When it comes to voter ID laws, activists tend to focus on racial and ethnic minorities who often lack the resources to obtain photo identification. The media focuses far less, however, on one group that is disproportionately affected by these ID requirements: the transgender community.

A new report from the Williams Institute think tank at UCLA has found that nearly one-third of the transgender population in the United States could potentially run into problems at the polls this November. Researchers estimate that out of 965,350 transgender adults who will be eligible to vote in the 2020 election, approximately 378,000 currently lack the required documentation that correctly reflects their name or gender. Nearly 81,000 of them live in the eight states with the strictest voter ID laws.

To understand why this is such a widespread problem, it’s important to understand why so many trans people lack accurate government identification.

State requirements for updating ID vary wildly

I’ve written before about some of the struggles I’ve faced updating my identification documents as a legally nonbinary person, but the truth is that my life is relatively easy. While my federal and state documentation doesn’t match, Oregon allowed me to change my name and gender without having to face a judge or publish my name in the paper. At the DMV, I only needed to check a box selecting the gender I wanted to appear on my card. And perhaps most importantly, I live in a vote-by-mail state, so I can’t be turned away at the polls. But in much of the country, the process isn’t so simple.

Laws vary from state to state, and it can be incredibly challenging for many trans people to access an accurate ID. While the majority of states now have a simple form that trans residents can use to legally change their gender on their ID or driver’s license, there are still a handful that have no official process, potentially resulting in costly court proceedings. All but 18 states still require anyone applying for a gender change to provide a letter from their medical provider before they’ll be allowed to update their documents, attesting that they have received care appropriate for their transition. Nine states still require proof that the petitioner has undergone specific surgical interventions.

Needless to say, all of this costs money. Filing the paperwork for a name change can cost hundreds of dollars, in addition to other expenses such as having a set of fingerprints taken or posting a notice of your name change in a local paper. These costs add up and can make obtaining an accurate ID out of reach. Another study by the Williams Institute found that 29.4% of the transgender population lives in poverty, and that trans people of color are even more likely to struggle financially.

This economic disparity is directly tied to the high level of discrimination faced by the trans community. After all, when there are still no federal laws protecting you from being fired for your gender identity, how are you supposed to pull yourself out of poverty?

Medical transition can be costly and inaccessible

The doctor’s note requirement is a form of gatekeeping that makes it almost impossible for many people to update the gender marker on their ID.

For those who are able to access health care at all, the struggles may only be beginning. Many doctors and therapists hesitate to write the necessary letter unless they’ve seen a transgender patient several times over a series of months, with copays quickly adding up. Some may struggle to find medical providers who are comfortable working with a trans patient at all: A report by the National LGBTQ Taskforce found that 50% of the trans people surveyed were being forced to teach their doctors how to provide transgender care. If the cost weren’t enough of a barrier on its own, consider that the Trump administration has rolled back what few protections there were for trans patients who might be discriminated against at their doctor’s office.

Going a step beyond a doctor’s note and requiring trans people to undergo surgery before they can update their IDs sets up an even more egregious and often insurmountable barrier. As an initial matter, it’s not even clear what surgeries would be considered enough to meet the governments’ standards. Though it might not be clear from the way the media talks about “the surgery,” the truth is that gender affirmation surgery is not a single procedure. There are a wide range of medical interventions that a transgender person may or may not desire to treat their gender dysphoria—and many of them have nothing to do with genitals. In any event, many trans people don’t want any surgery at all. For many, simply presenting in a way consistent with their identity may be enough to live comfortably, and for others, less invasive options such as hormone therapy are adequate. The standards of care from the World Professional Association for Transgender Health, which are used in medical offices around the world, do not require trans patients to undergo surgery as part of their medical transition.

Even if a trans person desires surgery, the costs often make it unattainable. Surgery on the chest—either a mastectomy for transmasculine patients or a breast augmentation for transfeminine people—can cost up to $10,000. Genital reconstruction costs are far higher, typically running about $25,000. Plastic surgery to masculinize or feminize the face is rarely covered by insurance, and the price can go up to $70,000. Even for patients with insurance, many of these procedures are not covered or come with hefty deductibles.

