The United States has moved quickly in the past few years towardacceptance of the transgender community, and embraced a moreinclusive approach when it comes to health care.

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Employers are increasingly offering services intheir health plans that are crucial to transgender people,including hormone therapy and sex change operations.

Gender-confirmation surgery has long been cost-prohibitive. Notmany hospitals have offered the service, and until recently, it wasrare for an insurer to provide coverage for such a procedure, sinceit was not considered a medical operation. In the past, sex-changeprocedures were largely the realm of plastic surgeons.

According to the Wall Street Journal, the Centers for Medicareand Medicaid Services started to allow coverage oftransgender-related surgeries in 2014. As it stands, Medicaidprograms in 12 states and D.C. cover care related to transitioning.Other commercial insurers have also begun providing coverage forthese procedures, such as Aetna, Amerigroup, Anthem, Cigna, Emblem Health, UnitedHealthcare, and UniCare, just to name a few.

But as attitudes toward gender identity change, more hospitalsare offering surgery for transgender patients while more insurersare offering coverage for operations.

Whether as a result of the increasing availability of surgeriesor because more transgender people are coming out in the wake of acultural shift in their favor, demand for transgender operations isrising significantly, say doctors. Two hundred people are on thewaiting list for vaginoplasty at Boston Medical Center, which onlybegan offering the procedure earlier this month, hospital officialstold The Wall Street Journal.

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Still, change may not come quite as easily in the publicsector.

While the Obama administration has authorized coverage oftransgender services for Medicare and Medicaid, only 12 states andthe District of Columbia have opted to include gender-confirmationoperations in their Medicaid plans. There will no doubt be plentyof resistance in GOP-run states to embrace such changes.

Transgender prisoners present another sensitive area in thedebate over the use of public funds for certain medicalservices.

The issue was broached in the Netflix show, "Orange is the NewBlack," in which a transgender character campaigns for access tohormone therapy. In the real world, the issue was demonstratedrecently in the case of Chelsea Manning, the former soldierimprisoned for leaking classified information to WikiLeaks. TheArmy recently agreed to pay for her to undergo surgery which hadbeen recommended by her psychologist in the wake of a lawsuit bythe ACLU.

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