The Fight Over Trans Healthcare Under Trump w/ Jane Migliara Brigham
Russell sits down with Jane Migliara Brigham of The Needle to discuss her recent article, "Ambetter Insurance, Centene denying hormones to trans patients across 19 states in push for MAHA Medicine."
Interview originally appeared in this full episode of the Psymposia Podcast: https://youtu.be/K6mfQj_TPz8
Chapters:
00:00:00 Intro
00:01:27 Ambetter and Centene
00:01:58 When The Needle's investigation began
00:02:42 Internal documents reveal 19 hormone coverage restrictions in 19 states
00:05:02 Strike-down of HHS ruling on anti-trans discrimination in medicine
00:06:41 What trans clients are being told by their insurance companies
00:08:00 Centene aligning with MAHA policy
00:09:42 How the MAHA movement views trans healthcare
00:12:35 Right wing support for cis gender-affirming care
00:15:30 The restrictive reproductive healthcare policy playbook is being used on trans healthcare
00:20:26 Hormone stockpiling and security
00:22:10 Broader mission and coverage of The Needle
Footnotes:
Ambetter Insurance, Centene denying hormones to trans patients across 19 states in push for MAHA Medicine (The Needle)
RFK’s HHS Finalises Rule Targeting Insurance Coverage of Gender-Affirming Care (Transitics)
https://www.transiticsnews.com/p/rfks-hhs-finalises-rule-targeting
Learn more about Trans Liberty's Operation Lifeboat
https://www.translifeboat.org/
Transcript
This transcript was generated automatically from YouTube's captions, then cleaned up by removing filler words, repeated words and background sounds. It may still contain errors.
[00:00] I actually was able to review a recording. The insurance claimed, "Oh, you hadn't paid us, but he was able to show that he actually had paid." And the insurance agent was just lying to him. The general vibe as far as like what they're being told is one thing and then another. There's confusion. There's not a clear picture. They're not being given a direct answer. Can you talk a little bit about how the Maha movement and RFK himself generally view or discuss trans healthcare initiatives? Badly in a word. I wanted to explain just how they're using the playbook that they manage for abortion care and using it for trans care. For example, Louisie Dobs, yes, it might have banned abortion, but most people in most of the states that banned abortion were not would not have had access to abortion anyway. It was just formalizing a system of discriminatory medicine that already existed.
[00:49] We're seeing them lay out the very same playbook with trans healthcare. Hey there, I'm Russell with Psymposia and today I'm here with Jane Bighgam of The Needle. She recently published a piece about the insurance companies Am Better and their parent company Sentine denying hormones to trans patients across 19 states in a push for Maha Medicine with Artemis T. Douglas. Jane, thanks a lot for being here with me today. Yeah, glad to be on. Yeah. And before we kind of jump into the details of your investigation, can you tell me a little bit about the players involved, just break down who Am Better is, who Centine is for the audience.
[01:36] Am Better is a budget health insurance company that operates primarily in the Midwest and South, but also in a number of other states. They appear to be expanding over time. Centine is their parent company. They operate a lot of private and ACA plans. They also are the administrators of Medicaid in several states. Got it. Thanks for that background. And when did you begin seeing denials of coverage for hormones being reported? When did this kind of story come onto your radar? I saw it a little over two weeks ago now. I'm in a server called Trans Liberty where we work with Operation Lipo be help people who are in Kansas who have been denied public documentations to get out of other states. And some people in there were talking about, hey, I'm in Kansas.
[02:23] I'm on ambiter insurance. My insurance is denying me my testosterone. And we kept seeing that again and again and again. So I started digging in and I very quickly found a pattern initially with a number of trans men being denied testosterone, but I quickly found that it was also trans women being denied estrogen and progesterone as well. So I started digging into their internal documents. I've eventually found their policy documents because they a lot of these states will still say yes we cover gender affirming care. We have gender affirming care policies on the books. Some of them have been quietly removed since last month but at the same time we found their documents specifically pertaining to testosterone. I think the specific drug was and anderm and I think it's worth reading what's on on here. gender dysphoria, female tomale transition.
[03:12] And this is under a document for the specifics of how to administer testosterone, the main substance in a trans man's hormone replacement therapy. A request and it says that a request has to be for a member in a state other than the following where gender dysphoria and gender transition treatment is not a covered benefit. And then it gives a list of 19 states, the vast majority of which are Republican controlled. And all of these are states in which we have been seeing a large cluster of insurance claim denials. And breaking this down, it's saying, so the request is for a member in a state other than the following. So is that saying that they will they're covering outside of those 19 states, but not in those 19 states? It implies it. We don't have hard data on what they're doing outside of those states. We're Trans Liberty is currently working on a poll to determine the actual specifics of that, but we don't know yet.