The truth is, only about 33% of the transgender population has had any kind of surgery. While that figure might be higher if care were more economically accessible, it should go without saying that $25,000 is a ludicrous fee to pay simply to update your photo ID. In states with a surgical requirement, it’s simply out of reach for most people.

Some states are working to make updating your documents impossible

As if existing laws didn’t make it difficult enough for transgender Americans to obtain accurate identification documents, some states are working to make it even harder—and it’s getting worse.

Updating all identity documents—driver’s license, Social Security records, birth certificate, passport, and more—is a long and complicated process that depends on two factors: which state you were born in, and which state you live in now. Most states will allow you to file a form with a local court to update your gender marker, and an increasing number will simply allow you to change the gender on your driver’s license with no questions asked.

However, there are a number of states that require an amended birth certificate in order to update your license. That requires a longer and more complicated legal process. In two states, Kentucky and Ohio, birth records will not be updated with a new gender marker, no matter where a trans person is in their transition, or how many doctor’s notes they provide. This can make it legally impossible for someone from these states to change their other forms of identification.

Republicans are actively working to spread these laws to more states. In late February, a bill passed in the Idaho state House that would ban transgender Idahoans from updating their birth certificates. While the claim is that this will help provide more accurate medical and research data by preserving an individual’s sex assigned at birth, it’s easy to see how this law could be disastrous for anyone attempting to obtain a new ID in a state that requires an amended birth certificate. The slight impact on research data cannot be prioritized over transgender citizens’ ability to live our lives and participate in democracy.

As this bill gains momentum, it’s likely other states will attempt to follow suit. We’ve already seen this in the past year as multiple states have launched anti-transgender legislation, frequently copying high-profile bills in other state legislatures.

Even in states without strict voter ID laws, trans voters could be turned away

While there are only eight states that the Williams Institute identifies as having “strict” voter ID laws, even those with more lax requirements still pose a challenge for trans voters.

During transition, the way someone presents can change radically—someone marked “female” on their ID might begin to grow facial hair and their voice may drop, or someone with a “male” gender marker might develop larger breasts. Because ID photos are only taken once every few years, they may no longer accurately reflect a person’s current state of transition.

Even if the photo is up-to-date, a legal name or gender marker that doesn’t reflect someone’s current gender presentation may arouse suspicion. This is a particular concern in states that require surgery before an ID can be updated, and it’s a process that typically requires hormonal treatment and ongoing mental health care to access. Someone can be years into their transition before they reach a point where they’re legally allowed to update the gender on their driver’s license, even if they have the resources to pay for all of it.

Ultimately, the call is made by poll workers, who can turn away trans voters on a whim.

“When voting at the polls, election officials and poll workers are the ones who decide whether the voter in front of them is the person on the voter registration rolls,” study co-author Jody L. Herman stated in a press release. “Especially in states that require an ID to be shown, this could result in some transgender voters being disenfranchised.”

What can allies do to help?

Unfortunately, the impact of voter ID laws on trans people isn’t an issue that’s likely to be resolved anytime soon. The introduction of anti-transgender legislation has been an ongoing problem for the community since Donald Trump’s election, and conservative states with strict requirements are unlikely to change them in the near future.

However, allies can help trans people update their identification documents. Donations to Trans Lifeline help support its microgrant program. So far, it’s disbursed $375,000 to help those who can’t afford a legal name or gender change. Not only does it help U.S. citizens update government documents, but it also helps update immigration documents, such as permanent resident cards and naturalization certificates. It also covers the costs of replacing tribal IDs. While there are a number of programs doing this work, Trans Lifeline’s is one of the most comprehensive and helps the most vulnerable members of the trans community.

Orion Rodriguez (he/they) is a nonbinary writer, artist, and activist. His writing has been published in Salon, Lightspeed Magazine, Inhabitat, and elsewhere. He is currently working on "The Life and Times...