Saida Agostini-Bostic, President, Funders for LGBTQ Issues
Hez Norton, Senior Portfolio and Partnerships Director, Laughing Gull Foundation
For decades, LGBTQ+ Americans have been at the forefront of powerful movements championing the freedom for all individuals to be themselves and pursue their dreams. This grassroots organizing has led to unprecedented public support for LGBTQ+ equality and increased visibility for transgender people within our society. However, despite growing acceptance, a dangerous political backlash threatens the progress made in securing health care access for transgender communities.
With 1.6 percent of Americans, and over 5 percent of young adults and teens, identifying as transgender or gender expansive (Brown 2022; Williams Institute 2022), funders must do more to improve health access and outcomes for these communities.
A Rise in Visibility and Public Support
Transgender visibility in the U.S. has surged with 42 percent of Americans reporting that they know someone who is transgender (Barnett 2021). Transgender people represent a growing part of our communities—they are our family members, coworkers, neighbors, and friends. There is also widespread public support for trans equality, with 64 percent of Americans supporting protections against discrimination in jobs, housing, and public accommodations (Parker et al 2022). Most Americans want transgender and gender expansive people to feel safe and supported.
Barriers to Health Care for Transgender People
This year, over 652 anti-trans bills have been introduced or considered across 43 states with nearly a third targeting health care access (Trans Legislation Tracker 2024). Though these bills often fail to become law, they instill fear, invite discrimination, and cause considerable harm to the health and well-being of transgender communities. These legislative attacks began in the South but have spread nationwide, testing tactics that undermine the rights and bodily autonomy of all Americans.
These legislative attacks ignore the guidance of every major medical association, imposing unnecessary restrictions on insurance coverage and threatening medical providers with felony convictions for offering needed health care for transgender young people. The estimated 102,000 trans youth and more than half a million trans adults living in the South now face significant financial, legal, and logistical obstacles to accessing essential health care. Nationwide, nearly one in three trans adults have been refused care due to their actual or perceived gender identity, one in five have lost access to health care due to anti-LGBTQ+ laws, and 58 percent have considered moving to a different state (FOLX 2024).
This denial of coverage and care refusal, combined with a hostile climate, leaves transgender people struggling to access routine and necessary care. Research shows that when we improve access to gender-affirming care, we improve all sorts of other health outcomes for trans people including dramatically reduced rates of suicide attempts, decreased rates of depression and anxiety, decreased substance use, reduced rates of harmful self-prescribed hormone use, and improved HIV prevention adherence (Montero 2022; Fenway Health 2021).
Recent Legal and Policy Advancements
Despite these challenges, there have been legal and policy victories (Weisner 2022). Advocates for Trans Equality (A4TE) and Lambda Legal, have won legal victories this year, setting important precedents and enhancing access to life-saving care for transgender people. Recent rulings in North Carolina, West Virginia, and Georgia found that denying coverage for transgender health care is unconstitutional (A4TE 2024). In addition, notable advocacy efforts by A4TE have led to major insurers like Aetna, the Federal Employee Health Benefits program, and Blue Cross Blue Shield removing discriminatory exclusions for gender-affirming care, improving the health outcomes of millions of Americans (A4TE 2021; A4TE 2024).
Community-Led Solutions
Grassroots efforts in the South, and across the country, are helping trans people navigate barriers to health care. Campaign for Southern Equality’s Trans Youth Emergency Project (TYEP) offers personalized support and emergency grants to transgender youth and their families to cover clinic visits and travel costs. Initially a project that only focused on the South, TYEP now operates nationally, recognizing the urgent needs of transgender youth in states that have enacted health care bans. Approximately 93 percent of trans youth ages 13-17 in the US live in states that have either passed or proposed laws restricting health care and other basic rights including use of bathrooms and other sex-separated facilities, affirmation of gender through pronoun use, and participation in sports (Williams Institute 2024).
Philanthropy Stepping Up at a Critical Time
Philanthropic funding for transgender communities remains woefully insufficient. In 2022, only $48 million was awarded to US-based transgender communities. Despite escalating political attacks and growing community-led organizing and activism, there was a real-dollar decrease in funding to LGBTQ+ communities between 2021 and 2022 due to inflation, according to Funders for LGBTQ Issues’ most recent tracking report. For every 100 dollars awarded by US foundations, only 25 cents went to LGBTQ communities in 2022. This funding gap is especially pronounced in the South, where more LGBTQ+ people live than in any other region. Funders for LGBTQ Issues’ Out in the South initiative works to increase philanthropic resources for LGBTQ organizations in the South, supporting a collaborative and thriving ecosystem that is investing in community-led solutions. On a national level, intermediary funds like the Fund for Trans Generations, Trans Justice Funding Project, Black Trans Fund, Trans Futures Funding Campaign are making strides in supporting transgender communities at a critical time but there is still a long road ahead.
Health funders have an opportunity to advance equality and health care access through strategic investments in organizations that directly engage transgender communities, especially people of color and those in rural areas. Hundreds of powerful trans-led organizations across the country are doing amazing work, and they are significantly underfunded compared to their needs and capabilities.
As funders, we must adapt our strategies to be more responsive to transgender people and experiences; including, learning from, and following their lead as we go. Regardless of gender identity, everyone deserves access to the care they need. By working together, we as health funders can build a future that ensures health equity and access for all.