Transgender and nonbinary patients have a wide array of experiences when attempting to access healthcare, including discrimination and having to educate providers about trans people. This study examines the mental health factors connected to transgender and nonbinary patients' experience with providers to determine the likelihood of transgender or nonbinary patients receiving respectful care after a provider knows about the patient's gender identity, and patients' experience of having to educate providers about trans people, controlling for sociodemographic factor. Using data from the 2015 United States Trans Survey (N = 27,715), chi-square tests of independence and multivariate logistic regressions were used to explore the odds of transgender or nonbinary individuals having a positive experience with a doctor or healthcare provider. Of the respondents, 24.31% experienced having to educate a provider about trans people when seeking care, and 62.90% experienced a provider knowing they were transgender or nonbinary and treating them with respect. Those experiencing depression and suicidal thoughts were significantly less likely to have had a provider treat them with respect, and significantly more likely to need to educate their providers. Gender, age, disability status, and educational level were significant across both variables; income was significant regarding having to educate a provider. Healthcare providers need ongoing training and education to improve their care of transgender and nonbinary patients, specifically around acknowledging the multiple backgrounds and experiences of such patients, including those related to mental health, gender, race, age, income, educational level, and disability.

This commentary explores how different types of insurance (Medicare, Medicaid, state government, and private insurance) address issues of transgender-related care, and how access to transgender affirming insurance coverage and healthcare across life stages depends both on type of insurance and geographical location. We argue that the current state of transgender health insurance policy and practices are inadequate for achieving goals of continuity of care and positive health outcomes across the life course. Transgender individuals are uninsured at a higher rate than their cisgender (non-transgender) counterparts, face discrimination or refusal of care from their providers, and, if insured, experience denials of coverage from insurance companies. These ruptures in coverage can be addressed through extending insurance coverage for all treatments necessary to affirm a transgender person’s gender identity, training to support transgender affirming healthcare, and research on the health needs of the transgender community across the life course.

Defunding the police is an abolitionist strategy to reduce policing and boost community resources that address the root social problems contributing to crime. Abolitionists advocate for solutions led and held accountable by the community, addressing community needs without reliance on criminal legal systems or carceral approaches. Since 2020, several US cities have partially diverted police budgets to social services, primarily through municipal contracts with nonprofits providing public safety-related social services. However, scholars and abolitionists caution that state funding ties may expand carcerality and undermine liberatory efforts. This article explores how state-nonprofit funding dynamics influence the implementation of police defunding and the pursuit of abolitionist aims. Drawing on a 21-month ethnographic study in Minneapolis and Austin, two cities that defunded the police, this study uncovers four key funding dynamics—organizational competition, funder control, organizational agency, and accountability—that impeded abolitionist aims. These dynamics favored nonprofits with state ties or approaches aligned with state interests, constrained the community needs met and how, directed police dollars to nonprofits collaborating with police, and lacked community accountability structures. This article illuminates the complexities of implementing abolitionist strategies like defunding within a nonprofit funding framework, advocates for attention to implementation processes, and discusses strategies to address state influence.