It’s ‘Scary,’ But Transgender Patients Are Fighting Trump’s Health-Care Discrimination Agenda

If the Trump administration gets its way, doctors will be able to claim a religious or a more nebulous moral objection as an excuse to deny care, gender-affirming or otherwise, to transgender patients.

[Photo: A nurse looks through medical records.]
Advocates for reproductive rights and LGBTQ equality are concerned that Trump’s bureaucrats will cause even more pain at the doctor’s office. Shutterstock

Stefi Honey had been with her primary care doctor for five years, visiting as often as every other week without incident. When she began to live openly as a transgender woman, however, the doctor-patient dynamic changed.

Honey’s doctor eyed her dresses and asked if she was “gay,” though sexual orientation and gender identity are not one and the same. The doctor “wasn’t very gentle in the way she was speaking about it,” Honey, 57, recalled in an interview with Rewire.News. Neither were the nurses and office staff. She watched their “giggles” and “snickers” via a door window into the waiting room.

For Honey, the experiences were dispiriting at a time when she needed support. “When you’re doing the transition on [your gender identity], the beginning part is so, so, so hard to just to get enough courage to go out,” she said.

Still, Honey believed she could trust her long-time doctor, so much so that she asked her for help with hormone therapy.

“She looked at me, and then she kind of hemmed and hawed and kind of got this stupid grin on her face, and she said, ‘Well, I just don’t believe in that, and I can’t help you with that,’” Honey said. “I cried. I cried.”

If the Trump administration gets its way, more and more doctors will be able to claim a religious or an even more nebulous moral objection as an excuse to deny care, gender-affirming or otherwise, to transgender patients. Like Honey, they could encounter doctors who refuse to assist in providing transition-related care, which can include therapy, hormone therapy, and surgery.

Or they could encounter resistance from medical professionals—among them doctors, nurses, pharmacists, and receptionists—over any care, from breast cancer detection to treatment for the common cold

“What if a doctor wouldn’t put a cast on your broken arm because you’re transgender?” the National Women’s Law Center (NWLC) asked in a video recapping various forms of discrimination that could have the administration’s blessing. “These situations aren’t hypothetical—this is what happens when a persons’ care comes second to their doctor’s religious or moral beliefs,” the NWLC explained in an accompanying tweet.

Even hospitals could turn away transgender patients. Catholic hospitals, which operate under religious directives that have been used to deny care, account for one in six acute-care beds nationwide.

The Trump administration is angling to give a giant out to the entire medical profession in the name of “religious freedom,” or religious imposition.

Trump’s bureaucrats known for demeaning transgender people and fighting for the “unborn” have made the U.S. Department of Health and Human Services (HHS) their home base. In January, HHS took steps to empower medical professionals who don’t want to treat LGBTQ patients or provide reproductive health care, including contraception, miscarriage management, and abortion care. With anti-LGBTQ activist Roger Severino at the helm, the agency’s Office of Civil Rights bolstered “conscience protections,” or health-care refusals, through a new health-care discrimination wing and proposed regulations that provide enforcement muscle.

The proposed regulations are open for public comment through March 27. Commenting allows advocacy groups and concerned members of the public alike to register their discontent and lay the groundwork for legal challenges, though HHS previously tried and failed to hide negative comments about anti-choice and anti-LGBTQ policy.

The National LGBTQ Task Force is collecting comments on the health department’s proposed regulations via an online portal. So is the National Center for Transgender Equality (NCTE). “We strongly encourage you to use your own words, including by sharing personal stories of how discrimination or the fear of discrimination in health care or related services has affected you or someone you love, or why you oppose this rule as a person of faith,” NCTE wrote in its appeal. Some of those stories are already circulating on Twitter under the hashtags #RxforDiscrimination#LicensetoDiscriminate, and #PutPatientsFirst.

Rewire.News’ Amy Littlefield recently documented three transgender women fighting for health insurance coverage as the Trump administration dismantles their right to care. “The future of transgender health access may depend on the willingness of patients,” Littlefield wrote, naming the women, “to continue to disclose the most intimate details of their lives in public—to fight back against insurers, employers, state regulators, and the federal government.”

