Y'all, congressional Republicans really fucking hate civil servants.
(Hey, if you have financial anxiety maybe skip this one. This post goes into a bit of the financial details of getting surgery and a bit of the stuff around it. If you’re waiting for a fundraising post, it will be coming shortly.)
The Affordable Care Act required that all health insurance plans to cover trans-affirming healthcare. Sort of.
The good news is that it means that my maximum cost for vaginoplasty—bottom surgery—is the annual out-of-pocket of my insurance plan—probably around $5,000. But almost everything else—facial hair removal ($4,000), facial feminization, breast augmentation—things that many trans femmes need to feel at home in our bodies—are not considered medically necessary. Neither is fertility preservation, so many (including me) have to pay to freeze (about $500) and store ($1200/year) sperm entirely out of our own pockets.
And it gets worse because surgery recover isn’t covered under the Federal Employee Paid Leave Act. Which means that if a federal employee runs out of sick leave and vacation time, surgery recovery is unpaid—which sucks because the initial recovery time is three months before returning to work—about 14 weeks or 528 hours of leave. Luckily, with the leave I have saved up (assuming I don’t get sick or take a vacation in the next 146 days), I will have about half of that as paid leave, but that is still around 250–300 hours of unpaid leave—which means I will have roughly $20,000 in lost wages for a medically necessary procedure.
Including the cost of surgery, and other healthcare needs related to transitioning, my out-of-pocket costs for getting surgery will be roughly $30,000—and that is assuming everyone who provides care and support is working for free because insurance companies assume that the extended care needed for recovery can be provided at home by family and without professional support. And without a care plan that includes 24/7 support—at least for the first month (more on this in a later blog post)—they won’t go through with the surgery. And while I have plans to engage a doula for supplemental support, live-in support becomes really expensive.
“But Cordy,” you might say, “you live in New York which has short-term disability protections!” And normally you’d be correct, except as a federal government employee, the separation between the ~church and state~ state and federal government means that I am exempt from state short-term disability laws.
Without a nesting partner to share the cost of lost wages or provide care over the recovery period, that estimate goes up to $40,000 for a surgery that will “cost no more than $5,000” under insurance. And since most of those costs aren’t direct medical costs, they can’t be deducted from my taxes as medical costs either.
Even though I max out my health care Flexible Savings Account (FSA), but I’ve always spent 100% of that on therapy—a necessity to receiving gender-affirming care in the first place—so it’s not actually a net decrease in costs.
Luckily I have some saved up, but every dollar that is spent on surgery and care is money that is not saved for my emergency fund, money that is not paying down student loans, for retirement, for buying a home. And this is only for bottom surgery, part of the reason I haven’t even considered top surgery or anything else is because I don’t believe I have the resources. Even bottom surgery still feels like a luxury rather than a necessity sometimes. When you’ve experienced times where you don’t know how you’re going to afford rent or groceries, anything that isn’t about feeding or housing sometimes feels optional. But it’s not, joy and gender euphoria are about survival. Because the opposite isn’t living, it’s subsisting. I have to remind myself that every day.
Sixty-two days to go. Next up is gonna be a post that I’ve had a lot of anxiety about: fundraising and how you can help.