The

Undeniable

Ruth

®

…and the Ruth shall set you free!

  • Non-Binary Americans Can’t Get Health Insurance

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    Ruth Carter

    Did you know that there are no health insurance options for non-binary people in the U.S.? Whenever you apply for health insurance, the application asks for your gender/sex, and every application only has male/female options.

    When I corrected my birth certificate to state that I’m “non-binary,” I called my health insurance provider to update my account. They said they could not do the update because their insurance plans are specifically and only for males and females.

    Photo by Ivan Radic (Creative Commons)

    Health Insurance Broker Claims They Could Help

    In the summer of 2022, I received an email from the State Bar of Arizona with information about its health insurance exchange. I snarkily responded that I cannot get health insurance because I’m non-binary. The rep for the program sent me a response that said they were “confident” that they could find me a health insurance plan because federal law prohibits discrimination based on gender.

    My thoughts were dripping with sarcasm. I thought they were coming from a good place, but I didn’t think they knew what they were talking about.

    Wait – The Rep Found Me Non-binary Health Insurance?

    A few months later, when open enrollment started, the rep from the health insurance exchange sent me an email saying they’d found me some options for health insurance.

    Really?! I figured, if they even bothered writing me back, that they would saying they couldn’t find any options for non-binary people.

    Intrigued, I clicked on the link to the options they found. My curiosity quickly shifted to anger when I saw that the rep classified me as “female.”

    What the fuck, dude! (I thought it. I didn’t say it.)

    I sent them an annoyed, but respectful, response that I explicitly told them months ago that I’m non-binary, not female. (This is the issue I’ve been dealing with for years.)

    The rep responded that every health insurance option requires the applicant to declare themselves as “male” or “female.” I messaged them back with something like, “Welcome to my non-binary life.” I refuse to declare a gender that’s a lie.

    Photo by Thomas Backa (Creative Commons)

    Obnoxious Emails from HealthCare.gov

    Open enrollment also meant the beginning of a slew of emails from HealthCare.gov about researching and applying for health insurance under the Affordable Care Act. Every time one of these messages arrived, I became more and more prickly.

    I finally replied to one of these emails with “I can’t get health insurance because I’m non-binary.” Less than a minute later, a response arrived:

    “The email is not monitored.”

    Damn it!  

    Photo by Timo Kohlenberg (Creative Commons)

    I Called the Government

    When HealthCare.gov did not provide an option to email the government for help, I picked up the phone and called them. I clicked through their menu of options to get to a human, a polite man with a southern accent.

    I explained to him that I’m non-binary and there are no health insurance options for people like me on their site. His response: “Let me put you on hold and ask my manager.”

    When he came back on the line, the rep said a trans person can claim their new gender, male or female, when applying for health insurance. I told him again that I’m non-binary, not male or female, and that’s what’s on my birth certificate, driver’s license, and passport.

    “Birth certificate?”

    “Correct.”

    “Let me put you on hold and ask my manager again.”

    When he got back on the line, he was apologetic, but said that every health insurance plan requires you to state that you’re male or female.

    I knew this would be the answer. The point of making the call was to spread awareness about this issue, and I was curious to see how long it would take them to realize that non-binary people can’t get health insurance without lying about who they are. Before hanging up, I asked the rep to please let his manager know that this is a problem impacting all non-binary Americans.

    I also set my email up to automatically send all future emails from HealthCare.gov to spam.

    Why I Keep My Current Health Insurance

    I need health insurance to cover my medications and to be there if something catastrophic happens. If I didn’t, I’d approach an organization like Lambda Legal or the ACLU about teaming up, giving up my incorrect health insurance plan, paying the penalty on my federal taxes, and suing the government and/or health insurance providers for gender discrimination for not providing a health insurance option for non-binary people.

    Photo by Joe Abbruscato

    Hope on the Horizon

    The Social Security Administration is expected to add the X gender option sometime in 2023. Hopefully, this is the last year we have to identify as something we’re not in order to get health insurance. (Trans men and women were recently given the ability to update their social security records without needing a doctor’s letter.)

    I think social security is the last piece of the puzzle. Once someone has “non-binary” on every document across the board, I don’t think health insurance providers can get away with not having non-binary health insurance options or an option that doesn’t require the applicant to disclose their gender.

