The Republican effort to repeal the Affordable Care Act is ramping up, with party leaders likely to reveal a redux of their health care bill this week. A vote could happen as soon as July 4, as the American health care crisis continues on; according to one report, nearly half of the money raised on crowd-funding platforms like GoFundMe and YouCaring goes towards medical costs. And, as ever, it is the marginalized who are most deeply impacted by government decisions. Amidst uncertainty about the future of American health care, photographer Yael Malka shot and spoke with seven trans people, in New York and Los Angeles, about what an Obamacare repeal could mean for them.
There’s already a fear when you go into a space of whether it’s safe or not. Even if they say it’s a safe space, you still have your concerns. It’s event after event, everyday something new. I am fearful, a lot of my friends are fearful, and a lot of my friends are just in a space where they’re trying to prepare for the worst right now. I was just speaking to a trans woman I know and she was talking to me about possibly trying to stock up on estrogen. But hormones are a controlled substance so we are already limited to a specific amount that we can get every month or every two months. A lot of my friends are trying to stock up on hormones thinking they won’t have health insurance anymore, or that it might not fit them or suit their needs. I’m trying to be grateful for what I have right now and to prepare for the worst.
I pay out of pocket for hormone therapy. I don’t think my insurance would cover much of it at the moment, anyway. A repeal would definitely affect the community and the people I care about. I feel like it would affect people getting their hormones. Getting top surgery or other surgeries could be a lot harder. I know in some places you need to have your gender marker changed already. That would be a big problem for a lot of people because that’s already hard to access.
I’m fearful of Trump as a whole. It’s especially scary because my family is really in support of Trump and all the shit he does. So, like, it would just give them more validation in all the bullshit they believe in and taking away people’s rights. That’s scary.
“Last year I bought hormones on the internet. There are companies from India that supply them.” — Flower
My health care at the moment is kind of in a transitional phase because I have this thing that’s extending my coverage that I had under my parents. But it’s not something I can afford, so I don’t know what the effect of a repeal will necessarily be for me. I have a bunch of things that qualify as pre-existing conditions so under this new thing, I [may] not be covered.
I was surprised that a fair amount of my friends were already relying on black market hormones. I didn’t know that until asking them about it. A couple of my friends were like, “Oh, I already don’t rely on the health care system for my hormones, because they don’t give a shit about me.” There’s been a nationwide injectable estrogen shortage for over a year. And it’s a thing that only trans women seem to know about. It’s like a completely manufactured shortage. There’s not actually a scarcity of it, it’s just about health care industry regulations. So that’s partially why a lot of people are not even relying on it. It’s actually kind of cool in a way to be like “Oh, yeah, don’t even have to rely on the mainstream medical industrial industry to do what you need.” Because it’s clearly failing everyone, you know? But the thing with black market stuff, you’re obviously at more of a risk.
Everyone has a pre-existing condition. Acne is a pre-existing condition. My dad has Parkinson’s and I worry about him. My mom has some serious pre-existing condition things. So I worry about my parents almost more than I do about myself in this case. I feel like how could one not be [scared]? It represents such a slap in the face to so many people, like, “We don’t care if you die. We know that you will die, we don’t care.”
I would definitely not have any access to my hormones or mental health services [if Obamacare was repealed]. I started taking hormones by chance in the past year. My mental health was so bad at some point, that I went to Callen-Lorde [a community health center], and they suggested it to me. I never knew it was accessible. Knowing that hormones are an option and just to have it so close for it to be almost taken away... it’s really scary for me.
My life has been so much better since I’ve been on hormones. I feel so much more myself and I don’t think I could survive without it. My mental health would be so bad. When I first went to Callen-Lorde, I was at a point where I just didn’t want to be alive anymore. So I think with the repeal, I would definitely go back to that route. I’m a little afraid... but I think if the repeal does happen, I expect there’s going to be pushback. Things have been a lot more accessible so people are not going to give up on it easily. I’m not going to give up.
I’m making a fair bit of use of my medical clinic and referrals to specialists, so if Obamacare were repealed, I would have to pay for all of that commercially. I don’t know what my plan would cost. Of course, one of the problems with Obamacare, and certainly with private care, would be the co-pays and deductibles that a patient would face. Because of my Medi-Cal, there are no co-pays and no deductibles.
I lived with a lady for a long time who supported me in my transition to be female. I became her caretaker for the last eight to ten years of her life. She passed away last spring, and then I left our shared home and went to Colorado where my sister lives. I came back here [to Los Angeles] in August, but I don’t have a permanent home.
Last year I bought hormones on the internet. There are companies from India that supply them. They will send them to you without a prescription. I believe in India, hormones are not prescription drugs, they are over the counter. If I were unable to attain prescriptions, that’s what I would go back to. On the other hand, I’m actually hoping [to have] bottom surgery. So if that were to occur, which I hope it will, then I would not need [hormones] any further.
“A couple of my friends were like, ‘Oh, I already don’t rely on the health care system for my hormones, because they don’t give a shit about me.’” — Chloe
If Obamacare is repealed, things would be much more difficult for me. I go to Saint John’s Well Child & Family Center in downtown LA and I pay $40 out of pocket per month for a $120 three-month package and I get my hormones from that. If I run out somehow or I lose it, I can go in and get an injection. [My plan] also includes doctors appointments, so I don’t have to pay co-pays. If there wasn’t Medi-Cal, and if I couldn’t afford any other insurance, I would have to pay a buttload of money, just to go in, like $200 for an appointment.
It would be possible [to still get the medicine I need] because I have a prescription, but for people starting the process, it would be much more difficult. I mean, this clinic would probably shut down, as my doctor told me. The clinic specifically specializes in transgender treatments. You would have to go to a more traditional clinic and there would be a lot more ropes and hoops you’d need to get through.
The night that Donald Trump was elected, I was really upset. I was crying. So yes, I’m very fearful [that Obamacare will be repealed]. Things will just become way more complicated. I’ll just have to figure things out as I go. I mean, it’s just anxiety about what I’m going to do to cover those costs.
I’m currently on birth control and without birth control my life is a total mess. It’s really hard to manage. As a trans masculine person, I don’t necessarily like to be on birth control but it’s better than not being on it. But what’s great is that with the ACA it’s free. If not, I don’t know how comfortable I would be paying that much money every single month, which would potentially make me start thinking about going on testosterone, which is not necessarily something that I want to do. I think a repeal is possible but living in New York City, I know there’s more privilege to that than living somewhere else in the United States.