The Trump administration wants to let doctors discriminate against trans patients

The Trump administration just released a proposal that could make it much harder for trans patients to get medical care.

The new rule, proposed last week, rolls back protections instituted by the Obama administration, which in 2016 released rules barring health care workers and insurance companies from discriminating against patients on the basis of gender identity. By getting rid of those protections, the Trump administration rule would allow doctors to refuse to provide transition-related care — or to refuse to see transgender patients at all, even for routine care like flu shots.

As Vox’s German Lopez wrote in 2016, many LGBTQ people experience discrimination in health care settings. In one 2010 survey, 28 percent of trans or gender-nonconforming people said they had been harassed in a medical setting based on their gender identity, and 19 percent said they had been denied care.

The Obama administration’s anti-discrimination protections were supposed to address the problem. But states and religious health care providers sued to block them. With its new rule, which will undergo a 60-day notice and comment period before being finalized, the Trump administration is proposing to get rid of the protections for gender identity altogether.

The Trump administration says the proposal is necessary to make HHS regulations comply with what Congress and the courts have decided. But LGBTQ rights advocates and doctors say the proposal will hurt patients by allowing health care providers to deny care like hormone therapy or surgeries or refuse to provide routine care because of a patient’s gender identity.

The proposal came shortly after the Trump administration finalized another rule that would allow health care providers to refuse to perform abortions or transition-related care based on their conscience or religious beliefs. That rule is already being challenged in court.

Meanwhile, another recent Trump administration proposal would allow homeless shelters to turn away transgender people or require trans women to share bathrooms with men, as BuzzFeed News reported. And earlier this year, the administration’s ban on trans people serving in the military went into effect.

Policies like these spread a “feeling of stigma and discrimination” among LGBTQ Americans, said Dr. Meera Shah, the associate medical director and director of gender-affirming care at Planned Parenthood Hudson Peconic in New York state. I reached out to Shah, who is also a fellow with Physicians for Reproductive Health, to get a doctor’s perspective on the impact of anti-discrimination protections and how the rollback of those protections might affect patients.

Shah fit in our phone call around her regular work with patients at the Planned Parenthood affiliate, which provides hormone therapy as well as sexual and reproductive health care. Our conversation has been condensed and edited.

What did the Obama-era anti-discrimination protections do for patients?

It made it so that health-care providers and insurance companies weren’t able to discriminate based on gender identity or sexual orientation. Now it appears that the current administration is trying to take away those protections, which could dramatically increase the risk of harm to the community, when it’s already difficult for so many of patients to come to a health center to request, not even things like hormone therapy, but services such as a flu shot or an HIV test or a Pap test for cervical cancer screening.

You anticipated my next question, which is: What might be some of the effects on patients of the Trump administration’s proposed rule?

Like I said, it’s already hard for so many people to get health care, out of fear of being discriminated against, or out of fear of stigma and feeling like they’re not going to get appropriate care, or feeling like they’re having to teach their doctors how to take care of them. [The proposed rule is] just going to make it so that health care organizations or insurance companies can say, we define gender this way, or we don’t agree with an individual identifying as trans, therefore we don’t have to care for that person. This could make patients feel more unsafe in accessing care and make it so that they don’t access care at all.

What kinds of health care might be affected by this rule? It sounds like you’re saying that people could be subject to discrimination with respect to any medical care. Is that right?

Yes. People of the LGBT community need health care just like everybody else. They need their yearly flu shot, they need their cancer screenings, they need their STI tests. They get strep throat and need antibiotics. It’s already really hard to go to the doctor, and this is just going to make it that much more difficult.

Can you talk a little more about what kinds of gender-affirming care trans patients seek?

I use the language “gender-affirming care,” but many members of the community don’t always agree with that language. The sentiment is that medical institutions don’t need to affirm someone’s gender, that somebody’s gender is decided by the individual, not by the physician, not by a politician, not even by a parent. So I just want to honor that.

Every gender journey and every gender experience is very unique to the individual. I have patients coming in saying, I don’t want hormones, but I do want a referral for top surgery, because for me that’s really affirming, or I want a referral for a hysterectomy. Not all individuals choose surgery. It can be getting support from a health care provider to change their gender marker on their legal documents. It can be about just seeking care in a space that feels really affirming, [where] an individual can walk into a health center and dress and present in a way that’s in line with their identity and feel affirmed by the environment that they’re in.

What are the benefits to patients of being able to get this kind of care, whether it’s hormone therapy or surgery or just an affirming space?

It’s literally lifesaving. There are really high rates of suicide in this community, high rates of depression, high rates of anxiety, because of the stigma that they feel in their environments — not being accepted by family members, by loved ones, in the workplace, at school. Being inclusive of everyone and how they identify can improve mental health outcomes and improve quality of life.

There have been several new rules released by the Trump administration in recent weeks, and some have been described as conscience protections or protections for providers’ religious beliefs. As a doctor, what’s your take on such protections?

I think that it’s not fair for a health care provider to bring their personal beliefs into the exam room. I’m an abortion provider, I’m a physician, I care for everyone regardless of how they identify, because my job is to treat the patients as human beings.

In addition to the potential practical effects on care, what message is the Trump administration sending with its proposed rule and other recent rules that affect trans people?

It causes so much anxiety. My patients express that to me all the time, and they look to me for reassurance — what does this mean about my rights, what does this mean about my health care?

Luckily I practice in New York, in a state that aims to protect the rights of the LGBT community. For example, public and private insurances have to pay for gender-affirming hormone therapy and gender-affirming surgery, and I’ve seen that have an incredibly positive effect on the lives of my patients. I think other states should follow suit. It would be even better if the federal government made policy that was broad and national and that made every state do that.

Anything else you’d want to say that we didn’t get to?

We’re all human beings and deserve access to health care, and I don’t think that it’s fair that some people get health care and some people don’t, just based on where they live and who they happen to see at the health center where they go, if they go at all.