Toward Open Military Service

August 2, 2013

Transgender people cannot currently serve openly in the U.S. Military. Military medical regulations, as currently written and implemented, effectively preclude service. These rules are based on unsupportable, old fashioned, unscientific nothing and they must end. And they will end.

Finally, nearly three years after Don’t Ask Don’t Tell was repealed, attention is finally turning to trans military service. Just this week, our colleagues at The Palm Center announced that they have commissioned eleven studies, supported by the largest known grant ever given to a trans policy effort. And yesterday, The Williams Institute released a new analysis of the challenges reported by veterans in the NCTE/Task Force National Transgender Discrimination Survey (NTDS).

Even more is happening behind the scenes. Conversations are starting, plans are being laid, and progress seems inevitable. We will win open military service for trans people.

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10 Years Ago Today

January 7, 2013
Mara Keisling, NCTE Executive Director

Mara Keisling, NCTE Executive Director

This is the 10th anniversary of my first day in the NCTE office, working for trans people. It took the founding Board of Directors a few more months of planning to formalize and incorporate the organization, but Monday, January 6, 2003 was my first day in the new office, in the new organization.

So I have been working for NCTE for ten years and have been privileged to see such amazing progress throughout the movement and throughout the country. I have been fortunate to work with so many remarkable, committed, smart, and good people. Together we have made stunning progress.

Thanks from my heart go to everyone who has worked at NCTE, served on the Board, supported us financially, worked with us from an allied organization or as an individual, and anyone anywhere who has just pitched-in on their own to improve trans lives.

I have been in service to transgender people for a decade in this role, and I could not be more honored and happy, humbled and proud.

Thank you. And wait until you see what we get done this year.

Why NCTE Cares About the Prison Rape Elimination Act Standards

May 15, 2012

If you have seen NCTE’s Blueprint for Equality, you know that the federal agenda we’re working on is both complex and comprehensive. Every issue on the agenda is important. Some of the issues are truly life saving, while others are simply necessary steps to full equality. All of it is important to some trans people who are facing obstacles to living fully. And one of these issues I’m really proud of working on is the National Standards to Prevent, Detect and Respond to Prison Rape.

In 2003, the Prison Rape Elimination Act (PREA) was passed by Congress and signed by President Bush. The Republican Senate, the Republican House and the Republican President all agreed that, regardless of various positions on corrections and crimes and related issues, in the United States we all agree that sexual assault in prison is unacceptable and must be stopped. A Congressionally appointed commission and the U.S. Department of Justice spent nearly a decade studying the issue and developing national standards to address all aspects of the problem. And NCTE has provided input all along the way.

And very soon—hopefully within weeks—the U.S. Department of Justice will release standards that could help significantly decrease rape in prison. We have not yet seen the final standards, but we are hopeful that our advocacy has influenced them in terms of how trans people are classified housed and searched among other things.

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Trans Health Care Protections at Risk with the Supreme Court

March 27, 2012

Yesterday kicked off National LGBT Health Awareness Week, a time when, as Secretary of Health and Human Services Kathleen Sebelius said in a statement, we “highlight the progress our country is making to address the unique health needs of lesbian, gay, bisexual, and transgender (LGBT) Americans, especially through the implementation of the health care law, the Affordable Care Act.”

But recently, instead of highlighting progress, we are being forced to defend victories. For instance, the attack on women’s reproductive health and the constant war on “Obamacare” symbolize for me how extremists are taking distinctly anti-equality positions. And today, even more is at risk as the U.S. Supreme Court hears arguments related to the constitutionality of the Affordable Care Act.

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99 Steps Toward Federal Transgender Equality

March 22, 2012

Download the Blueprint for EqualityIf you asked me what I would most like people to know about the National Center for Transgender Equality, I’d need to name a few things: we have a truly remarkable board and staff, we do exceptional work with almost no resources, and our federal agenda is really, really complex. I hope that the quality of our board, staff, and work shows.  However, I do sometimes think that the community doesn’t always see the breadth and complexity of the work we do.