[04:03] Okay. Yeah, that's great information and a wild find in the documentation there. By the time this go this you said this is going to be out at the end of the month. By the time that happens, this poll should be public and we should be able to link it. Great. I would love to link that as it comes out. I would be happy to attach it with this interview. And so the testosterone was kind of the main focus there. But you mentioned that there have been cases that you've begun seeing for estrogen and other gender affirming care. Yes. Their document has it lists their page where I found the document on testosterone lists a number of things including forms of estrogen. However, those forms of estrogen are for things like vaginal dryness, things that are typically not associated with trans women's transition. We don't have a document, for example, for estrogen pills or injectable estrogen.
[04:51] So, we don't know if they're having similar restrictions. However, the amount of denials we're seeing seems to imply that's what's going on. Gotcha. Gotcha. And in your reporting, you reference this 2024 ruling by the Health and Human Services Department that required insurers to cover the same medicines for trans patients that are also available to CIS patients. And you note that there's been some change or push back to this policy that's allowing for some of these insurance changes. Is that correct? Well, it's not that there's been change or push back. It's that that policy was was struck down back in October. And it's also the fact that the reason it hasn't had much coverage, one because it's trans news, so that really doesn't get picked up unless it's like the kind of thing that mainstream media will pick up on.
[05:37] And two, the actual not formal legal notice for that ruling was only put up, I believe, on June 2nd, so three days ago from when we're recording in the middle of when we were writing of writing up the article. So, it's been law since October, but the public notice of that of this being the basis of law now was only put up months and months later, and by that point, it was already being used to shut off care by ambiter insurance. That seems [expletive] up. So, the insurers had access to this policy change, but the general public wasn't aware of it. Well, there were a few articles. I believe Transics covered this. You could probably put up a link there at some point, but the general public, unless you were like clued into the legal specifics of this ruling, would not have had any way of knowing that this had actually happened and they wouldn't have had any reason to know.
[06:33] Oh, why is my insurance not covering my testosterone, estrogen, etc. I guess it's I guess I'm part of an isolated case. I guess this isn't part of a trend. In your investigation, you spoke to a number of trans individuals who have begun being denied this kind of care. What are they telling you about what they're being told from insurance companies? Well, it seems like the insurance companies very often don't seem to know what's going on. Like I had one that I actually was able to review a recording of this one man who had called to his called his insurance. The insurance claimed, "Oh, you hadn't paid us. Therefore, we're not going to cover you." But he was able to show that no, he actually had paid and the insurance agent was just lying to him. Interesting. And are other people being told that they're not going to get coverage that it's no longer covered and that kind of thing as well?
[07:23] One person claimed that their insurance agent was actually had actually said that and I have a report that I have not been able to verify yet that this is happening on the back end as well. But we would have to do more digging to confirm to what degree and to what level of obviousness this is being done. Is it being is it like some subtle coding thing or just like, "Hey, they're trans. They're looking for estrogen, testosterone, etc. Don't cover them. We don't know." Gotcha. But the general vibe as far as like what they're being told is one thing and then another. There's confusion. There's not a clear picture. They're not being given a direct answer. At the same time as these policies are affecting trans people, Ambed's parent company, Centine, has been aligning itself with RFK Jr.'s MA.
[08:09] Can you talk a little bit about the moves they're making to align themselves with that and how the Maha movement RFK himself has treated or views trans healthcare initiatives in general? I'll take those one at a time. Know that Asentine initially gave $50,000 to Trump's inauguration campaign. For large corporations, that's not that unusual, bad as it is. However, in the last month, they have been making moves which are much more direct. three of their executives published an opinion piece in I believe it was health affairs calling on hey health foods should be the primary line of defense rather than medicine which was their traditional bent and they're saying that these foods should be covered by Medicaid at least it's either Medicare or Medicaid I'm trying to remember and they're should be covered in the same way that medicine is so they're publicly aligning themselves with the administration in a way that by all accounts should be directly opposed to their bottom line which is always a very strange thing.
