Opinion | The ACLU of Iowa is right: Trans people should not be discriminated against in healthcare

Iowa law that allows Medicaid to deny coverage for necessary procedures is discrimination plain and simple.


Katie Goodale

The Iowa State Capitol building is seen in Des Moines on April 9, 2019.

Evan Mantler, Opinions Contributor

Health care for transgender people is just that — health care.

The American Civil Liberties Union of Iowa and the national ACLU LGBTQ & HIV Project recently filed a lawsuit against the state of Iowa. The lawsuit challenges a 2019 law that would allow Iowa to discriminate against transgender individuals and deny them Medicaid coverage for necessary gender-affirming care.

The ACLU of Iowa claims this practice and the statute that reinstated it violates the equal protection requirement of the Iowa Constitution — and they’re right.

The 2019 law followed an Iowa Supreme Court case that found denying Medicaid coverage for gender-affirming surgery violated the Iowa Civil Rights Act. Shortly thereafter, the Republican-controlled Legislature created a loophole that would specifically allow for such discrimination.

This amendment to the Iowa Civil Rights Act is blatantly discriminatory. Its whole purpose is to allow the state to deny coverage for medically necessary health care simply because someone is transgender, even though Iowa Medicaid covers the same surgical procedures for people who are not transgender. It’s clear the motivation behind this law is just transphobia.

By denying Medicaid coverage, this law makes it functionally impossible for many trans people to receive the care they need. Particularly when it has no basis in medicine or science, this law should not come between a person and their doctor.

Medical treatment is not optional. Laws like these can have disastrous effects on the lives of transgender people. The psychological and physical strains of living in a body incongruous with one’s gender identity have been demonstrated time and time again.

According to the National Center for Transgender Equality’s 2015 report, 23 percent of trans respondents did not see a doctor when they needed to because of fear of being mistreated as a transgender person, and 33 percent did not see a doctor because of cost.

Further, 39 percent of respondents were currently experiencing serious psychological distress, while the same was true for only 5 percent of the U.S. population. Similarly, 40 percent of trans respondents reported attempting suicide in their lifetime, compared to 4.6 percent of the U.S. population.

Aside from the mental and physical harm this law causes, it also displays Iowa’s willingness to discriminate against transgender people and further anti-trans attitudes.

With transgender people facing disproportionately high rates of violence, it is important to cultivate a culture of respect, rather than one of hostility and discrimination.

Public opinion shows an increasing acceptance and understanding of transgender people, with 73 percent of Americans saying that transgender people should be protected from discrimination.

Iowa should not be opening loopholes in laws designed to protect its citizens, nor should it be implicitly encouraging discrimination.

Even the U.S. Supreme Court in 2020 ruled in favor of transgender individuals in Bostock v. Clayton County, finding that the 1964 Civil Rights Act, which prohibits discrimination on the basis of sex, also protects LGBTQ employees.

It is clear the tide is changing on transgender issues throughout the country. Transgender people are not going away. Iowa should get with the times and start actually protecting and caring for all its citizens.

The fight for trans equality is just beginning. This lawsuit shows just how much we have yet to accomplish. If Iowa is not ready to fight for trans rights, it should at least stop fighting against them.

Columns reflect the opinions of the authors and are not necessarily those of the Editorial Board, The Daily Iowan, or other organizations in which the author may be involved.