November 2022 e.Bulletin

Please RSVP to attend our Annual Educational Conference and Meeting on December 3.

This month’s 2nd Wednesday Speaker Series featured Fran Rourke leading us in a discussion about Navigating Transgender Diversity.  

Don't forget the December 15 Universal Health Care Commission meeting and Finance Technical Advisory Committee details below. 

Universal Health Care Commission

By Consuelo Echeverria 

 A couple of announcements about the Universal Health Care Commission!

  1. Next meeting is scheduled for Thursday, December 15, 2022, 3-5 p.m

As this is the last meeting in 2022, we highly encourage our members to sign up for public comment by 5:00 p.m. December 14 at [email protected]

Talking points could include: 

  • The need for more staff support to move the work along
  • The need to break down the FTAC into smaller work groups. Oregon’s  4 Technical Advisory Groups can serve as an example
  • The need for community outreach in rural, BIPOC and other underserved communities such as LGBTQI+. 
  • The need to implement commissioners' ideas,  such as Commissioner Beyer’s roadmap for the vision of a universal health care system. 

For example: when discussing Eligibility, frame the topic by asking: 

  • What can we learn from other states who have tried to implement universal health care - OR, MD and CT has had success while CA and VT failed 
  • What are the current programs in WA - PEBB and Cascade Care
  • Equity - addressing Social Determinants of Health 
  • What current efforts provide foundational support for universal health care, e.g., the Total Cost of Insulin Work Group, the Health Care Cost Transparency Board

If you have written comments, email your comments 2 weeks before December 15 at [email protected]

Subscribe to receive announcements of future meetings in your own in-box.

  1. UHCC has a Call for Applications for their Finance Technical Advisory Committee (FTAC)

FTAC members will support the commission by helping with the significant planning, analyses, and evaluation needed to transition to and implement a unified health care financing system. Read about subject matter expertise (SMEs) and qualifications here. 

Deadline: November 30.

If interested please email the below materials to [email protected]:

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2nd Wednesday Speaker Series: Navigating Transgender Diversity with Fran Rourke
By Consuelo Echeverria 

Our November 2nd Wednesday Speaker Series featured Fran Rourke, AASN, MA, EMT, and a member of the Diversity Alliance of the Puget Sound.They led us in a discussion about Navigating Transgender Diversity and identified health equity issues for the Transgender population. Below are some highlights and resources for best practices and support. 

Click here for the full video.

Four concepts that we really need to know

Sex assigned birth is not the same as gender identity, and is not the same as sexual orientation, and none of those are the same as gender expression or presentation. Furthermore, as folks transition sexual preferences can change. They highlighted in their talk that scientific findings are challenging the traditional binary categories of male and female as in Ainsworth’s article in Nature Magazine (2018), Sex Redefined: The Idea of 2 Sexes Is Overly Simplistic and the movie Science Proves There are More than 2 Human Sexes 

Standard of Care

Transgender people experience high levels of unemployment along with poverty and lack of insurance coverage, forcing them on Medicaid. There is a very high incidence of mental health issues in the transgender community. With all these barriers high standards of care are essential.  

The World Professional Association for Transgender Health (WPATH) does just that. WPATH’s mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. Their publication Standards of Care 8 (SOC 8) outlines 18 standards some of which are called out below.

Hormone replacement therapy (HRT)

  • Puberty Blockers are given in the early teens to avoid the effect of puberty that can cause dysphoria in those who identify differently than their assigned sex at birth.
  • Hormone replacement therapy consists of testosterone for trans men and non-binaries and estrogen and progesterone for trans women.
  • Primary care providers need to educate themselves about the different medications and applications.

Surgery

Surgery is a complex process physically, financially and emotionally. 

