Policy Works – Lister Hill Center for Health Policy

March 31, 2022 | Kimberly Randall, Lister Hill Center for Health Policy

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Background:

Since their inception, United States government documents have only allowed two options for gender selection: male or female. The modern understanding of gender identity has shifted to view gender as a spectrum, rather than a dichotomy. Research has differentiated between biological sex and gender identity, which has opened up conversations regarding gender-inclusive language on a variety of platforms in recent years.

The idea of including a third gender option on government identification has already been taken up by several state agencies. According to the National Center for Transgender Equality, 22 US states currently allow for a third gender option on a driver’s license or state-issued photo identification, while 16 states allow for the option on a birth certificate. In almost all cases, the third-gender option is marked with an X.

In 2020, legislation was filed in the US House of Representatives calling for a third-gender option on passports, and the following year, the first passport with an X gender marker was printed. However, its recipient, Dana Zzyym, underwent extensive legal and medical scrutiny to demonstrate that they were neither male or female but intersex, and represented themselves as non-binary. The process for obtaining a third-gender passport in the US was seen as expensive and lengthy, requiring extensive documentation, prior to recent changes.

Denmark became the first nation to allow for a third-gender option on official documentation in 2014, with Malta following suit in 2016. To date, fifteen countries officially allow for third-gender options on government documents.

Policy:

Announced via Twitter on Transgender Day of Visibility, US Secretary of State Anthony Blinken stated “we recognize the achievements and resilience of transgender, nonbinary, and gender non-conforming persons worldwide. … U.S. Citizens will be able to select X as their gender marker on their U.S. passport book starting April 11.”

The official State Department website was updated to reflect the announcement, detailing the process for how citizens can apply for or update their passport under the new guidelines:

“You can select the gender marker you would like printed on your U.S. passport. The gender you select does not need to match the gender on your supporting documentation such as a birth certificate, previous passport, or state ID. We no longer require medical documentation to change the gender marker on your U.S. passport.

Beginning April 11, 2022, you can select male (M), female (F), or unspecified or another gender identity (X) as your gender marker if you are applying for a U.S. passport book and selecting routine service. Beginning in late 2023, you will be able to select X as a marker if you are seeking a passport card or selecting expedited service.”

The policy with initially apply to traditional passport applications utilizing Form DS-11, however the State Department has stated that additional documents including passport cards, emergency passports printed at embassies and consulates, expedited and emergency passports issued at passport agencies, and Consular Reports of Birth Abroad will have the option by late 2023.

Impact:

Recent population studies have shown that up to 4.6% of individuals currently identify as nonbinary or gender nonconforming, while as many as two million US citizens identify as transgender. A study in the Journal of Adolescent Health found a positive correlation to overall mental wellbeing with higher rates of gender affirmation through medical care, educational experiences, and social interactions. Gender-affirming government documents are anticipated to have similar positive impacts on mental health.

The addition of a third-gender option enables individuals to feel gender congruence, or “the feeling of harmony with one’s gender.” Being noted as a gender nonconforming person could help aid in how individuals are seen and recognized in an official capacity. Increased gender congruency has been shown to increase positive outlook regarding one’s identity and overall life satisfaction. In addition, gender-affirming recognition and language are linked to lower rates of anxiety, depression, and suicide in non-binary persons. According to the ILGA, “the X marker could provide relief to non-binary person, persons not identifying with any gender at all and persons currently transitioning.”

While activists have advocated for a third-gender option on official documentation as early as 2000, there are some fears that it could increase discrimination for visa applications and border crossings. Australia, an X-gender issuing nation, has warned that travelers utilizing the third-gender option could face difficulties when entering certain countries. Additionally, logistical issues such as checking in for an airline flight where there is no third gender option may impact travelers as well. It is expected that following the updated passport policy, federal regulations regarding this will change in the coming months.

Next Steps:

The policy for U.S. passports will go into effect on April 11th and the move has received support from President Biden. However, legislation has been passed in the Alabama Senate and is now in debate in the House of Representatives that would restrict access to gender-affirming medical care for citizens under the age of 18. SB184 would prohibit medical procedures or prescriptions intended to alter the physical appearance or hormonal balance of individuals undergoing transition. If you want to make your voice heard on this or future legislation, click here to identify your elected officials.

Don’t know what to say? Check out this guide from the American Civil Liberties Union on drafting a letter to your government officials.

Learn More:

Want to learn more about LGBTQ+ policy initiatives? Check out these resources.

International Lesbian, Gay, Bisexual, Trans, and Intersex Association

Magic City Acceptance Center

Movement Advancement Project

The Knights and Orchids Society Inc

The Trevor Project

January 18, 2022 | Kimberly Randall, Lister Hill Center Program Coordinator

Photo Courtesy of Getty Images

Health policy can take many forms and impacts multiple parts of the public health sector. From housing reform to addressing nutrition in impoverished communities to climate change, legislation can have widespread impacts on the health of citizens.

Following rising cases of the Omicron variant of the novel coronavirus, President Biden announced a series of executive actions on December 21st to assist hospitals and public health agencies. In addition to mobilizing 1,000 troops with medical experience to be dispersed to hospitals overrun with COVID-19 cases and launching distribution systems for PPE to hospitals, clinics, and the general public, the White House also announced an initiative to provide free at-home antigen testing kits to be delivered through the United States Postal Service.

This initiative follows similar actions in the United Kingdom and Canada, where at-home test kits have been available to citizens free of charge for several months, either through mail delivery or at designated pharmacies. Tuesday, January 18th saw the launch of https://www.covidtests.gov/, the official website where US Citizens can request a set of four at-home test kits to be delivered via USPS. While the test kits are estimated to be delivered in late January, registration is open now. The federal government has purchased 1 billion test kits for this initiative, after doubling its original pledge of 500 million.

In addition to the at-home delivery service, President Biden announced that private insurance companies will be required to reimburse expenses for at-home test kits purchased at local pharmacies. According to the Centers for Medicare and Medicaid Services, private insurance companies are required to reimburse over-the-counter COVID-19 tests purchased on or after January 15, 2022 at a cost of up to $12 per test. Health insurance providers must reimburse the cost of up to 8 at-home test kits per month, per person enrolled. According to Blue Cross Blue Shield Alabama, the largest health insurance provider in the state, “members who purchase a test kit should file a claim to be reimbursed. Claims can be filed electronically by logging in to your account or by submitting a Medical Expense Claim Form along with the test kit receipt.” A full list of reimbursable kits can be found on the FDA’s website.

The Centers for Disease Control lists at-home testing as one of the key measures to reduce the spread of COVID-19. While at-home tests have a higher chance at a false-negative than a PCR test, it is suggested to utilize them prior to indoor social gatherings and other close-contact situations where the virus might be transmitted. According to the CDC, “a negative self-test result means that the test did not detect the virus and you may not have an infection, but it does not rule out infection. Repeating the test within a few days, with at least 24 hours between tests, will increase the confidence that you are not infected.”