Len Meyer knows what it's like to fight a health insurance company for coverage.
Meyer, who is nonbinary and transgender, spent more than six months battling an insurance company to cover a double mastectomy. The company claimed the procedure wasn't medically necessary, and denied it three times before the insurer agreed to cover it in 2015, Meyer said.
"It was really frustrating," said Meyer, 47, of Bloomington, Ill. "For me to feel like I was my true, authentic self, having that surgery really made a change for me."
More transgender individuals may find themselves confronting similar obstacles to care if the Trump administration finalizes a proposal to roll back a regulation of the Affordable Care Act that prohibits discrimination in health care based on gender identity.
That Obama-era regulation, which went into effect in 2016, applies to health care providers who receive federal funds, which most do. Federal rules also prohibit discrimination based on gender identity in health insurance, but the proposed changes would undo those rules as well.
A federal court has temporarily put enforcement of the regulation on hold, but the Trump administration wants to go even further, doing away with the rules entirely.
Opponents of the change worry that if the protections are removed, transgender people could be denied gender transition services or even routine care, such as pap smears and prostate cancer screenings, because of their gender identities. They also worry it could cause many transgender people, who often face obstacles to getting medical care, to stop seeking needed medical services.
Illinois already has taken steps to safeguard the heath care rights of transgender residents -- but they still might not be immune to changes at the federal level. The Illinois Human Rights Act prohibits discrimination against people based on gender identity.
But the state law doesn't apply to self-funded insurance plans, the kind often offered by large employers. About 68% of workers with insurance through their employers were covered by partially or completely self-funded plans in 2016, according to the Kaiser Family Foundation.
The U.S. Department of Health and Human Services has said the change is necessary because of legal issues and to "relieve billions of dollars in undue regulatory burdens," stated a notice published in the Federal Register in June, shortly after the administration announced the proposal. The proposal could be finalized in coming months.