[09:07] It's like if you see a corporation acting against the profit margin, that's telling that something strange is going on. So, we know that ideologically they seem to be aligned in a way that would oppose a profit margin. This is around the time where you start seeing a large mass of trans hormone denials. The hormone denials we start seeing late March, early April. They seem to has they seem to have ramped up in the past month as it has been implemented in various states. Now around the same time, this is where we start seeing the public alignment between Sentine and Maha. Can you repeat the second part of that question? Yeah. And the second part of that question was just how the MA movement and RFK himself generally view or discuss trans healthcare initiatives. badly in a word. You to understand RFK's views on healthcare in general and trans healthcare in particular, you need to go back to his repeated comments where he's calling for people to be sent to wellness camps to be repared into being a productive member of society by not
[10:09] Using the kind of drugs that you would have be on for all your life. He typically uses examples like anti-depressants, ADHD medication, and the like. But the same the principle that would make these other drugs bad in his eyes are the same things that apply to estrogen and testosterone, drugs that trans people like myself will be taking for the rest of our lives. And so it would follow that he would want to get rid of them and that he would want us to be repared by basically sending us off to what could fairly be described and has been described by other outlets as forced labor camps. At the same time, he has been constantly making policies making access to estrogen and testosterone for trans people much more difficult because he doesn't want these things to exist.
[11:00] He has much more leverage over youth transare and across this country it is almost impossible to get youth trans healthcare at this point because of the administrative attacks on these various smaller hospitals and at the same time you're starting to see these same attacks go to trans adults at this point. So you're seeing the his effect of using the administration to go after the care he doesn't like and it's been very effective by the point where a major insurer like ambiter can just say nope we're just not going to cover this. This has been going on for months and the regulators seem to have either not noticed or if they have noticed they don't care. So it is having a very dilitterious effect on the lives of trans people. Yeah. There's kind of this rhetoric up top that allows everyone on the way down to just get in line.
[11:48] It seems like it's not just that they're getting in line, it's they're enacting the animosity that they've always had. You had like a about a decade from 2014 to 2024 where like being trans accepting was like the woke thing to do and it's like a lot of for a lot of these people the acceptance of trans people was paper thin and now that they don't have to like pay for their healthcare, they're just going to do that. Yeah. Yeah. That's what it seems like. And what I find really fascinating about this moment in like history is that the same people who are interested in repealing access to trans health care and doing this kind of stuff are also some of the same people that are pushing easier access to like hormonal therapies and what would typically be called gender affirming care for cis people.
[12:35] We just saw this in like the enhanced games publicity, if you followed any of that, where some of the major investors behind that were like Donald Trump Jr.'s VC company or Christian Anger Meer who has aligned himself with Trump. He's a German billionaire, aligned himself with Trump in a lot of ways. And I find that very interesting. Do you have any thoughts about this general right-leaning manosphere looks maxing subcultures embracing hormonal therapies and access to like teleaalth services where you can get GLP1s and testosterone if you're a cy person versus the coverage of these things under trans healthcare? I have quite a lot of thoughts. They want for in particular, they want testosterone to be available for cis men and not for trans men and the reverse for cis versus trans women on estrogen because they just don't want trans people to exist.
[13:27] If you that's the skeleton key to unlocking their entire attitude towards these drugs. They want cis men on testosterone because they because in their mind that's being more cis or more of a man. They want cis women to be on estrogen if they need it because to them that's being more of a woman. Whereas what they would describe the estrogen treatments that I take as sex denying procedures or whatever the euphemism of the month is. They believe that these drugs should be freely available for cis people and they should be made impossible for trans people. Yeah. And they're using these regulations to enact that. For example, they are pushing to remove testosterone in particular from the list of controlled substances.
[14:17] Now, to be clear, that is a move that I support because it is for decades specifically harmed trans men when it was put in place in the '9s, specifically to protect the health of cis men bodybuilders. It is a law that was made for cis people's protection and has disproportionately harmed trans people. At the same time, they want to make it so you have to go through doctors to get it, not rather than being over the counter. So, such that doctors can regulate who can get it. In other words, they can determine, yes, sis people get it, trans people don't. So, they use the doctors as gatekeepers. What I would want is, okay, you want say testosterone, estrogen, progesterone, etc. You could just get that over the counter.
