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A group of protesters sit on the ground linking arms with signs that read “Trans Love” and “Trans People Belong.”
Protesters supporting LGBTQ rights block the street in front of the Supreme Court on October 8, 2019.
Caroline Brehman/CQ-Roll Call, Inc via Getty Images

Coronavirus isn’t transphobic. But America’s economic and health systems are.

Here’s how the pandemic could further devastate trans people.

Ade was about to begin onboarding for two separate jobs, one at a bar and the other at a guitar store, in Lansing, Michigan, when the coronavirus pandemic first hit the state. But several days later, Michigan issued a shelter-at-home order and both job offers evaporated overnight.

Ade had previously depended on student funds from graduate school and worked weekends as a contractor doing lighting and audio work for local DJs. With both jobs now scuttled, and the event planning space completely suspended for the time being, the pandemic turned out to be the perfect storm for wiping out Ade financially.

“I don’t have any savings beyond like a few extra bills worth,” they told Vox.

Ade, a 25-year-old black transmasculine nonbinary person, had just recently moved in with their partner, who is a faculty member at a local university. The couple can pay their bills for now, thanks to their partner’s job, but she’s a contract worker, so Ade is unsure how they will pay their bills once the semester is over.

Ade’s economic coronavirus story is similar in many ways to what many people are experiencing across the country right now. On Thursday morning, it was reported that 6.6 million people had filed initial claims for unemployment insurance over the past week, bringing the total to at least 10 million people over a two-week period.

But while there’s no evidence that Covid-19, the disease caused by the novel coronavirus, disproportionately affects trans people, America’s economic and health care systems often marginalize the trans community in several unique ways.

In other words, the coronavirus itself isn’t transphobic, but the US is.

Before the pandemic, the unemployment rate was at near-historic lows, but trans people were still three times more likely than their cisgender peers to be unemployed, according to the 2015 US Transgender Survey. Meanwhile, 29 percent of trans people live in poverty, and one in five trans people in the US will experience homelessness in their lifetimes.

“There was already a significant level of economic instability and high rates of discrimination for the trans community before we started with this epidemic,” said Laura Durso, executive director at Whitman-Walker Institute, the research, advocacy, and educational program arm of Whitman-Walker Health in Washington, DC. “So much like other marginalized populations, anything that was going to destabilize the health care industry, [and] the economy overall was going to significantly impact trans folks.”

Trans people started the pandemic economically behind

Aisling, a 28-year-old trans woman from Boston, lost her only source of income when the local university where she was working as a part-time lifeguard shut down because of coronavirus. Aisling would have been in a much better position to weather the financial storm, but she was forced several months ago to quit another part-time job as a swim instructor because of transphobia.

Aisling said that her previous employer didn’t have a good alternative to the men’s locker room for her to change in and she experienced hostility to her trans identity from management. “There were like a few people ... who [were] really seeing me as a trans person. Most everybody else was seeing me as a man,” she told Vox. “It was just generally an environment where I didn’t feel comfortable being out of the closet.”

If Aisling had been able to continue her other job, she may have had more savings in the bank to deal with the pandemic. Now she and her seven roommates, six of whom are also trans, find themselves struggling to make rent.

“A lot of us work in food service,” she said. “One of my housemates is on disaster pay, but most of us just aren’t getting any income at all. There [are] only three people in the house who have full-time income and it’s a house of eight people.”

Her housemates have begun drafting a letter to their landlord offering to pay half rent until the pandemic is over. The city of Boston has suspended eviction proceedings because of the pandemic.

Much of the economic instability facing trans people is tied up in the hardship of finding work. Discrimination against trans people in employment is fairly common. According to data from the National Center for Transgender Equality, three-quarters of all of trans people have experienced discrimination on the basis of their gender identity at work, and more than one in four have been fired from their jobs for being trans. And that discrimination only compounds when trans people have other intersecting identities — like being a person of color, or femme-presenting, or both.

Ade said that they experience more discrimination for being black than they do for being trans, though they partially attribute that to their being able to pass more easily as a man since they started testosterone.

“I never know what I’m getting when I walk into an interaction with someone, especially when there’s employment on the line,” Ade said. “You see, there’s a lot of assumptions. They come, like, baked into things.”

The health care system was already not trans-friendly

While much attention has been paid to the trans people who have had to delay transition-related surgeries due to the coronavirus pandemic, trans people are also marginalized within the country’s health system in many other ways.

Since access to health insurance in the US is mostly dependent on being employed and trans people are more likely to be unemployed than their peers, trans people are less likely to have health insurance to begin with. According to the 2015 US Transgender Survey, 13 percent of trans people do not have access to health insurance.

Coronavirus has already strained the health care system to its limits, and the resulting economic fallout will only exacerbate existing disparities for trans people.

“I hear from some patients that there’s often fear of losing insurance, [and] losing that care when it’s tied to employment,” said Britt Walsh, director of gender-affirming services at Whitman-Walker. “People feel immense anxiety and stress right now in a world of all this uncertainty. ... I think keeping employer-based health insurance feels extra critical to trans people.”

Aisling is on MassHealth, the state health insurance program in Massachusetts — one of the oldest and best state health insurance programs in the country — so she won’t be cut off from her hormone treatment or basic medical care. But not all trans people are so lucky.

Dice Redden, a social worker case manager in Southern California, has struggled to help some of the young trans people whose cases they manage, to sign up for the state’s health insurance program. They say that two clients have had their applications rejected due to a lack of credit history. “How are you trying to call it universal health care if the kids who need it the most don’t have access to it? And that’s trans and nonbinary kids who got kicked out of their house.” (Medi-Cal told Vox that it does not deny applicants for “lack of credit history.” “DHCS is not privy to an individual’s credit history or credit score; nor do we request or use either to determine eligibility,” Carol Sloan, the PIO at California’s Department of Health Care Services, told Vox.)

