Queenie Royale says she cannot afford to be lazy when it comes to appearances. The 26-year-old says she has to make sure everything in the mirror looks just right, even when she heads to workout in her neighborhood. She says, as a trans woman, it isn’t about vanity, it’s about personal safety.
“I don't know who’s going to see me, I don't know what they think, you never know who you're going to encounter,” said Royale. “It’s just a really big thing of like knowing how you look, knowing how people perceive you and doing everything in your power to protect yourself.”
Royale says gender-affirming health care, which helps bring a person's gender expression in line with their gender identity, also serves as a form of shield for many in the gender-nonconforming community.
“We do not have the luxury to be lazy. We have to go through, pretty much a checklist, before we go out outside, even if I'm checking the mail,” explained Royale. “It's pretty much of like looking in the mirror, making sure that everything looks right, not as far as like I can't go outside in my pajamas, I can definitely do that, but I have to make sure that I look presentable because of the things that could happen.”
She says this is why she is concerned for her community as the Trump administration advances regulations and restrictions targeting people’s access to gender-affirming care. Those concerns range from limits on how federal Medicaid dollars can cover gender-affirming care to health care providers being subpoenaed to release information who accessed this form of care through their systems. Those worries have been amplified after the New York State legislative session came to a close without votes to advance two bills to expand and protect gender-affirming care.
One of the bills, which would establish the Gender Affirming Care Access Program, called for providing support to agencies offering this form of healthcare, including a specific ask of $8 million in funding to support organizations doing this form of work.
State Sen. Kristen Gonzalez, the Democrat who sponsored the bill, says while it had support from both the Senate and Assembly, the bill needed more allies.
“When we negotiated with the executive to finalize the state budget, that line item fell out altogether,” said Gonzalez. “I think it's really important to ensure now more than ever we're expanding funding and access to care for trans youth and that we have a partner in the executive in doing so.”
Kei Williams, the executive director at New Pride Agenda, says the bill was part of an effort to expand access to gender-affirming care beyond New York City. It focused on areas where there are little-to-no healthcare systems that provide this kind of care – or, if they do, have long waitlists.
“The access programs were actually to be like currently responsive. There already are people not accessing gender-affirming care in New York. There already is a lack of gender-affirming care access across the state of New York. Look at the entire state,” said Williams. “These two programs would have helped us continue to be able to provide gender affirming care in New York State.”
Another bill proposed was the Gender-Affirming Care Act. It would have codified protections for people accessing care through Medicaid by ensuring coverage regardless of federal funding.
The push for this piece of legislation came as the Centers for Medicare and Medicaid Services issued two federal proposals that would prohibit most Medicare and Medicaid-enrolled hospitals from providing gender-affirming care to youth and would also prohibit federal Medicaid programs from covering this form of care.
While these two federal proposals are still under consideration, some New Yorkers who access care say they are worried – and confused. Royale says the back and forth of the proposals has led to people either delaying care or foregoing it all together.
“I specifically actually work with someone who is worried about switching insurance coverage because they won't cover the medication…Because there's a specific type of testosterone that they have to take, so that's also a worry of like if they will cover it or not,” said Royale. “And, if they won't cover it, it's trying to find a new managed care provider that will cover it, and if Medicaid is not a thing, that's going to be another issue.”
The Gender Affirming Care Act was advanced to a third reading but failed to move out of the Senate Rules Committee, the final committee a bill needs to pass before receiving a vote on the Senate floor.
Williams says, for the next legislative session, their coalition is going to shift the message to focus on gender-affirming care as a push for healthcare.
“Healthcare is a winning message, and so that's one of the things that we're thinking about, especially going into and knowing that right now we're in, obviously, in election season,” said Williams. “[It’s] understanding that we need leadership that's going to invest in gender-affirming care. We need leadership that is going to stand in the values of believing that healthcare is a necessary right.”
Gonzalez adds that with everything happening on the federal level, she hopes the urgency of the need for this care will push these bills forward when they are proposed again next year.
“I hope that in seeing these consistent acts that there will be increasing urgency and political momentum, and we’ll actually pass a significant fund at the state level.” Said Gonzalez.
