At the beginning of the COVID-19 global pandemic, I confronted one of the most important aspects of who I was to become. Transitioning is not an easy decision and for some, the process takes months, even years to fully realize. As the world felt like it was crashing down around me, I made that leap. 

As a state worker for the Pennsylvania Department of Transportation, I am a member of AFSCME, a national union of state, county, and municipal employees. As a union member, my union-negotiated healthcare plan allowed me to receive fast and affordable transgender healthcare in the middle of a pandemic.

I didn’t need any signed psychiatrist letters. I didn’t have a mandated “waiting period.” I called a doctor in the local hospital network, said I wanted to transition, and within five minutes of providing my informed consent, we set up a virtual appointment. The day after this appointment (and some same-day blood tests), I received my first dosage of hormone replacement therapy (HRT). 

This is not the norm for the vast majority of transgender people in the United States. The standard wait time for most trans people can take several weeks to months with so many bureaucratic hoops to jump through, that the initial task may seem so daunting: why bother? Constant phone calls with insurance to make sure your coverage includes hormones, surgeries, mental services, etc. These obstacles can cost untold damage to people’s mental health alone knowing who you are but being unable to be who you are is a curse that is all too common for many trans people. 

My situation is unfortunately rare for many queer people, but it shouldn’t be. It was my union healthcare that provided me affordable treatment and the access I desperately needed even amid a pandemic. This is why the fight for unions in all of our workplaces is so crucial, and points to why all working people have a stake in fighting for equal rights for transgender people. Workers in unions can wage an organized rank-and-file struggle for contracts that set all-encompassing healthcare in stone, guaranteeing care not just for transgender people, but for the needs of all workers.

Although my union healthcare is a significant step up compared to other expensive plans at non-unionized workplaces, my contract is still limited. Workers with disabilities are unable to get the coverage they need. Even basic treatment for the most healthy among us can break the bank.  That’s why union members must get active in contract negotiations and organize for the strongest possible care for all members. A strong contract means coverage for all surgeries and treatments, without having to empty your wallet. That is why, beyond struggling on the job, we need to fight for a Medicare for All system where workers will not have to constantly fight with insurance companies to get their basic needs met. This would be a massive boon to the labor movement: a common union-busting and strikebreaking tactic of bosses is to pull workers’ healthcare during a strike, and any raises won are often offset by the skyrocketing cost of for-profit healthcare. 

Amazon and Starbucks workers are at the forefront of the labor movement today, and queer workers in particular are leading fighters for what we need in our healthcare system. Trans Starbucks workers are fighting for gender-affirming healthcare for all workers – part- and full-time – so that the bosses can’t cut workers’ hours only to leave them at a loss for healthcare coverage.

Internationally, the National Health Service in the UK has been continuously defunded, leading to horrifically long wait times for trans and queer people seeking care. The struggle for a stronger NHS and against austerity will require coordinated action and strikes against further cuts while demanding comprehensive trans healthcare. Trans issues are a livewire in the U.S. as the right goes on the attack to roll back gains won for queer people in recent decades. As these attacks primarily take aim at schools and healthcare, nurses’ and teachers’ unions must take the lead in defending LGBTQ workers, patients, and students. 

Winning more sensitive care for trans people is not enough to save our lives. Not if we can’t afford to see a doctor or go to a hospital. The fight against bigotry must go hand in hand with the battle to make health care affordable. Nurses and doctors are not the enemy, they want to do right by their patients including trans people. Hospital bosses and board of executives care more about profit than actually taking care of their patients. When people of color or people with existing conditions don’t get the right treatment because practitioners or insurance companies “don’t believe them” it all comes down to overworked nurses and corporations always worried about the bottom line. 

Building a mass organized movement of nurses, doctors, trans people, people of color, and people with disabilities can help fight against racism, ableism, transphobia, and queerphobia in clinics and we can fight against the bosses that work nurses to the bone, paying them garbage wages, and long hours.