Doing so puts the onus on transgender people to prove their humanity, time and time again, when trans-directed acts of violence are on the rise. Transgender women of color disproportionately experience fatal violence.

NCTE Director of Policy Harper Jean Tobin said that speaking up can take many forms, whether that’s “going and complaining to the administration of a hospital about the way you were treated by a provider,” or talking to the press, or fighting in the courts.

“That [act] is a really stressful and sometimes scary experience for trans people to put themselves out there, but it is powerful and necessary, even while we’re trying to protect people’s health-care privacy,” she told Rewire.News in an interview.

For the purposes of critiquing the latest regulations, some people some may choose to share personal stories anonymously, given the public nature of the comments.

Federal and state laws already provide a web of so-called conscience protections for health-care workers. LGBTQ people, however, routinely face “discrimination and mistreatment” from their providers, according to recent data from the progressive Center for American Progress (CAP). Among transgender respondents to CAP’s survey on LGBTQ discrimination in health-care settings, 12 percent reported that a doctor or other provider refused to provide transition-related care. Twenty-nine percent didn’t even make it through the door because a doctor or other provider “refused to see them because of their actual or perceived gender identity.”

Another 29 percent “said that they experienced unwanted physical contact from a doctor or other health care provider (such as fondling, sexual assault, or rape)”—just as Angela Bridgman, a 46-year-old transgender woman, experienced some two decades ago.

Bridgman in an interview with Rewire.News said her Louisville, Kentucky-based doctor sexually assaulted her before falling back on a religious health-care refusal, all in the same visit.

“He came back five minutes later with a nurse and told me he would not treat me because of his religious convictions,” said Bridgman, who has since moved to North Carolina. “And I screamed at the guy. I [said], ‘Yeah, your religious convictions didn’t stop you from reaching your filthy hand up my skirt, you pervert.’”

Bridgman recalled first coming out as transgender in the mid-1990s when Washington, D.C., emergency medical technicians denied life-saving care to Tyra Hunter, a young transgender woman who died in 1995 as a result of their negligence. Robert Eads died a few years later from ovarian cancer “after being turned away by dirty dozens of health care providers because he was a transgender man,” NCTE posted in an online tribute.  

Their deaths are not far from Bridgman’s mind in the Trump era.

“That’s why I’m telling my story today, because of what Trump is doing now,” she said, referring to the administration’s religious imposition at the expense of LGBTQ people. “The history is there. This has been done to us in the past, even before Trump is basically greenlighting it. What do you think happens now when Trump greenlights this shit? A whole lot more people do it.”

Ray Gibson echoed Bridgman’s concerns. The 60-year-old Georgia resident told Rewire.News about experiencing multiple layers of discrimination living as a Black transgender man since Trump’s inauguration.

“What I find absolutely horrifying about this presidency and the administration is that they just open the door for people to do whatever they want without one single law being enacted,” Gibson said in an interview. 

Repeated TSA body searches contributed to Gibson’s decision in 2017 to seek gender-affirming top surgery from a renowned surgeon in another state. According to the retired software engineer, who lives on a fixed income, the surgeon’s office staff and finance department incorrectly told him that Medicare wouldn’t cover the procedure. (Medicare in 2014 dropped a blanket exclusion on transgender-specific health care. “This means that coverage decisions for transition-related surgeries will be made individually on the basis of medical need and applicable standards of care, similar to other doctor or hospital services under Medicare,” according to an NCTE fact sheet.)

Gibson, an Air Force veteran, turned to the U.S. Department of Veterans Affairs (VA) for help. Though the VA in November 2016 dropped plans to cover gender-affirming surgical care for veterans, he hoped the department’s benefits would cover a bilateral mastectomy from a civilian doctor due to physical pain in both sides of his chest—a common side effect of chest binding—and his strong family history of breast cancer. Gibson’s mother and his mother’s aunt died from breast cancer; his mother’s sister is a survivor. But a VA office wouldn’t cover the genetic test, referring him only to an agency pain clinic. 

