The latest attack on trans rights from the Trump administration is another salvo on access to health care. According to the New York Times, the Department of Health and Human Services plans to roll back an Obama-era rule that prevents discrimination in health settings.
If the policy change moves forward, guidance on nondiscrimination in health care programs would be reversed, allowing providers, facilities and insurance companies to discriminate against transgender people, as well as those who don’t conform to gender stereotypes.
Currently, this nondiscrimination rule, which clarified anti-discrimination protections in the Affordable Care Act to include gender identity and “stereotypical notions” about gender, means that health providers cannot deny services to transgender and gender nonconforming people on the basis of their identity — and this includes all health care services. Whether an individual seeks hormone therapy, emergency treatment for a head injury or insurance coverage for mental health, it has to be provided equally.
Members of the religious right insist that people need “conscience exemptions” so they aren’t required to provide health care services they disagree with. This argument is common in the realm of abortion and birth control services — and a recent Trump administration mandate allowing people to deny these services on the basis “moral conviction.”
Civil rights activists fear that these exemption rules could be used to justify abuse and discrimination of LGBT patients in a variety of contexts.
The religious right wants the public to think that transgender people are compelling health care providers to offer transition-related services, which isn’t true. These services are provided by people who actively and voluntarily pursue additional training in order to care for trans patients, working in the context of clinics that provide gender-affirming care.
Trans people don’t want transition-related services from people who aren’t interested in providing them — not just because it would be an unpleasant experience, but also because a disinterested care provider might not be up-to-date on the most current standards of care.
What trans people do want is equal insurance coverage: Insurers should not be able to deny coverage for a health care need just because someone is transgender. Thus, for example, a medically-indicated hysterectomy should be covered regardless of someone’s gender, as long as the medical need has been demonstrated.
And transgender people also want the ability to visit a doctor to receive health care for situations that have nothing to do with their gender. Concerns about being able to access health care are justified, with many trans people reporting experiences of harassment, discrimination and even assault in health care settings.
Imagine going to the doctor for a persistent cough and being refused care. Or requesting a sexual health checkup and having the health care provider mock, belittle and shame you because of what your body looks like. Or begging people to not call an ambulance in an emergency, fearing that the ambulance crew might refuse to treat you.
This move comes on top of trying to ban transgender people from serving in the military, withdrawing guidance on including trans students in school and attacks on public services like Medicaid that will hit the trans community particularly hard. Advocates are watching developments here closely.
Rulemaking is a lengthy process: If the Trump administration decides to move forward with this rule, there will be a public comment period you can participate in.
You can also join fellow Care2 activists in calling on Congress to short-circuit the Trump Administration and proactively protect trans health care.