A new report on the impact of Trump’s discriminatory health care rule claims the proposed policies could have a devastating impact on LGBTQ people.
In January, the White House announced plans to reshuffle the Department of Health and Human Services (HHS) to create a new Conscience and Religious Freedom Division. The proposed department would allow medical employees to deny care to transgender people and individuals living with HIV if doing so would conflict with their sincerely held religious beliefs, as INTO previously reported.
The Trump administration also signaled the repeal of Section 1557, the nondiscrimination clause of the Affordable Care Act. That provision forbids bias in federally funded health centers on the basis of “sex,” which Obama’s HHS ruled included the categories of “sex stereotyping” and “gender identity.”
Information on Section 1557 was recently removed from the HHS website.
In “You Don’t Want Second Best’: Anti-LGBTQ Discrimination in U.S. Health Care,” Human Rights Watch predicts these decisions will have a chilling effect on access to care for queer and transgender people.
“These developments threaten to exacerbate the barriers to care that LGBTQ people already encounter, and give insurers and providers who would deny services to LGBT people, women, and others a license to discriminate against them,” researchers with HRW claim.
Research cited by HRW indicates already high levels of anti-LGBTQ discrimination in health care settings.
In a 2016 survey, eight percent of queer respondents told the Center for American Progress they have been refused care due to their sexual orientation, and more than three times as many transgender people said the same. Nearly three in 10 trans respondents (29 percent) said they had been turned away by a doctor or other medical professional because of who they are.
A separate report from the National Center for Trans Equality in 2015 found that a third of transgender individuals had “a negative interaction with a health care provider” over the past year.
Ryan Thoreson, an LGBTQ researcher with HRW, claims queer and trans people often forgo care in fear of discrimination.
“One psychologist I talked to in Knoxville, TN said she sees people who are past the point of crisis,” Thoreson, who authored the report, tells INTO in a phone conversation. “People will be brought in very emergency conditions where they’re well past the point of mental health treatment. They’re already in crisis mode by the time they see someone.”
“What ends up happening is that people wait until their health is seriously compromised rather than doing things like preventative care,” he adds.
There are numerous examples of this phenomenon scattered throughout the report. Clara B., who also lives in Tennessee, says her trans son refuses to see the dentist because their local orthodontist is religious. Because they can’t agree on an alternative, her son hasn’t seen the dentist in two years.
Others say they remain in the closet just to have access to their basic health needs.
Chris Sanders, executive director for the Tennessee Equality Project, claims a transgender woman in Maury County on the outskirts of Nashville contacted him because she hasn’t told her therapist about her gender identity. She considered it but ultimately decided coming out wasn’t worth the risk.
“That’s not anything the therapist did,” Sanders tells HRW. “She wasn’t turned away, but it was the fear of being turned away.”
Thoreson maintains that this fear isn’t just a matter of paranoia. After Tennessee Gov. Bill Haslam signed a law in 2016 allowing therapists to refuse to treat LGBTQ patients, interviewees tell him that “counselors weren’t returning their phone calls.”
A transgender youth cited in the report was scheduled to have a psych evaluation until the medical provider claimed, “Oh, we don’t see trans clients.”
For LGBTQ people who are turned away, it’s not as easy as finding another doctor or psychologist in the area who will treat you. Thoreson tells INTO one of the things that stuck out to him most when conducting interviews is how few resources were available in many parts of the country.
A large percent of trans interviewees, for instance, experienced “difficulty finding any providers who would offer hormone therapy in their area.”
“If they did find them, they had to grapple with many of the questions that lots of marginalized people have to deal with: Do I have insurance?” he explains. “If I do, do they take that insurance?”
Although the national conversation around religious exemptions like those proposed by the Trump administration have framed this as a “free market” issue — that if one center is unwilling to provide services, others will — that’s not the reality. If LGBTQ people have the door slammed in their face, there may be nowhere else to go.
“It’s great when there are a diversity of beliefs in the marketplace because consumers can shop around for an option that fits their needs,” Thoreson says, adding: “That doesn’t align with the narrative that I was hearing.”
The end result of the Trump administration’s proposed policies is that LGBTQ people — who already face disproportionate health disparities — will get sicker. Thoreson pointed to the already high incidence of breast cancer among lesbian and bisexual women, who are less likely to get regular gynecological screenings than their heterosexual peers.
These at-risk populations are likely to continue staying home, rather than getting a potentially life-saving exam.
“When you know that HHS isn’t going to enforce your rights and they seem much friendlier to the people who want to discriminate against you than you as a patient who face discrimination, it does have an effect on [whether you] make yourself vulnerable by seeking health care,” he claims.
That’s why HRW is recommending the White House abandon its healthcare discrimination plan and instead address systemic bias “against LGBTQ people as a public health issue,” Thoreson claims.
Given the Trump administration’s commitment to rolling back LGBTQ rights, that probably won’t happen. Thoreson urges marginalized groups to continue asserting their right to equal protection under the ACA, but the fact is that many health providers will read headlines about the White House’s new health care rule and believe they have carte blanche for bigotry.
The people who were already targeting LGBTQ people will, thus, only feel even more empowered to do so, Thoreson claims.
“Most states in the U.S. don’t have state-level protections on the basis of sexual orientation and gender identity in health care,” he says. “There aren’t affirmative protections in place, and then when you enact these kinds of regulations, it just emboldens people to discriminate that much more.”
Read the full report here.