[15:03] So, like if you're for example a man wanting testosterone, it doesn't matter if you're sis or trans, you should just have a right to these because it's a human right. They don't believe in that because they want people to change their bodies, be the best they can be, just so long as you're still capable of making babies. And once that function of being a baby maker goes away, they will shut the entire thing down. That is where it seems like we are heading. And is there anything else related to your recent story that we didn't touch on yet that you wanted to work in? I wanted to explain just how they're using the playbook that they managed for abortion care and using it for transare prior to the Louvie Dobs decision in 2022. Yes, abortion was legal in all 50 states, but there were so many administrative decisions in many of these red controlled states that getting an abortion became functionally impossible because no one would provide it or you just had to travel to some other state which would cost you a lot
[16:03] Of money such that large numbers of people simply would not be able to get that care. For example, Louisie Dobs. Yes, it might have banned abortion, but most people in most of the states that banned abortion were not would not have had access to abortion anyway. It was just formalizing a system of discriminatory medicine that already existed. We're seeing them lay out the very same playbook with trans healthcare. In a lot of these mostly red states, they're using the administrative rulings to slowly make it ever so slightly harder to get trans healthcare for adults in the exact same way that they've that they did for kids prior to the mass wave of bans in the early 2020s. Okay, so backing up, it was never easy to get trans medicine as a kid.
[16:49] It was administratively quite difficult. You had to go through a hall of rings. You had to get your parents to approve it. You had to get your doctor to approve it. You had to get a psychiatrist to approve it and then you had to get an endocrinologist to administer it. That was a very very difficult system to go through and very few children were able to get it. I believe it was something I did a report on this where it was like 1,000 people a year. Meanwhile, they're saying that kids are just going to school and seeing their school nurse and coming back like with sex changes or something. is the biggest cuz can you imagine your child goes to school and they don't even call you and they change the sex of your child. Think of it. [cheering] Oh yeah. Because they because in their mind somebody using trying on they them pronouns and getting like your genitals changed are they're not like the same thing but they're on the same spectrum of the same thing.
[17:45] So like, oh, they think one is just gonna like lead might lead to the other and therefore you have to shut it down like a within a zero tolerance sense, right? They want to make it socially impossible to do these things. Going back to trans youth healthcare, it was socially impossible to do it. Even in a lot of the blue states, the more tolerant states, if you can't get all these resources aligned, you can't do it. And now they're using the like, oh, we can just ban it for kids. So that's what they've done in states that compose about half of the US population and about half of the US states where you just can't get this stuff legally anymore for kids. They're starting to do the first step of setting up the administrative blocks for adults and they're roll starting by rolling it out in red states where ambiter operates.
[18:33] They're just like doing it slowly by slowly and like oh oh it'll be like harder to administer like we're just not going to cover it. They're doing that and eventually, mark my words, a couple of years down the line, if this doesn't get stopped, they're just going to do formal bans on these drugs. We already saw a formal ban on all HRT, including for adults, get introduced in Oklahoma. Now, that that didn't end up passing. They ended up taking the language of the bill, making it something completely different. I don't remember off the top of my head, and they made that as some other unrelated restrictions. But it shows that there is a legislative will to ban these substances and they're using a playbook that already worked with abortion and that already work with trans youth healthcare.
[19:20] And if you quote the head of the Heritage Foundation, we want to get rid of this for all adults. They're laying it out there and laying out the intention and they're also starting to use the same legal and administrative framework to get that done. So I believe that this movement by ambiter to not cover these medications that until October would have been mandatory to require coverage for. They're starting to see the same restrictions play out and I think we're going to have the same outcome. Yeah. They're slowly chipping away at their main goal which is the elimination of this coverage. Yes. And adding on to that, by the time they actually get around to doing formal bans on trans adult health care, most trans people will not have had regular access to their hormones.
[20:10] So, it won't be a like a quick shut off. It'll be like, yes, they will have formally banned it, but the most vulnerable trans people will not notice that that the formal ban will have gone into effect because they will already have had their hormones taken away. And to that effect, the conclusion of your article speaks to the topic of stockpiling. When you talk about it, in your conclusion, you talk about how those who stockpiled HRT were far more secure than those who did not. Can you speak a little bit to the stockpiling of HRT medications? Yes. So, when I interviewed all these people for this story, one of the things I asked them was, how secure are you when I went security is how long do you have dosage dosages of the hormones you need to live? For example, for people who had like months and months of supply, they were fairly capable of waiting out the storm.
[21:02] They were like, "Oh, maybe I can like maybe this insurance dial is a temporary thing, but and while I wait that, I can keep injecting myself with what I need to live such that it's not really affecting my life in an immediate way. Meanwhile, for people that did not have this stockpile of hormones on hand, they were all thinking, "Okay, I have three months of testosterone left. That means I have three months to leave the state that I'm currently living in and go to somewhere else where I can get what I where I can get my medicine." There's a reason. It's like a state of panic. Yeah. It's causing panic because you need that stuff to live. And as I conclude my article, having HRT can mean the difference between security and being driven from your home.
