Living on $3,400 a month: How one couple pays the bills while juggling medical debt and saving for gender-affirming surgery
Last year Alex Mixson and his wife Marley Britt were having a string of medical crises. She was unable to work because of an undiagnosed illness, and he had to have an appendectomy.
"We couldn't afford Columbus anymore," Mixson said of the Ohio city where they lived. Multiple emergency medical visits drained their savings and racked up thousands of dollars in debt.
Mixson, a trans man who's been transitioning for eight years, put off his top surgery to focus on saving money and helping his wife, who had been suffering from undiagnosed Postural Orthostatic Tachycardia Syndrome — a condition that causes dizziness and lightheadedness that was making it difficult for her to work.
"I'd rather take care of my wife than be comfortable in my skin," said Mixson, who is 26. The couple moved back to West Virginia, and both of them are employed, earning about $3,400 a month total. Mixson is building savings to have top surgery in the next few months.
Britt and Mixson are part of a cohort of about 91 million Americans who cannot afford or don't have access to quality medical care. A study from the UCLA Williams Institute also found that while transgender people have high rates of enrollment in health insurance, 1 in 3 avoid seeking healthcare because of the cost.
"It's a lot to struggle with, and it's hard," Mixon said, of his journey to afford surgery, "but it's so rewarding at the same time to just wake up and not feel so shitty about yourself."
Finding community and fundraising for gender-affirming medical care
Mixson works as a front desk receptionist, and his wife is a remote IT worker. Since spiraling into debt, the two have had to cut amenities like eating out and have chosen to prioritize rebuilding their emergency savings over paying back their medical bills.
The two spend over half of their combined monthly paychecks on rent, transportation, utilities, and food, leaving them with about $100 a month to set aside for savings.
"I haven't paid a medical bill. I just kind of let it sit on my credit," Mixson said. Britt was finally diagnosed with POTS this past month and is receiving proper treatment for it while working remotely. The newfound stability has allowed the pair to schedule Mixson's top surgery this summer.
Mixson estimates that if insurance doesn't cover his top surgery, he'll be on the hook for another $10,000. He has saved some of that amount and started a GoFundMe to raise an additional $3,500. Mixson said it's been hard to fundraise from the small queer community in his hometown, as he said most are also struggling to make ends meet.
Mixson has been posting to Reddit forums about his fundraiser in an attempt to reach a wider audience online and garner more support. As of March 31, he's only raised $980 toward his goal.
He said that his close friends have been pivotal in helping him figure out things like insurance and extending cash in times of need, including $200 when he moved, so he and his wife could buy groceries.
For Mixson, top surgery is a matter of safety in being able to pass as a cisgender man.
Since starting testosterone, he said, few people recognize him from before his transition, but in the small city, word spreads quickly. There are moments when Mixson is afraid he'll be recognized. He's even more worried since the election, given that the Trump administration has pulled funding from institutions that work on DEI-related projects and purged inclusive language and mention of transgender people on federal websites, saying it promotes "woke" ideology.
"I need to do what I need to do, keep my head down and come home," Mixson said. His wife has asked him to carry pepper spray in his car in case he is attacked. Research from the Williams Institute at UCLA in 2021 found that transgender individuals are four times as likely as their cisgender peers to be victims of violent crime.
Despite the financial challenges, getting the surgery is important to Mixson. From a young age, he has struggled with body dysmorphia — feeling that his gender identity didn't match the gender he was assigned at birth. Mixson has been taking testosterone for five years and flattens the appearance of his chest using a compressive top, but that has also led to other kinds of discomfort.
"I've been binding for years and it's at a point now that my back is almost always hurting," Mixson said, adding that his transition has brought positive changes to his mental health. "I am definitely more outgoing than I used to be. I feel stronger."
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