And with repeal of the Affordable Care Act, the situation could get far worse.

Two new studies document the daunting health challenges faced by transgender Americans — at a time when the proposed repeal of the Affordable Care Act threatens to make their situation even worse.

Trans people have a higher prevalence of poor general health than the cisgender population, report more days per month of poor physical or mental health, and are less likely to have health insurance, a health care provider, or dental care, according to a study by the Williams Institute at the University of California, Los Angeles, School of Law.

A report by researchers from two hospitals affiliated with Harvard Medical School in Boston offers similar findings: Transgender people are less likely to describe themselves as healthy, to have health insurance, to let a health problem go untreated, or to be depressed, notes a summary in the Los Angeles Times.

Both studies drew on material from the Behavioral Risk Factor Surveillance System, a nationally representative health survey conducted by the Centers for Disease Control and Prevention, gathering information via telephone interviews in all U.S. states and territories, plus the District of Columbia. Not all the states, however, include questions about gender identity; doing so is optional. The Williams Institute has recommended that all federal surveys identify sexual and gender minorities so they can be better served.

Nonetheless, “this study is groundbreaking in that we use representative samples of transgender people to study health disparities,” said Jody L. Herman, coauthor of the Williams Institute report, in a press release.

“The findings support calls by policymakers and advocates to pay attention to the unique needs of transgender individuals,” added Dr. Ilan H. Meyer, the Williams Institute study’s lead author. “At this time, when a measure to repeal and replace the Affordable Care Act could remove health coverage from as many as 24 million people, the health needs of transgender people could be further threatened, increasing disparities in health coverage between cisgender and transgender Americans.” The “repeal and replace” measure has been passed by the U.S. House of Representatives but has yet to receive a vote in the Senate.

The Williams Institute study was published in the American Journal of Public Health. The other, by researchers with Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center, was published in JAMA Internal Medicine. They are the first to analyze the Behavioral Risk Factor Surveillance System data.