    Perhaps a non-gendered option will have a questionnaire that will ask about what body parts we have as well as what types of medical treatment or procedures we’ve had to date.  That seems fair and reasonable to design coverage based on your current health care needs. If you don’t have a prostate, you don’t need coverage that includes prostate cancer. Likewise, if you can’t get pregnant, you don’t need coverage for prenatal care or delivery.

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  • Ironman Lake Placid – Your Questions Answered

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    Ruth Carter

    Thank you for being part of my journey to become an Ironman. I hope you’ve enjoyed the other posts to date that highlighted the 2.4-mile swim, the 112-mile bike, the 26.2-mile run, and the numerous supporters who helped me along the way. Now it’s time to answer your questions:

    What Made You Start Doing Ironman Races?

    Coach David is certified in train people to do running races and triathlons. After I completed my first marathon, I said I wanted to cross train with swimming and biking. That led to me signing up for a sprint triathlon in 2018 to see if I liked doing all three activities consecutively.

    About 10 seconds into that race, I thought, “Yeah, I like this.” Once I finished that race, I signed up for and competed in my first Half Ironman in Maine in 2019. That was also the first race I did with my coach. I went into that race with the plan that if I liked the Half Ironman that the next step would be to do the full.

    What is the Cut Off Time for Each Segment?

    Swim: 2 hours, 20 minutes after the last swimmer enters the water

    Bike: 5:30 p.m.

    Run: 17 hours or midnight

    Did You Have a Time Goal for Each Segment or was the Goal to Finish with Little Regard for Time Other Than to Make the Cut Offs?

    My goal was to finish within 17 hours. I didn’t have any goals for each segment.

    What was Your Strategy for Preparing for this Race that Wasn’t in the City Where You Live?

    Most of my swim training was in the pool and not in a lake, but that’s probably true for most racers. Two days before the race, my coach took me for a practice swim in the lake where we’d be racing so I could get comfortable with the water and the guide cable.

    The Lake Placid bike course is notorious for its hills. Earlier in my training, I did my long rides at South Mountain where the inclines were as steep as Lake Placid, but not as long. As it got hotter, I had to do my bike rides closer to home because I couldn’t logistically make it work to get up, drive to the mountain, and do my workout before it got too hot.

    I had the same issue with running. For my long runs, I had to do loops where I regularly stopped at home to refill my Gatorade and drink extra water because it was so hot. I regularly ran hills because the Lake Placid run course was also quite hilly, but the shorter hills closer to home were more than sufficient.

    We knew my longest training days would be hotter but less humid than Lake Placid. Part of why I arrived days before the race was to adapt to the time change and get used to the humidity.

    Team Roher started the race together.

    Did You Get Kicked a lot in the Swim?

    Did I get kicked? Yes – kicked, hit, and bumped. I also ran into a kayak and more than one buoy.  

    I wouldn’t say I got kicked a lot. Taking the inside track had the advantage of keeping me away from a lot of the other swimmers. I wanted to be on the left side of the guide cable, and most people opted for the right side.

    Did You Use Multiple Strokes and Which One was the Dominant One?

    I used freestyle (front crawl) for the entire swim. That’s what I trained with. I saw and passed one swimmer who appeared to be doing the breast stroke the whole way.

    Unlike most races, Lake Placid had a guide cable, so I didn’t have to spot the buoys during the swim. It’s also why I ran into at least two of them. In a race without a guide cable, I could see myself doing mostly freestyle with the occasional breast stroke break to better track the buoys while maintaining forward momentum.

    As a Non-Binary Person, How was Your Experience in the Transition Area?

    The transition area had two changing tents – one for men and one for women. As I entered the transition area during T1 (swim to bike) and T2 (bike to run), there was a different volunteer directing the racers to the tents, saying “Women here. Men down there.”

    Each time, I responded with “I’m non-binary,” and without skipping a beat, the volunteer said, “Use whichever one you want.”

    I doubt the volunteers had training about what to do with non-binary racers because Ironman does not currently offer a non-binary division. Instead, I think their supportive responses were likely due to the volunteers thinking one or both of the following:

    1. I don’t care.
    2. It’s your race. Do whatever you need to do.

    What Socks Did You Wear for Ironman?

    For the bike, I wore DeFeet 6” cycling socks. For the run, Feetures Elite Max Cushion socks.

    How Were Your Interactions with Other Competitors?

    Super friendly! If you’re racing near me, you’re not there to win. You’re there for the experience and to finish. There was lots of upbeat encouragement between us.

    What Did You do for Nutrition?