Meanwhile, Ade is currently uninsured and has to use coupons each month in order to afford their testosterone shots. Additionally, testosterone is classified as a controlled substance by the Food and Drug Administration, meaning they have to pick up their prescriptions in person and their doses are strictly monitored.

So when Ade tried to pick up their prescription early to prepare for sheltering in place, their pharmacy declined to refill their prescription and they had to make an extra trip back to pick up a fresh dosage. “I actually [ran] out, even though they were trying to tell me that I still had more proper doses. So I almost had to wait a week.”

Prescription delays, postponed surgeries, and lost insurance are all part and parcel for the trans community, who’s used to being one of the health care system’s last priorities. But health care discrimination presents a particularly sinister risk in a time of rationed care for coronavirus patients.

Bre Kidman, a nonbinary person running for the US Senate in Maine, teared up when they described their biggest fear for trans people diagnosed with Covid-19. “Trans people have already been facing medical discrimination for years, that’s not new. So when it comes to getting care for coronavirus, I expect those same biases to be in place,” they told Vox. “I also am afraid, I don’t even want to say this out loud ... I’m scared to say this out loud, but I’m afraid that trans people will face things like being deprioritized for ventilators or for care.”

Some Italian hospitals have had to decide between patients who get access to ventilators, and Alabama and Washington state already laid out guidelines deprioritizing people with disabilities for Covid-19 care when services and equipment need to be rationed. The US Department of Health and Human Services released a bulletin Saturday specifically outlining that discrimination because of disability is against the law. While several forms of discrimination were listed in the HHS bulletin, notably absent, however, was discrimination on the basis of gender identity.

Withholding ventilator access from a trans person in order to serve a cisgender patient is illegal under the Affordable Care Act; however, the Trump administration has proposed a rule striking those protections for trans people from the law. Advocates have petitioned the government to delay implementing the rule change until after the pandemic passes.

But the coronavirus crisis hasn’t so far stopped the administration from furthering and advocating for discriminatory policies. The Department of Justice filed a statement of interest last week in a federal lawsuit seeking to overturn the Connecticut Interscholastic Athletic Conference’s transgender participation policy.

Trans people have always had an economically precarious existence, but they have developed their own survival systems

Trans people have a long history of being marginalized economically because of their trans identities. But along with that history, they’ve learned to create their own makeshift systems for survival.

Many trans people, especially trans women of color, have traditionally been able to pay their bills through engaging in sex work, and have often taken the lead in providing mutual aid for each other. Trans revolutionaries Marsha P. Johnson and Sylvia Rivera started the Street Transvestite Action Revolutionaries (STAR) in the 1970s in order to advocate for homeless trans and gender-nonconforming people in New York City. The organization also ran mutual aid campaigns for the community, especially for incarcerated trans people.

That tradition has carried on into the coronavirus era.

A man wears a button with a picture of transgender activist Marsha P. Johnson during an event at the Lesbian, Gay, Bisexual & Transgender Community Center in New York on May 30, 2019.
Timothy A. Clary/AFP via Getty Images

As a social worker, Redden works with about 20 young people who are economically precarious in different ways, and most of whom are trans or queer. Redden explained that most of them are just transitioning into adulthood with their first part-time job, some even their first apartment. But many are homeless after being kicked out of their homes for being trans or queer.

Redden tries to fill that gap by helping them access essential needs like prescriptions and food. “I’m barely hanging on myself, but I have to be the pillar. I have to be the one with answers,” they said. “I’m just reaching out to the folks that I know are vulnerable. ... Do you need a hundred bucks to pay your phone bill? Do you need a hundred bucks to keep your groceries in the cabinet?”

Since California’s shelter-in-place order on March 19, face-to-face resources for Redden’s clients have closed up shop, forcing them to access support through phone calls and Zoom meetings.

“Some of my kids are on the street or they’re living in their car or they’re couch-surfing, and things like having a phone become a problem when you’re living in your car on the street. So it’s definitely thrown some curveballs my way in terms of trying to keep connected to my kids and make sure that they have the things that they need.”

Making sure that people have what they need has taken on increased importance for Kidman, the Senate candidate who is having to think outside the campaign box now that Maine is under a shelter-in-place order. Searching for ways to help their community, Kidman decided to get involved with local mutual aid campaigns run by the local Democratic Socialists of America chapter as well as Mainers Together.

“Our campaign has had to be nimble. We’ve had to be adaptable from the beginning, like a trans person running for federal office is a rarity,” they told Vox.

Kidman got approval from the Federal Election Commission to use campaign dollars to fund grocery runs in their local community, and decided to deliver groceries themselves. They start with a basic list of about $75 worth of food and essentials and ask people without food security specifically what they need for a few weeks. Kidman bundles several orders together based on geography and picks them up at the grocery store, then delivers the orders directly to people’s doorsteps. Kidman then waits to ensure the people take their orders inside and follows up with a phone call to ensure no items were missed.

The system allows both Kidman and the people in need to avoid person-to-person contact, lowering the risk of potentially transmitting coronavirus between them.

But social distancing isn’t always a possibility if you need to pick up work to pay the rent, and the coronavirus is likely to hit the trans community particularly hard along the way. But trans people are also banding together for mutual survival, a skill honed over decades of discrimination and brutal treatment by society at large.

Redden perhaps summed up the trans community’s reaction to the virus best. “We’re still doing this work of connecting all the dots so that no youth falls through the cracks,” they said. “I’ve seen that only solidify in the last month or so. And that’s heartening.”


Update, March 29: Includes comment from Medi-Cal, which says applicants do not need to provide their credit score to become eligible for the state program.

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