In late 2007, when we knew that a new Presidential administration was imminent, we began a process to really dig into and understand all the federal policies that needed to be adjusted to be fairer for trans people. Most bad policies weren’t intentionally hurtful to us; they just ignored us or didn’t anticipate us.

Late in 2008, we released a list of policies we wanted changed and we set about changing them. Since then, we’ve had some very important successes like working with the State Department to update their passport gender marker rules and working with the Social Security Administration to get them to stop sending gender no-match letters that effectively out trans people to employers.  We’ve also had dozens of other successes, big and small.

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Remembering Our Dead

November 20, 2011

Unquestionably, the most solemn day for transgender people in the U.S. is the Transgender Day of Remembrance which is commemorated every November 20, throughout the United State and worldwide. On this day, we memorialize the many transgender people who have lost their lives to hate-based violence. It has been estimated that one trans person per month on average is killed in the United States in a hate crime murder just for being transgender.

Most people I suppose have no idea that transgender people in the United States face obscenely elevated levels of violence compared to non-transgender Americans. The epidemic of school bullying against lesbian, gay, bisexual and transgender students has received much needed attention lately. That’s great and helping our children should be a priority. But we also face higher rates of sexual assaults, domestic violence, assault by police and hate violence—attacks and frequently murder just because of who we are.

The recent National Transgender Discrimination Survey showed that 26 percent of trans people in our sample had faced physical attack at some point for being transgender and ten percent experienced sexual assault. In Washington, DC alone there have been 25 anti-transgender attacks, including two murders, reported to the police just since July, according to the DC Trans Coalition.

All this violence is a well-known, deeply felt and, too often, personally experienced reality for the transgender people in your life—your trans children, coworkers and neighbors.

Violence against trans people is such a public health and safety issue that it is finally getting attention from the federal government. This Wednesday, with a small group of transgender and LGBT anti-violence advocates, we briefed White House officials on strategies for addressing the problem.

Fortunately, there is much the federal government can do: count transgender people in crime and health surveys, implement the Prison Rape Elimination Act recommendations (making sure they apply to immigration detention as well), insure that federal anti-violence programs take transgender people into account, and consider trans people when addressing problems of violence against women, youth, people of color, homeless people and immigrants. We provided the administration with over twenty common sense policies we desperately need to have implemented.

This week too, NCTE released a model school district policy with our partners at the Gay, Lesbian, and Straight Education Network (GLSEN) to help schools better incorporate the increasing number of transgender students coming out in America’s schools. As a first-of-its-kind resource, we hope to better prepare schools to support trans students, end bullying and establish procedures that allow young trans people to grow up as safe, whole people..

Trans people have far too many murder victims to commemorate on this Day of Remembrance. There is some solace and hope to be had in seeing that every year, more and more good people who are not transgender are taking note of this crisis, attending Day of Remembrance events and pitching in to help end it.

U.S. Dept of Health and Human Services To Begin Counting Trans People

June 29, 2011

Today the Secretary of Health and Human Services Kathleen Sebelius announced a plan to develop and use survey questions to collect public health information on trans people.  This is the culmination of a lot of work from a lot of people.  Why is it so important?

  • Public health data has never really been collected by the federal government.
  • Federal public health data is the gold standard in public health data.
  • Without such data, getting the federal government to focus on a public health problem is extremely difficult or impossible.
  • Soon (or at least in a few years), we will have good public health data we can use to advocate with the federal government for programmatic focus on trans health disparities.

In other words, if there is no federal population-based study data identifying and quantifying a public health issue, there will be no governmental focus to solve it. Because of the HHS announcement today, there will soon be federal population-based public health data on a variety of trans public health issues.

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Trans Policy Brief: Medicare Card Gender Marker

May 26, 2011

Among the most frustrating and dangerous things for many trans people is having inaccurate identification that does not match their gender identity. It is especially troubling with documents like the Medicare card for which there is no programmatic or practical reason to include a gender marker on the card. This bureaucratic mistake causes trans seniors and people with disabilities who are Medicare beneficiaries to frequently and unnecessarily be outed as trans whenever they show their Medicare cards to access services. The gender marker is in big letters smack in the middle of the Medicare card and can’t be missed by any pharmacist or a doctors’ office front desk staff–people who just don’t have a reason to know about your trans-related medical status.

