health systems that often deny care, or schools that won't let them use the bathroom that matches their gender identity — the chance to explain those experiences publicly can matter a great deal.
"A lot of people think this is a choice, and it's really not," says McFadden. The media "have objectified trans people so much. By me and other people telling our story, it makes me a real person and not an object."
It wasn't until Jessica McGuinness fell off a bridge on a camping trip in West Virginia 10 years ago that she finally felt comfortable starting her transition. The thought that she might have died without ever having lived in the gender she's identified with since age 5 terrified her. "I don't like the person I would have been if I had died. That's when I started transitioning," says McGuinness, who works at the University of Pittsburgh.
That process didn't start until McGuinness was 30, partly because she didn't feel comfortable transitioning in school. It wasn't something she'd ever seen anyone do. "When I was little, there was no such thing as trans youth," she says.
That's one of the reasons McGuinness, now 40, supports Cohen's Transgender Students Rights bill, which is modeled after similar legislation in California. Under the proposal, "students would be able to follow the dress code, use facilities such as locker rooms and restrooms, and participate in athletic programs based on a students' self-attested gender," according to a memo Cohen attached to the legislation. "This bill would not allow for harassment in gender-segregated spaces, nor would it require the dismantling of such spaces."
