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Health insurance often doesn't cover gender-validating surgeries or therapies for transgender people, including nonbinary people who want a physical transition. It can be difficult to find an insurer that does, or to persuade one to do so. Such insurance companies think transgender health care is merely cosmetic and optional. They don't understand that, for many transgender people, it is life-saving and not optional. This transgender rights issue needs to be addressed by activism, so that it will someday be standard for insurance to cover transgender health care.