    In the final days before the race, I ate as much as I could. In the morning before the race, I had overnight oats loaded with pumpkin seeds, almonds, chia seeds, ground flax seeds, peanut butter powder, protein powder, and raisins. I also had a banana.

    Between the swim and the bike, I had a calorie-bomb cookie. During the bike ride, I had 2.5 scoops of chocolate protein powder in one of my water bottles. I grabbed a fresh Gatorade and half a banana at every aid station. I took a hit of BASE salt at every aid station. I had some gels during the ride too.

    Between the bike and the run, I had some electrolyte gummy candies with caffeine. During the run, I had gels at Mile 5, 10, and 15. I drank Gatorade at most of the aid stations, and I took a hit of BASE salt at each mile marker.

    How Did You Eat Enough?

    You don’t. My coach lost 7 pounds during the race.

    I couldn’t eat right after finishing the race, but once my body settled for a few hours, I was famished!

    How Did You Handle the Heat?

    Pretty well. Starting at Mile 47 of the bike, I dumped a bottle of cold water over my head at each aid station. During the run, I dumped ice into my sports bra at each aid station, and I ran through the “human car wash” each time a spectator set one up for us.

    How Many Moments Did You Want to Quit During the Race?

    None.

    Less than 10 miles to go – still smiling!

    Did You have to Push Through any Walls You Hit, Both Physically and Mentally?

    I never wanted to quit, but there were some challenging moments. The first was right before the race when we were squished together waiting to start the swim. I don’t do crowds well.

    The second challenge was near the end of the first loop on the bike. I took a break at one of the aid stations, tired and frustrated, and I realized I was probably under fueled. Once I bumped up my calories and protein, I felt better. Shifting my mindset to accepting the pain made the second lap much easier.

    At any Time During Training (as opposed to the race itself), Did You Consider Backing Out? If so, How did You Keep on Track?

    No. Once I paid my registration fee, I was committed to race and the training it would take to get to the finish line. It was exceptionally challenging to do my long bike and run workouts in the Phoenix heat, but I pushed through.

    What was Your Biggest Surprise During the Race?

    I don’t think anything can fully prepare you to bike up the Lake Placid hills, particularly how long those climbs are. I trained on hills that were as steep as the Lake Placid hills, not nothing like how long those hills are. During my training, I regularly stood up on my pedals while climbing hills, and early on in the race I learned I go faster when I stay in the saddle.

    Did Your Body Have any Serious Difficulties at any Point such as Cramps or Muscle Tightness that Made Progress Difficult?

    No. By the time I got off the bike, my quads and hamstrings hurt a lot. I couldn’t lift my feet far off the ground. Every step hurt, but I was happy taking each of those steps.  

    At What Point on the Marathon Did You Know, “I’ve Got This?”

    I knew from my first step into the run course. My legs were sore and tired, but I had plenty of time on clock to finish. It was just a matter of putting one foot in front of the other.

    What was the Last Mile of the Marathon Like Physically and What was Going Through Your Mind?

    By the last mile of the run, my legs were exhausted. I only ran when the course was flat or going downhill and walked every incline.

    What was going through my mind? I was excited to cross the finish line and achieve this massive goal of becoming an Ironman. It was a bit overwhelming. I’d worked so hard for years, and this moment was finally here. As I crossed the finish line, I burst into tears, overwhelmed with joy and relief.

    Being Non-Binary, Does the Gender Specific Name “Ironman” Bother You?

    No. Ironman is a brand.

    I’ve had people refer to me as an Iron Person, and I correct them saying, “I’m an Ironman.”

    I already have the M-dot keychain!

    Are You Going to Get the Tattoo?

    Of course! I plan to put a variation of the M-dot on the back of my calf.

    Are You Going to do Another Ironman?

    There’s a good chance. I’m looking at a Half Ironman for 2023 and a full Ironman in 2024.

    Those of my quads – covered with exercise-induced vasculitis.

    What Would You do Differently?

    If I do the Lake Placid Ironman or a race with a hilly bike course, I’ll change my winter and spring long bike workouts to include steeper and longer hill climbs.

    One of the challenges I had with the long run workouts in the hot sun leading up to my race was exercise-induced vasculitis, aka Disney Rash. My legs between the bottom of my shorts and the top of my socks were covered with red splotches. After the race, I learned there are climate controlled indoor running tracks in my community. I will definitely use one of them for my long runs instead of running outside if I do another summer Ironman.

    Do You Feel any Shifts in How You Think About or Carry Yourself After Completing such a Herculean Goal?

