HHS’ new rule imperils transgender health
Riah Milton and Dominique “Rem’mie” Fells, both black trans women, were murdered earlier this month. Their deaths appear to be part of an epidemic of hate crimes against transgender people, particularly trans women of color. Yet that same week, against the backdrop of Black Lives Matter protests, a global pandemic and Pride month, the Trump administration issued a rule to further imperil transgender people by stripping them of their right to seek health care without discrimination.
The rule, finalized on June 12 by the Department of Health and Human Services’ Office of Civil Rights, rewrites part of the Affordable Care Act by interpreting “sex” discrimination to apply only to biological sex, thus allowing health care providers and insurance companies to refuse care or coverage to patients merely because they are transgender. Although the Supreme Court’s recent groundbreaking ruling that employers cannot fire individuals based on sexual orientation or gender identity sets an important precedent, it doesn’t keep the HHS rule from taking effect.
By negating the existence of transgender people, the HHS rule flies in the face of medical knowledge and, frankly, the makeup of America. In 2016, 0.6 percent of Americans identified as transgender. For comparison, about 2 percent of Americans have red hair. Major medical organizations, including the American Medical Association and the American College of Physicians, support coverage and care for transgender patients. The administration states that revising the discrimination protection to exclude LGBT people will “reduce confusion” for providers. This line of thinking should scare us. If providers are confused, they must educate themselves. We would not dream of asking doctors to practice outdated medicine simply because they are unwilling to learn new information.
The fact is that the medical field recognizes that sex is not binary. For example, about 1 in 1,500 babies are born with atypical genitalia, termed “intersex.” While the standard of care used to be surgery to alter genitalia to fit with typical female or male sex, leading urologists now recognize that the “one size fits all” model is wrong. Similarly, gender identity is not binary for all people. The HHS should be at the leading edge of health and science, rather than pushing outdated and ill-informed policies.
At a time when the entire world is calling out for equity, this rule provides safe haven for ignorance. It also imperils the health of patients during an ongoing pandemic, patients who are already at high risk. Transgender men and women have high rates of cardiovascular disease, psychiatric disorders, substance abuse and suicide, in part due to the high rates of discrimination they already face in our health care system. This rule will allow providers to refuse diabetic care and other critical needs.
One in five transgender people report having been denied health care outright, and 33 percent report delaying or avoiding health care because of fear of harassment. This rule will create more fear and further decrease patients’ willingness to seek care or share important aspects of their medical history. This lack of trust and transparency will result in more medical and psychological needs down the line and higher costs for the entire health care system.
Research shows that discrimination related to gender identity is directly linked to higher risk of serious medical conditions like HIV. While the Trump administration sets bold public health initiatives such as ending the HIV epidemic, its policies directly undermine those goals.
To improve health care, we can advocate for systems that create less, rather than more, harm for our patients. We can actively oppose discriminatory policies such as the HHS rule and support policies such as the Equality Act that move our nation toward justice for all. As health care providers, we can ensure that our electronic medical records accurately capture a patient’s name and gender identity and that our staff and providers treat them with the respect they deserve.
As the global pandemic has taught us, our nation is only as healthy as its most vulnerable citizens. The HHS rule is medically unsound and will harm individual and public health. We cannot continue to allow the seeds of transphobia that kill so many people to be buried in our medical system.
Norwood is an assistant professor of medical education at Dell Medical School at the University of Texas at Austin where she leads the UT PRIDE Pop-up Institute on Sexual and Gender Minority Health and Wellness. As a primary care physician, she provides gender-affirming care to transgender and gender non-conforming patients. She is also a Public Voices Fellow of The OpEd Project.