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How Massachusetts can protect trans people

The Legislature should pass bills requiring parity in primary care, eliminating cost-sharing, and protecting health care providers.

Threats against Boston Children’s Hospital for its transgender care are forcing providers to grapple with the fear of possible violence.Lane Turner/Globe Staff

At a recent Conservative Political Action Conference, a speaker said that transgenderism should be “eradicated from public life entirely.” The person later argued that transgenderism is “not a legitimate category” and hence trans people are not real people. These remarks exposed a deeply sinister political motivation behind the anti-trans wave sweeping the nation.

Some may call this just another Republican culture war. But this one goes further. This is an attack on our very existence. Republican-controlled state legislatures are codifying hate, restricting basic constitutional freedoms, and denying lifesaving health care to people they have decided do not have the right to exist. Families with trans children are relocating to Massachusetts in search of the freedom to choose their own health care journey.



While Massachusetts is a leader in providing health care to those pushed to the margins, the Legislature should pass bills requiring parity in primary care (where most gender-affirming care happens); eliminating cost-sharing for gender-affirming care; and protecting health care providers.

Massachusetts ended required parity for primary care and chronic disease management. Simultaneously, payers like Blue Cross Blue Shield and Point32Health (Tufts Health Plan and Harvard Pilgrim) announced reductions in payment for telehealth, with Blue Cross reversing course until July 1.

Insurance companies often argue that telehealth costs less, and therefore, providers who offer it should be paid less. But research by the Massachusetts Health Policy Commission concluded that telehealth was largely cost neutral.

Telehealth can reduce no-show rates and improve treatment adherence for many of the state’s most vulnerable patients. An Act Relative to Telehealth and Digital Equity for Patients would protect telehealth parity and thereby access to telehealth. Many trans folks have to commute long distances, sometimes taking time off work, to find competent health care. Telehealth can help solve this through accessible clinical care and community support.


Meanwhile, cost sharing, the cost that a patient must pay out of pocket, can deter patients from accessing care. Specifically, individuals with fewer resources will skip provider visits or refrain from visits due to high copays or deductibles.

The Legislature should champion the elimination of cost sharing for gender-affirming care. Trans individuals make up a minority of those in the Commonwealth but experience exorbitant barriers to care. We know that gender-affirming care is cost-effective, value-based care and makes economic sense while dramatically improving mental health and reducing harmful behaviors like smoking, saving health care costs in the long term. We have seen our neighbors to the north, in Vermont, consider this — so why can’t we? Massachusetts needs to lead here.

Reforms in Massachusetts need to be comprehensive, focusing not only on access but on protecting our health care providers.

Last year, An Act Expanding Protections for Reproductive and Gender-Affirming Care was signed, which protects providers of affirming care from out-of-state criminal charges. However, there is no guarantee that the state will intervene if health care workers or organizations are sued in civil court by other states. In addition to lawsuits, providers are also worried about doxxing, cyberterrorism, and physical violence.

There must be a clear pathway for health care workers to ensure they are protected. This means protecting providers who may be sued from out of state.


The trans community represents a small percentage of our state’s population, but we are being attacked in colossal ways. Now is the time for the government to stand up and swing big.

Dallas Ducar is founding chief executive officer and president of Transhealth. Follow her on Twitter and Instagram @DallasDucar.