When it comes to clinics for women’s health, who counts as a woman? For breast cancer screenings funded by the CDC, there’s a requirement that advocates for transgender Americans find discriminatory and problematic: patients must be “born as women,” excluding women who were identified as male at birth but who now need services like mammograms. Routine health care can become very complicated, and accessing public health services is too.

ProPublica presents to us the case of a 62-year-old Colorado woman who had a common enough problem for women in late middle age: A fast-growing lump in her chest and no health insurance. She qualified for a state-run women’s health services program that funds mammograms for low-income people. Great! Except funding for the program comes from the federal Centers for Disease Control and Prevention, and 1990’s Breast and Cervical Cancer Mortality Prevention Act restricts these funds to people who were identified as female at birth.

To state the obvious, women who are transgender can get breast cancer. All humans can get breast cancer, actually, and should be aware of unusual changes in their chest tissue.

Without getting too far off-topic, surgery to change patient’s genitals isn’t always required in order to change whether their driver’s license, passport, and medical records say “M” or “F.” This means that Mr. Joe Consumer may have a uterus, and Ms. Jane Consumerette may have a prostate. They need the routine screenings and health care services that go along with those organs.

In theory, this shouldn’t be a problem. The Affordable Care Act explicitly forbids discrimination according to sex, gender, and age. Programs like the Colorado women’s health program that aren’t part of the regular health care and insurance networks can be exceptions…and advocates for transgender Americans find that problematic.

For Transgender Patients, a Growing Fight Over Health Coverage [ProPublica]

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