EUGENE, Ore. - Every morning, Aveline Galtere - Ava, for short - stands in front of the mirror.
She applies her mascara and lipstick.
And she takes her hormone pills.
Six months ago, her reflection looked different.
"You know the things that have changed for me don't surprise me as much as the things that haven't changed," she said. "I'm ultimately the same person, just a bit more freer."
Freedom for a transgender woman can come at a price.
"I get bro'd, sir'd a lot, even in this area," she said.
Dating can get complicated. "I swing both ways," she said.
But to Ava, the transition was inevitable.
"I did choose to go to therapy," she said, "but I did not choose to feel this way."
The transition would have been a lot tougher if she didn't have Medicaid to help cover the costs, she said.
It's been a year of hormone therapy for Ava.
She hasn't yet decided to take the next step: surgery.
Ava's story is not entirely unique.
Since January 1, the Oregon Health Plan has spent more than $400,000 on gender dysphoria treatments for about 700 Oregonians.
Nearly $170,000 of that has been on gender reassignment surgery for about 40 adults.
Not everyone thinks taxpayer money should be spent this way.
"How would I explain it to someone going through it? That's a personal choice and that's not my issue. That's absolutely not my issue," Sen. Jeff Kruse of Roseburg said. "It's critical medical services. We can't afford everything. what should be a higher priority? And that should be the whole thing."
Trillium Community Health said they abide by international guidelines that outline coverage for medical needs.
"The psychological need, the psychological distress that a person might experience is a medical need," said Dr. Lynnea Lindsey-Pengelly with Trillium. "Brains and bodies are connected, and when you're creating a great deal of mental stress for somebody, you're actually changing them neurobiologically."
Although the Oregon Health Authority said it does not cover cosmetic surgery, the agency does cover certain surgeries, such as chest reconstruction.
For Ava, the issue comes down to equality.
"There are a lot of different folks out there being helped for different reasons, and we are just one of them," she said. "We don't want special rights. We want equal rights."
