Communication Studies, Department of


First Advisor

Dr. Angela Palmer-Wackerly

Second Advisor

Dr. Kristen Hoerl

Third Advisor

Dr. Jordan Soliz

Date of this Version

Spring 4-19-2019


Baker, J. T. (2019). Contextualizing transgender individuals' discourses about health insurance. Master's thesis, Department of Communication Studies, University of Nebraska-Lincoln, 2019.


A THESIS Presented to the Faculty of The Graduate College at the University of Nebraska In Partial Fulfillment of Requirements For the Degree of Master of Arts, Major: Communication Studies, Under the Supervision of Professor Angela Palmer-Wackerly. Lincoln, Nebraska: April, 2019

Copyright 2019 Jonathan Baker


Transgender individuals face a variety of disparate health outcomes compared to cisgender individuals within the United States. Additionally, 23% to 52% of transgender individuals do not have health insurance, meaning transgender individuals are two to five times more likely than the general population to lack access to health insurance coverage. Extant research typically treats health insurance as a quantitative (yes/no) variable; thus, we do not know what (not) having insurance contextually means for transgender individuals. The current study addresses this gap by privileging the voices of 17 transgender individuals through in-depth, semi-structured interviews. Using the Culture-Centered Approach (CCA), I conducted a constructivist grounded theory analysis to identify three key themes: Including/Excluding Transgender Health Needs in Health Insurance Structures (conditions), Advocating Against and Resisting Structural Insurance Barriers (actions/interactions), and Compromised Health Decision Making (consequences). I then lay out theoretical implications for Health Communication and systematic change, and practical implications for patient-centered advocacy.

Advisor: Angela Palmer-Wackerly