Gibson suspects that his race, gender, and income level factored into last year’s repeated health-care denials. The runaround contributed to gender dysphoria that he didn’t have before.

“All of the ‘no, no, no, no, nos’ in 2017 just made me all of a sudden super aware that I need to get rid of these things,” Gibson said. “It’s critical.”

Advocates for reproductive rights and LGBTQ equality are concerned that Trump’s bureaucrats will cause even more pain at the doctor’s office. Almost from day one, the Trump administration turned to the federal agencies to wage a stealth regulatory campaign against vulnerable LGBTQ populations, in addition to flashier actions like the transgender military ban.

HHS is behind much of the discriminatory work. “Despite Trump’s promise to defend LGBT rights, his health agency has blocked efforts to combat discrimination,” Politico reported in a sweeping story about the agency’s agenda.

Section 1557 of the Affordable Care Act, often called Obamacare, expressly prohibits anti-transgender discrimination and refusals to provide reproductive health care. But it’s under attack from the Trump administration, too. The U.S. Department of Justice (DOJ) last year stopped defending Section 1557 from GOP state-level legal challenges. DOJ’s move ended litigation in a federal district court that had temporarily halted enforcement of Obamacare’s nondiscrimination protections. The conservative judge in the case then granted DOJ’s request to return the regulations enforcing that part of the law to HHS—presumably, to be gutted in the coming months.

Despite fully intact Section 1557 enforcement under the Obama administration, refusals over gender identity were the most common form of discrimination among closed Section 1557 complaints involving LGBTQ people, according to a new CAP analysis of 34 such complaints that HHS reviewed and closed from 2012 through 2016.

“Complaints included a transgender woman being denied a mammogram because of her gender identity; transgender people being denied sexual assault medical forensic examinations; and a transgender man being refused a screening for a urinary tract infection because the clinic claimed it only provided those screenings to women,” Sharita Gruberg and Frank J. Bewkes of CAP’s LGBT Research and Communications Project wrote.

Even heath-care settings that don’t refuse to treat transgender patients can quickly turn into hostile environments.

Kyler Prescott, a 14-year-old transgender boy, was experiencing suicidal ideation when his mother brought him to a San Diego hospital in April 2015. Prescott “went into a spiral” after hospital staff repeatedly misgendered him, his mother told the Washington Post. Weeks later, he took his own life. 

Knowing they have an out could increase existing complacency among other providers toward transgender patients, resulting in substandard or no care.

Anton Prosser, a 37-year-old transgender man, initially sought hormone therapy at the Austin, Texas, primary care clinic that he had regularly visited for two or three years. The clinic, he said in an interview, was “totally fine with me as a person” but admittedly clueless about transgender health care. Rather than try to learn, the clinic turned him away.

“‘We’ve never treated a trans patient, so we can’t treat you because we don’t have a protocol,’” Prosser recalled the clinic’s manager telling him.

Prosser left the clinic with a list of about 30 local Austin-based endocrinologists, sat in his car, and called each one, outing himself over, and over, and over. He got “the whole range of answers,” from “‘we’ve never heard of that,’” to “‘call some other office,’” to “‘why did anyone tell you to call us, we would never do such a thing.’”

“It was so horrible,” he said. “It was one of the worst experiences I’ve had trying to find a doctor.”

And when he did, he discovered the doctor didn’t take any health insurance. Four years later, he still pays $150 out of pocket for each office visit despite being on his husband’s robust policy. The insurer last August started covering the cost of the hormones, though not the syringes, Prosser uses to administer the drugs at home.

Stefi Honey eventually found a doctor for her hormone therapy, too. She’s since become an activist, founding a local transgender support group and working with others in her community, including the local police department and government, to advocate for trans rights. And now, she’s targeting the Trump administration’s health-care refusals at the federal level.

I say we as a community, I think we should stand up and fight this,” she said.