[21:49] It's no coincidence that we met these people in the Discord server of Operation Lifeboat whose purpose is to get people out of Kansas. And it's no coincidence that Kansas is one of is the first state where we saw reports of trans men being denied testosterone. Yeah. Well, I really appreciate you reporting on these subjects and coming on here to talk with us about it. If people are interested in these topics and following these things as they play out, I think the needle's an incredible source of information. Can you speak a little bit to the broader mission and content that is discussed at the needle, what you report on and the coverage there? We started The Needle, that being myself and my coworker Artemis started the needle because we were reading a lot of trans news. And to be clear, most news about trans people is made by sis people who are indifferent to actively disliking us.
[22:41] Therefore, they're not going to be that sympathetic to our cause. They're not going to understand us or they're going to make sure that they're including the opinions of people who want us dead for neutrality reasons. Cough, New York Times, Atlantic, BBC, etc. Meanwhile, you have transowned outlets that yes, you have like Eron in the Morning being the most famous one who are doing trans news, but it's doing trans news that's still to a cis audience and is written for a sis audience. And I know this for a fact because when I interviewed to work for Aaron last year, she specifically told me that our primary audience is not trans people. Our primary audience is the cis family members of trans people. So I didn't when I was realizing okay this is the field in which we're operating in I want to do news that is by us for us is I'm going to use the language that the trans people use amongst themselves because I want that
[23:43] To be our core audience. I'm fine with sis people reading us. plenty of sis people do, such as yourself. And like, but I want sis people to understand trans people in the language that trans people understand themselves. And I want sis people that want to learn about trans people to take seriously the issues that trans people are trying to get them to take seriously. Yeah. So we have we kind of cover these stories that are very important such as for example ambiter insurance cut cutting off care because this wasn't a one-off story. Yes, as far as we knew it was only located to Kansas. It's only within the past week that we found documents proving that no, this is much wider than Kansas. We have proof of them denying coverage in 19 states.
[24:30] But for example, most outlets would not have covered a Kansas specific case unless it's extremely severe, such as the license is being revoked in that back in February. So we decided just, hey, we're just going to do an editorial stance of what do we think trans people need to know? And that's been our guiding light that there's a reason why we dug into for example there was a fake threat of FBI letters going around to trans creators that was going on in January. The there was a letter said that was allegedly saying hey trans creators we this is the FBI stop making content about trans people or else. And this is like a massive panic. No people couldn't really figure out where it was coming from.
[25:17] They knew a few people who had claimed to have gotten these letters, but it was a massive panic without any evidence. We ended up doing an investigation into that. And I was able to figure out that one of the main people who was promoting this and was getting publicity off having been threatened by the FBI had faked her evidence because she had sent it to me. And I was able to identify within five minutes. It was an AI generated image of a fake document. And this was the basis on which he was claiming to have been threatened by the FBI. So I'm glad that the most popular thing I've ever done by pure view count. It's not the hey trans people, here's how you're getting [expletive] over today. It's hey trans people, you have been lied to. The threat that you thought was going on actually isn't happening.
[26:03] Therefore, you should be worried about these certain things. These are the kind of what to sis people would be considered a niche story. the kind of things that cis writers about trans people or trans people writing for a cis audience wouldn't really think to cover which is why we have so many stories of that are just kind of like out there to a cis audience but trans people are like oh my god you covered that I was like that's a huge deal and I want to emphasize that we are doing this on essentially a shoestring budget I was able to go into this over the last couple weeks interview a number of people on this issue and I was able to do that on a fraction of minimum wage. This is my full-time job that I began working on in October. And I hope to be able to support myself doing this.
[26:50] I hope to support more people doing this. Artemis also would like this to be her full-time job as well. That's the other person who works at this with me of the main people who work this at this with me. But that requires money. If you want to support coverage like this, you should get a subscription to our outlet. We are looking to do more with ambiter. We know that there's more to dig into. We are hoping to do other stories as well, but we need the ability to fund ourselves in order to do this. For example, next week I'm going to be in the courtroom at Manhattan covering the DOJ's attempts to get documents related to trans children. essentially making it so that they can create a list of trans kids who are going through NYU, Mount Sinai, and some unknown number of other hospitals.
[27:41] We want to cover that. That costs money and we would we need your support to keep this going. If you like what we're doing, if you think what we're doing is helpful, please buy a subscription to The Needle. Yes, check out The Needle. That's the needleenews.com. I think you all are totally on the pulse. You show up with the receipts in everything that I read from you and there's insight in your reporting that I'm not finding anywhere else. So, I can't recommend you all enough. Thank you so much. Are you there?
