Devin Payne had gone years without health insurance -- having little need and not much money to pay for it. Then Payne， who had a wife and four children， realized she could no longer live as a man.

In her early 40s， she changed her name， began wearing long skirts and grew out her sandy blond hair. And she started taking female hormones， which caused her breasts to develop and the muscle mass on her 6-foot one-inch frame to shrink.

The next step was gender reassignment surgery. For that， Payne， who is now 44， said she needed health coverage.

\"It is not a simple， easy， magical surgery，\" said Payne， a photographer who lives in Palm Springs. \"Trying to do this without insurance is a big risk. Things can go wrong ... not having the money to pay for it would be awful.\"

Payne learned in the fall that she might qualify for subsidies through the state's new insurance marketplace， Covered California， because her income fell under the limit of $46，000 a year. She eagerly signed up in March for a Blue Shield plan for about $230 a month， and began making preparations for the surgery that would change her life.

\"Feeling complete\"

Growing up in Kansas， Payne remembers trying on her mother's clothes and dressing as a girl every year for Halloween. She dreamt of having another life after this one， as a girl. But Payne said she mostly suppressed her feelings and tried to live up to the expectations for a male.

\"I put it out of my head，\" she said.

She married a woman she met at work and they had four children， now ages 7 to 22. But she never felt comfortable in the traditional role of father and provider.

\"I was just horrible at it because it wasn't who I was，\" she said. So Payne became the primary caretaker， playing the \"mommy role\" as she worked from home doing software development for pharmaceutical companies.

She felt increasingly anxious， and in late 2012， a therapist helped her to realize that she was meant to live as a woman. Payne said her entire outlook on life changed when she started taking female hormones.

\"All my anxiety and all of the bad things that I felt inside were just completely washed away，\" she said.

Payne told her wife， who was upset. She told Payne： I married a man， not a woman -- but she also admitted that she wasn't entirely surprised. With mixed feelings， Payne's wife stayed in the marriage， and the family moved from Kansas to California， in part so Payne could be more comfortable living as a transgender woman. They rented a small house in a middle class neighborhood on the outskirts of Palm Springs and sent their children to the public school.

Late last year， Payne's wife， who had battled alcoholism for years， died of liver disease.

Payne said the children worried how people would react to her transition， but she said they soon realized it wasn't as big of a deal as they had feared. When Payne brought birthday cupcakes to her 7-year-old daughter's classroom last year， the children asked if she was a girl or a boy. After Payne told them she was a girl， \"they just wanted their cupcakes.\"

In California， Payne found transgender friends and became an advocate within the community. \"You find out that there is a whole world of people out there，\" said Payne， who wears little makeup or jewelry and calls herself a \"T-shirt and skirt kind of a girl.\"

Payne was ready for the surgery.

The day of the surgery at Sequoia Hospital in Redwood City， Payne said she remembers being wheeled in to the operating room and feeling very calm. When she woke up， with oxygen still attached and wearing her hospital gown， a friend told her that the surgery had gone well， without any immediate complications.

Later that day， she had just enough energy to type a few words on her Facebook profile： \"Feeling complete.\"

43歲的德溫·佩恩雖然有妻子和四個(gè)孩子，但仍一直夢(mèng)想像女性一樣生活，于是她決定改變自己。佩恩開(kāi)始服用雌性激素并接受了變性手術(shù)。奧巴馬醫(yī)改為她的手術(shù)提供了保障，因?yàn)榕宥骺梢詮恼@得補(bǔ)貼。手術(shù)很成功，現(xiàn)在的樣子讓佩恩感到舒服和圓滿。

[http：//www.cnn.com/2014/08/26/health/obamacare-transgender-surgery/index.html？hpt=he_c2]