In one regard, many transgender Americans face the same plight as Chelsea Manning -- their health insurer won't cover the costly procedures associated with transitioning genders
But that isn't the case everywhere.
While the majority of private and public health insurance plans in the United States won't cover certain types of care or treatments for transgender people, a surprising array of countries including Iran, Brazil and the United Kingdom, cover procedures like hormone therapy and sex reassignment surgery either free of charge or at a low cost.
“The U.S. is very far behind,” said Kellan Baker, the associate director of lesbian, gay, bisexual and transgender progress at the Center for American Progress, a left-leaning think tank. “There are many countries with national health care systems that cover what transgender people need without prejudice.”
The Obama administration is tackling this issue under the president's health care reform law. The U.S. Department of Health and Human Services has specified that the nondiscrimination laws in Obamacare protect transgender people.
Manning, who is facing a 35-year sentence in an Army prison for leaking government secrets, was known as Bradley until Thursday morning, when she announced that she'd like to begin hormone therapy in order to live the rest of her life as a woman. Later in the day, a spokesperson for the Army told NBC that the Army does not provide hormone therapy or sex-reassignment surgery for gender dysphoria.
Insurance companies leave out transgender clients in a few ways. At the most basic level, many refuse to cover the surgery, hormone therapy, mental health counseling and other procedures involved in transitioning. However, transgender patients are also sometimes denied coverage for conditions unrelated to their transitioning, when providers erroneously assume a connection, said Shane Snowdon, the director of the health and aging program at the Human Rights Campaign foundation. If a man transitions into a woman, but retains her prostate, an insurer may no longer cover her annual prostate exam.
“The reality for most transgender people, even if they’re insured is that they do not have coverage,” Snowdon said.
Transitioning procedures are costly. The surgery alone can cost around $30,000.
Transgender Americans are disproportionately poorer than the rest of the population -- more than one-quarter are living off $20,000 per year or less, according to the National Transgender Discrimination Survey. As a result, many turn to dangerous options for transitioning, like buying hormones on the black market or getting silicone injections from someone who isn’t a medical professional, said Baker.
“You see a lot of people doing whatever they can,” he said.
Insurance options for transgender people are better than those a few years ago, however. One-quarter of Fortune 500 companies offer at least one health care plan that includes coverage for transition-related care, according to the Human Rights Campaign’s 2013 corporate equality index. And the number of insurance providers offering plans that cover transgender people is growing.
The situation could improve in the coming months. Starting in 2014, lesbian, gay and transgender people will benefit from one of the main components of Obamacare: Health insurance companies will not be able to deny coverage based on a pre-existing medical condition -- which is how some insurers have categorized transgender people.
"Beginning in 2014, no insurance company will be allowed to deny coverage to anyone, thanks to the new 'guaranteed issue' requirement, which is vitally important news," Jason Young, of Health and Human Services, wrote in an e-mail to HuffPost.
Under Obamacare, health care providers, health insurance companies and employers are subject to penalties if they deny treatments or coverage to transgender people. The policy applies to hospitals, physicians and other providers that receive federal dollars; because most health care entities treat patients covered by government programs like Medicare and Medicaid, the policy would be widespread.
"Last year, HHS clarified, based on case law, that sex discrimination extends to discrimination based on gender identity, and since that time has accepted such complaints for investigation," Young wrote. "HHS and the entire [Obama] administration remain committed to improving the health and well-being of the LGBT community."
What Obamacare doesn't do, however, is require health insurance companies to pay for gender reassignment surgery, hormone therapy or other services.
Currently, many transgender Americans turn to doctors outside the U.S. to get more affordable, and in some cases, better access to these types of procedures. Thailand, where the procedure costs about $7,000, is a "huge hotspot for this type of surgery," according to Sara McCaslin, a filmmaker working on a movie about the cost of gender transition.