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Hundreds of D.C. residents wrote the Trump administration to oppose its latest rollback of LGBTQ rights.
In June, the administration proposed a regulation that would undermine the Affordable Care Act’s Health Care Rights Law (or Section 1557) by eliminating the ban on sex discrimination, which includes discrimination based on gender identity and sex stereotyping. Under this proposed rule, health care providers like hospitals or doctors could refuse to treat transgender or gender-nonconforming patients, or insurers can refuse to cover services they need.
(The sweeping regulation does a lot more than affect LGBTQ patients; for example, it weakens language-access protections for non-native English speakers that prevent discrimination on the basis of national origin.)
Hundreds of LGBTQ patients who live in the District formally submitted comments to federal officials, demanding the administration not attack their health and well being. The administration is required to review and consider these comments before releasing its final rule with the effective date. The National Center for Transgender Equality shared 203 comments from D.C. residents with City Desk that were submitted through its portal, ProtectTransHealth.org, after the comment period closed this week on Tuesday. Many of the concerned residents were LGBTQ patients, health care providers, and other allies.
About 21,000 people from across the country submitted comments through ProtectTransHealth.org. The National Center for Transgender Equality, along with other advocacy groups, collected roughly 132,000 comments and formally submitted them to the Federal Register on their behalf.
“I am trans and I deserve to have my health care rights protected,” writes Elliot Richardson. “Repealing these protections is discriminatory.”
Charlotte Clymer writes: “I am a proud trans woman, and there is no reason a doctor or nurse or other medical provider should be able to turn me away if I have a heart attack or broken arm just because I’m transgender.”
Griffin Moore detailed their experience spending months looking for health insurance that includes gender-affirming coverage. Moore says undoing nondiscrimination protections would exacerbate their situation.
“The job I had that provided the insurance was so toxic I had to find another job before I could access care,” writes Moore. “And like many others, I avoid going to the doctor most of the time because I’ve been disrespected by providers so regularly, and I know my experiences have been simple relative to my friends.”
Local doctors also wrote the Department of Health Human Services (HHS), which is overseeing the proposed rule.
One of them, Sarah Meyers, writes in: “As a physician, I have witnessed some of the best, most appropriate and sensitive care to transgender patients, and some of the worst, most dehumanizing care, from physician colleagues. I am deeply troubled that HHS is proposing to enshrine in law, protections for providers who harass, dismiss, and neglect their transgender patients. If a person cannot provide appropriate care to patients regardless of gender identity, they have no business being a physician, and is is unconscionable that HHS would enshrine this malignant discrimination into law.”
A particularly moving comment came from a former HHS employee, Jay Wu.
“As a transgender person who has only accessed health care services related to my transition in Washington, DC, I have been lucky enough to work only with affirming health care providers who are at least respectful of my gender identity, if not fully trained on how to interact with transgender patients. I have never had trouble getting insurance coverage for the safe, necessary, and appropriate medical care that is part of my transition,” says Wu.
“I am appalled to see my former workplace—where I was lucky enough to witness the original publication of the 2016 regulation on Nondiscrimination in Health Programs and Activities—promote a policy that goes against the consensus of health care providers, scientists, and people who truly believe in equal treatment for all,” they write.
Separately, Attorney General Karl Racine formally submitted a comment this week with a group of 22 Attorneys General, writing that it licenses discrimination in health care.
Hundreds of residents wrote the administration because the District is not immune to what happens if the administration moves forward with its regulation.
While D.C. law makes it illegal for Medicaid (or insurance for residents who are low-income or have a disability) to discriminate based on gender identity and regulates private plans similarly, federal protections are still very necessary, says Whitman-Walker Health’s Daniel Bruner. Some residents who get coverage through work have self-funded plans, and therefore those plans do not need to follow D.C. insurance law, says Bruner, who’s senior director of policy.
“Health insurance remains a very significant problem,” he says.
As is finding health providers who provide sensitive care. Bruner says some patients who visit Whitman-Walker Health clinics can attest to providers elsewhere in the city who misgender them, be it intentionally or not.
“While we are proud of the reputation we have, it’s not acceptable for us and a handful of other providers to be the only option,” he says.
It’s still illegal for health care providers and insurers to discriminate against LGBTQ patients, and it’s unlikely the White House rule is on solid legal footing, says Bruner. Once the final rule is published, lawsuits are inevitable. But nevertheless, he’s nervous that the rule is already damaging because some patients might forgo health care anyway.
“The transgender community is terrified,” says Bruner. “And one of the real problems is people who don’t go to the doctor or hospital and ought to go, but who don’t because they figure they will encounter a lot of problems.”
It’s true that transgender patients already have bad experiences with the health care system. According to the 2015 U.S. Transgender Survey, one third of transgender people said they had at least one negative experience with a health care provider because they were transgender.
Photo by Flickr user karendesuyo, used under the Creative Commons 2.0 Generic (CC BY 2.0) license.