When Gaines Blasdel decided in 2012 that he wanted surgery so his physical identity would match the male character he'd long had in his head, his health insurance wouldn't cover it — not even student coverage at Hampshire College, which he admits with a laugh is the "social justice warrior capital of the world.''
Blasdel went ahead in 2012 and had his breasts removed at his own expense, but by the time he wanted a phalloplasty to construct a new penis in 2017, the insurance situation changed. The 25-year-old Brooklyn resident, who works for Callen-Lorde Community Health Center, a trans advocacy group, had work-based insurance that covered gender-transition surgery. So does Medicaid in New York, as do all individual plans offered on Healthcare.gov, the online insurance mall set up by the Affordable Care Act.
Gender affirmation surgery — sex-change surgery is now a passé term — became four times more common between 2000 and 2014, for a total of 4,118 in-hospital procedures. Between 2012 and 2014, there were 1,260 surgeries, according to the most recent comprehensive data included in a study by Johns Hopkins Medicine.
"Five years ago it was so rare to have access, that people didn't know what they would even want," Blasdel said, referring to the array of surgeries transsexuals might seek over and above hormone therapy — from breast augmentation or reduction and construction of new genitals to facial feminization or masculinization plastic surgery — the latter often being the most expensive part of gender transition.
"The access leads to the cultural change that makes people want it," Blasdel said.