Pictured above: Iowa Gov. Kim Reynolds, Republican.
Heather Dunn’s GoFundMe page is sitting empty. Five days ago, she launched a campaign to pay for the cost of a vaginoplasty, more commonly referred to as “bottom surgery.” While the full cost of the procedure is $30,000—$20,000 for the surgery itself and then an additional $10,000 for aftercare—Dunn set her sights modestly. She only asked for $2,000 of that total, advertising it as a backup plan in case Iowa lawmakers blocked her ability to pay the procedure through Medicaid.
“Unfortunately, I'm having to go this route because politicians in my state think they know better than my doctors and therapists do,” she wrote on her crowdfunding page. “Praying for a miracle!”
At the time of writing, Dunn has not received a single donation. But after Iowa Gov. Kim Reynolds signed a budget bill on Friday that prevents transgender people from using public insurance policies to pay for gender-confirmation surgery, she will need that miracle to come through.
Dunn (pictured above) is one of several transgender Iowans whose plans to surgically transition now hang in the balance. After the Iowa Supreme Court ruled in March that its Medicaid plan must start providing coverage for transgender care, a last-minute amendment to the $2 billion budget bill rolled back that decision. It gives medical providers the ability to opt out of procedures related to “transsexualism, hermaphroditism, gender identity disorder, or body dysmorphic disorder” funded by government health plans.
Many transgender Iowans had already begun scheduling their appointments in the wake of the historic court ruling. Aiden Vasquez has a consultation planned for later this month with a doctor at the University of Wisconsin, who was covered under a reciprocity agreement with the state of Iowa. He says the meeting felt like an act of fate: Vasquez also had his top surgery in Madison.
When Vasquez found out the appointment was effectively canceled after Gov. Reynolds signed the budget bill, he kicked a garbage can in front of his home; there were also some expletives in the mix. His wife came outside and asked what was wrong. “She just took my life, my freedom, and my wholeness,” he said, referring to the governor in oblique terms.
“She just took that from me, and she doesn't even know who I am,” Vasquez added in conversation with NewNowNext. “She doesn't know my pain, she doesn't know my life, she doesn't know my story, and she doesn’t know my struggle.”
While not all trans people identify with the “trapped in the wrong body” narrative, Vasquez (pictured above) does. Having been aware that he’s male since he was just two years old, he claims his gender dysphoria has progressed to extreme levels without the ability to surgically transition. Vasquez hates looking in the mirror, taking his clothes off, or bathing. He doesn’t like to even touch his own body, which he describes as an apple wrapped in orange peels.
“You peel back the skin, and there’s an apple in there, not an orange,” he claims.
With the governor’s signature in place, Vasquez worries he won’t have many more chances to make the man he sees inside match the person he is on the outside. He’s 51 years old. He can’t afford the thousands of dollars in out-of-pocket costs it would take to get the surgery he needs.
Never once mentioning Gov. Reynolds by name, Vasquez worries “her” decision will mean he spends the rest of his life “stuck in between.”
If Vasquez’s reluctance to say the governor’s name shows how painful this issue is for him, that’s doubly true for Dunn. She volunteered for the governor’s 2018 election campaign. After coming out as a trans woman in September 2017, she remained a member of the Republican Party, hoping to change things.
When Gov. Reynolds released a statement on Friday calling the budget bill a “narrow provision” that “returns [Iowa] to what had been the state’s position for years,” Dunn felt “betrayed.”
“I felt like I was lied to,” she tells NewNowNext. “I was told that I'm such a great asset to the party because hopefully I can have a moderating influence. Then this happens and I thought, ‘I supported you and the support’s not reciprocal.’ I basically spent like an entire year and a half beating against a brick wall. All I was doing was hurting myself.”
The same day the budget bill passed, Dunn resigned from her position on the Polk County GOP Central Committee and switched her voter registration to Democrat.
Dunn is now in a similar position to Vasquez. After March’s Iowa Supreme Court ruling, she began gathering the paperwork necessary for gender confirmation surgery. She needed reference letters from a therapist and the physician who administers her hormone replacement therapy (HRT), as well as a psychiatric evaluation.
While she hadn’t scheduled an appointment yet, things were moving in the right direction. She recently had a free phone consultation with a surgeon in Minneapolis who takes Medicaid.
Even though the odds may seem stacked against them, Dunn and Vasquez say they are prepared to fight back. They have begun meeting with civil rights attorneys to mount a legal challenge to the budget bill and believe they have a strong case. The legislation, as many have pointed out, is nearly identical to the provisions the Iowa Supreme Court ruled unconstitutional just weeks ago.
While opponents of the ruling claimed extending public health care to transgender Iowans would cost the state up to $20 million a year, HRC reports the 17 states (and D.C.) that include gender-affirming care in their Medicaid plans have not seen significant cost increases as a result.
Gov. Reynolds attends a summit with President Trump in 2018.
According to UCLA’s The Williams Institute, there are only 7,400 trans people in the state of Iowa.
If Dunn moves forward with a lawsuit, she hopes to send a message to Gov. Reynolds’ party—the party of which she was also a member until a few days ago—that they only stand to benefit by embracing the LGBTQ community. While she claims the GOP is “held hostage by old, white, straight men,” Dunn believes there’s a growing movement of young conservatives that understand the Republican Party “needs to start respecting demographic changes” in the United States.
“We need to reach out to people of color, poor people, and people with disabilities,” she says of her former party, which she still refers to as her own out of force of habit.
But Dunn also wants to show the GOP—which has been gripped by anti-trans bathroom panic in recent years—that transgender Iowans are no different from them. They deserve basic equality and respect, and their pleas to be seen for the people they are shouldn’t be contingent on whether benevolent strangers on the internet hear them (and donate $10 accordingly).
“We're taxpayers,” she says. “We're your neighbors. We go to your church or synagogue. We're not who you think we are. We're human beings.”