NCTE has been working to fix this problem and will not stop until it is done.

Who Issues Medicare Cards?

The Medicare program is run by an agency within the U.S. Department of Health and Human Services called CMS, or the Center for Medicare & Medicaid Services. [You won't be the first person to wonder why it isn't abbreviated as CMMS, but it's not--they call it CMS.] Technically, CMS specifies what information is on the cards, but the cards are actually printed using information from the Medicare enrollee’s Social Security account, which is managed by the Social Security Administration (SSA).

This means that NCTE is working to solve the problem in two ways with two different agencies. First, we are asking CMS to remove the harmful and unnecessary gender field from the Medicare card.  Second, we have been working with the SSA to modernize their gender change policy to match other updated federal policies such as the State Department’s passport policy, making it possible for trans Medicare enrollees to have the correct gender listed on their cards. If trans seniors and others can get their gender marker changed to match their gender identity, it won’t matter as much that it is listed on their Medicare card.

Why Does the Medicare Card Have Gender on it Anyway?

No one in the federal government has a good answer for this because there is no programmatic answer for it. The gender marker is on the card because it always has been. This is similar to why the gender marker is on driver licences.  Before picture IDs, government agencies put lots of identifying information on IDs to help with matching a card to its user. With the advent of picture IDs, most states have limited the number of personal characteristics (such as race, weight and hair color) listed on licenses, but no one until recently had thought to remove gender.

This is not uncontroversial among trans people either, by the way.  Many who are able to change the gender on their IDs like having a corrected gender marker to prove their gender. Those who can’t meet whatever change requirement there is or those who can’t afford new ID fees are stuck with embarrassing and potentially dangerous moments every time they show their ID.

What Are We Asking the Federal Government To Do?

NCTE is advocating for two government policies that could alleviate the problem we face with Medicare cards–one CMS policy and one SSA policy.

1. CMS should remove the gender marker from the Medicare card. It is not necessary for CMS or for healthcare providers who accept Medicare. And, as we have said, it is an unfair and dangerous violation of privacy for Medicare enrollees.

2. SSA should update its gender change policy to reflect the modernized policy used by the State Department’s Passport Office and many states’ motor vehicle agencies. Rather than require proof of particular surgeries, SSA should require proof from a medical provider that the person has had appropriate medical care for transition.

How Long Will It Take To Fix This?

Good question. We know it can be frustrating that so many needed federal policy changes take what seems like too long, but the federal government is a sticky-slow bureaucracy and, despite our best work, everything takes longer than any of us would like.

Honestly, we too are increasingly frustrated that SSA has not yet followed the very reasonable model set by the State Department on passports. We continue to advocate with them for a better policy.

However, CMS faces a legitimate and understandable challenge in redesigning the Medicare card without the gender marker.  While we are advocating for a slightly redesigned Medicare card because of the gender marker problem, other interests — including many in Congress — are advocating for a significantly redesigned card because the cards also currently show enrollees’ Social Security numbers. In fact, there are several bills in Congress that would mandate the government stop using SSNs on various government IDs, including Medicare cards.

This is no easy or cheap task, it turns out. The Social Security number is the account number for Medicare, so CMS can’t just remove the number; they must design an entirely new records system giving all Medicare enrollees new account numbers.

In fiscal year 2006, Congress mandated that CMS study how much it would cost to switch over to a non-SSN system. The estimates range from $300 to $870 million. So, though removing the gender marker from the card seems like a no-brainer to us, there are complicating factors, which are making this take longer than we would like. We are caught in this larger debate about SSNs.

NCTE will continue to advocate with CMS, SSA and Congress until no more trans people who rely on Medicare for their healthcare are forced to show inappropriate ID to people who just don’t need to know.

To read more about the issue of Social Security numbers on Medicare cards, please see these articles:

NY Times May 22, 2008

AARP November 2008  (2008)


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