    After the race, I started using the mantra, “Fuck you. I’m an Ironman.”

    I only say this in my head, and I don’t use this in an I’m-Better-Than-You way.  Instead, it’s an exultation to mean, “I can do this” when directed toward myself, and I’ve used it to mean “You can’t intimidate me” when directed towards opposing counsel.

    Thank you for following along for my Ironman journey. I hope you enjoyed it!

  • When Your Kid Says They’re Non-Binary

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    Ruth Carter

    A few weeks ago, I received a message from one of my classmates from high school that said her child recently came out to her and her husband as non-binary and said their pronouns are they/them. My friend asked how she can educate herself and what guidance I could offer for dealing with relatives who may be less accepting.

    When I responded, I started with, “Oh geez – your life just got a lot more complicated, but in a good way.” I gave her my number and asked her to let her kid know that they have an Oggy Ruth that they can talk to if they need a non-binary grown-up to talk to who “gets it” in ways they’re afraid that others can’t understand. (Oggy is the title I chose since there isn’t a gender-neutral term for aunt/uncle. It rhymes with “doggy.”)

    This button is on my backpack.

    There’s No One Way to be Non-Binary

    If your child was assigned male a birth (AMAB) and they’re actually female or assigned female at birth (AFAB) and they’re actually male, the expected trajectory is more clear and can include a new name, new hairstyle, different clothes, hormones, and gender affirming surgery. If your child is non-binary, it’s best to follow their lead. Invite them to tell you what they need, whether it’s a new name, new hairstyle, or different clothes. They may want some specialty items like a chest binder, stand to pee (STP), or a packer. Ask your child about their thoughts about hormones or hormone blockers. (Hormone blockers didn’t exist when I was a kid, but if I knew I was non-binary back then, I would have wanted them.) They may also want counseling. It’s not easy to navigate a binary-centric world as a non-binary person.

    Ask your child what they need from the institutions in their life. They might need gender neutral bathrooms at school. Some schools won’t address a child by their new name unless you legally change it. Your child may want to have their birth certificate and/or driver’s license corrected. Hopefully, you live in a state where you have that option.

    In regards to resources, I recommended Free Mom Hugs’ resource page. I love this organization, and this page has a wide variety of resources listed. I love seeing people in the audience at the Pride parade who wear t-shirts that say “Free Mom Hugs” and “Free Dad Hugs.” I always try to stop and hug them.

    Dealing with Less Than Accepting Relatives

    As the parent, you are your child’s advocate. Ask your kid how they want to tell the relatives, and as long as it isn’t inappropriate, support it.

    You may have to have a heart-to-heart with a relative if they are struggling to accept that your child is non-binary. They may have known your kid by a different name and pronouns for over 10 years, and adjusting to the new name and pronouns will be hard. Tell them it’s ok if they make mistakes, as long as they’re trying, and they correct themselves when it happens. Give them a chance to practice by talking about your non-binary child with them. (I have a co-worker who is working on using my correct pronouns. I’m tempted to tell him to talk about me with his family to practice.)

    Note: I have a friend who has had a non-binary kid for years. She still occasionally refers to them by the wrong name or pronoun. It’s ok if you or your family doesn’t adapt overnight.

    Your relative may have trouble wrapping their head around the idea that a person may not be male or female. That’s ok too. As long as they respect and accept that your child is telling the truth about who they are, I suspect your relative will be fine in the long run. Here’s my favorite video to share with people who are new to learning about what it means to be non-binary. (It’s also quite validating for me.)

    Whether your child is a different gender or sexuality than what you originally expected (or both), assume there are going to be inappropriate questions. I tell people that it’s fine to ask me all their potentially inappropriate questions as long as their coming from a place of respect and curiosity. There may be times when it’s best to respond with, “I understand that you’re curious, but that’s a very personal question. My kid will talk about that if and when they decide they want to bring that topic up with you.”

    Don’t be Afraid to Go into Mama/Papa Bear Mode

    If you have a non-binary kid, there may be times when you need to go into full-on mama bear or papa bear mode on their behalf. It may be with your child’s school, doctor, a relative, or even the government. Going to bat for your kid validates their experience, even if you don’t get the outcome you want.

    When your child tells you about a frustrating experience as a non-binary person in a binary-centric society, acknowledge it, even when you don’t understand why something is a big deal to them. Their feelings are valid, whatever they are. Hold space for your child so they have at least one place where it’s safe for them to be themselves and explore what their gender means to them.