  •  There are many types of gender re-reassignment surgery all with the aim of mitigating gender dysphoria by altering the person’s physical appearance and sexual characteristics to resemble those associated with their identified gender
  • Health insurance is hard to negotiate, many times leaving Medicare or Medicaid as the only option.  
  • Providers are few and far between and are booked months out

Reproductive issues

  • There have been cases where trans folx will have children by saving the egg or sperm before their surgeries
  • Trans males look masculine but need pap smears because they still have a uterus - Imagine how awkward that is
  • STIs are present in the trans population with BIPOC trans women at high risk because sex work is often the only option they have to survive

Sexual health

  • Sex education for a queer folx is almost non-existent with partners teaching each other. 
  • Care providers should make every effort to maintain and enhance sexual functionality through the transition process.

Mental health 

Mental health is one of the most important aspects of trans healthcare. According to the finding from the 2015 US Trans. Survey 

  • 44% of respondents attempt suicide at some point in their lives
  • 30% of respondents who had a job reported being fired, denied a promotion, or experiencing some other form of mistreatment in the workplace due to their gender identity or expression
  • 46% of respondents were verbally harassed
  • 47% of respondents were sexually assaulted at some point in their lifetime

This is far above the general population. Our speaker noted how astounded they were by how common, pervasive and wide-ranging the mental health challenges of the community are. They also emphasized the need for low barrier mental and physical health care as many folks do not have the mental energy needed to navigate complex systems to receive the support they need. 

Final take home 

To be a good ally (provider, friend or advocate) cis gendered folx need to listen to trans folx as well as respect their name and pronoun. 

Resources 

Diversity Alliance serves the trans and gender diverse community of Washington State through direct service and financial and material assistance programs.

The World Professional Association for Transgender Health (WPATH), and Standards of Care 

The National Center for Transgender Equality advocates to change policies and society to increase understanding and acceptance of transgender people.

Here is the link to their publication Supporting the Transgender People in Your Life: A Guide to Being a Good Ally

The Gender Unicorn is a national organization run by young transgender people with many resources including the Gender Unicorn.  

Story to end with 

“There is a transgender person that I volunteer with. This is a transgender man assigned female at birth who has endometriosis, which makes periods really agonizing. He also has severe, severe depression, sometimes he just cannot even make it through a volunteer shift. So we were doing food prep and dishing out food for our participants, and he couldn't cope. He went into the back pantry and curled up in a fetal position, sobbing for probably a quarter of an hour. It seemed like a long time later when he finally came out, and I said, “I really feel bad for you. I wish there was something I could do,” and he replied, “I really just need health coverage and a good doctor.”

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Measure 111 passes, giving Oregonians a constitutional right to access affordable health care

"Measure 111 does not spell out what the state must do to meet its new constitutional obligation, or define what access to affordable health care means. It will be up to the Legislature to shape what health care access for all looks like and how to pay for it... 

"Legal experts agree the amendment opens the door for Oregonians who don’t have access to affordable health care to try to sue the state."

‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions

The Ambulance Chased One Patient Into Collections 

Bremerton Hospital Charge Nurse calling the ER for help

Silverdale hospital where nurse called 911 for help amid staffing issues could be denied accreditation

Washington Consumer Healthcare Experience State Survey found that respondents are worried about affording healthcare and are looking to policymakers to address healthcare costs. Notably:

  • 3 in 5 (62%) respondents experienced at least one healthcare affordability burden in the past year;
  • 4 in 5 (81%) worry about affording healthcare in the future;
  • Lower-income respondents, respondents with disabilities and Black/African American and Hispanic/Latinx respondents reported higher rates of going without care and incurring debt due to healthcare costs; and
  • Across party lines, respondents express strong support for government-led solutions.

Health Justice Monitor is a blog that replaces Don McCanne's Quote of the Day. It arrives in your mailbox 2-3 times/week focusing on an issue or recent report of current interest, with commentary by Don and other health policy experts.

Health Care Reform Articles Periodic posts of articles of interest about health care reform in the United States and elsewhere.

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 Editor: Consuelo Echeverria ★ Graphics & Communications Specialist: Sydnie Jones 
★ Health News: Rich Lague  & Cris Currie  
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