By Milo Due & Quincy Guinadi
On Friday, June 12, the Department of Health and Human Services finalized a decision to eliminate federal protections for transgender patients to prevent discrimination by healthcare providers including doctors, health insurers, and hospitals—protections that have been tirelessly fought for by generations of LGBTQAIGNC+ activists. In this decision, the Trump administration redefined sex discrimination as “only applying when someone faces discrimination for being female or male, and does not protect people from discrimination on the basis of sexual orientation or gender identity.”
What does this mean for transgender patients? Simply put, this rule would allow healthcare providers to refuse services and treatment to transgender patients IN THE MIDDLE OF A GLOBAL PANDEMIC. To pour salt in the wound, this rule was finalized during Pride month, on the anniversary of the massacre at Pulse, a gay nightclub in Orlando, which resulted in 49 deaths. Again, we can’t believe we have to say this – Transgender people deserve the basic human right to receive healthcare without discrimination!
As psychology students, we know just how detrimental this decision will be to trans health. Transgender individuals have long faced barriers to quality healthcare that are both personal (such as providers’ attitudes towards trans people) and structural (such as lack of insurance coverage for gender-affirming care). In a 2011 survey of over 6000 transgender individuals, 19% report having been being denied healthcare because of their trans identity. In a 2015 NPR poll, a third of trans individuals in the U.S. reported they did not have access to regular healthcare.
The perhaps even more insidious public health threat from this most recent decision is widespread fear, which may cause more trans people to disengage from the healthcare system entirely, going without necessary care until treatable conditions become medical emergencies. The 2011 survey cited above revealed this is already taking place: 28% of trans respondents reported postponing necessary healthcare when sick or injured, and 33% had delayed or not sought preventative care because of fear of discrimination. Nor is this fear unfounded: the reality that trans people now live with every day is that our government is actively trying to kill us. Stripping anti-discrimination protections during a pandemic is tantamount to murder, when trans individuals might forgo COVID testing for fear of discrimination, and are in danger of being left to die by medical professionals who hold personal biases.
And providers who hold these biases have just been authorized to act on them by the highest office in the land. Remember that 19% of trans people reported being denied needed healthcare for being trans. This decision will come down hardest on Black and indigenous trans people, who, by virtue of their positionalities vis-à-vis structural racism, are already at higher risk of severe complications or death from COVID-19.
The executive vice president of the Christian Medical Association, one of the groups who pushed for this decision, lauded the change, stating healthcare professionals must base decisions on “biology and science, not ideology” (quoted by NPR, June 12, 2020). Fair enough! Let’s look at what science does have to say about transgender healthcare:
The science says that experiences of discrimination have detrimental effects on the mental health and mental healthcare utilization of LGBTQ individuals.
The science tells us that social stress, transphobia, stigma, and discrimination are all positively associated with mental health problems.
We know that lack of access to healthcare providers who are adequately knowledgeable about transgender health is the most common barrier to healthcare reported by transgender survey respondents, and that transgender populations experience significant health disparities.
And the science says that having access to a trans-competent healthcare provider decreases depression and suicidality among trans people.
In other words, nowhere in the scientific literature is there support for denying care to transgender patients. Our healthcare needs—and our existence—are not matters of ideology.
The COVID-19 pandemic has highlighted two truths: (1) that we are all intimately interconnected (such that our behaviors impact the health of others, and we therefore have a responsibility to one another to keep each other safe); and (2) that deep racial inequities in our country and state have a dramatic effect on health outcomes. Taken together, these truths suggest that our healthcare system is only as good as its ability to serve the most marginalized among us.
While none of us can take on Trump directly (and this decision will be legally challenged), as future health service providers, we can start right away in improving trans healthcare by educating ourselves on issues that affect trans health. We can speak up against transphobia in our homes, neighborhoods, classrooms, workplaces, and practicum and internship sites. We can read, listen to, and uplift the voices of trans people, especially Black and Indigenous trans folks. We can unlearn the ways in which we ourselves have internalized cissexism and rethink binary notions of gender.
It’s not all bad news in the land of transgender civil rights. Yesterday, tens of thousands of people gathered in Minneapolis, Brooklyn, and other cities to uplift Black trans voices and demand an end to violence against Black trans women. The trans-led NYC organization GLITS raised over a million dollars over the past week for housing for formerly incarcerated Black trans folks, and are now able to put a down payment on two Manhattan apartment buildings. And today the supreme court ruled that existing protections against sex discrimination also apply to LGBTQAIGNC+ folks, making firing someone for being trans illegal in all 50 states. Still, my social media feed is awash with posts from trans folks who had experienced employment discrimination in states where it was already illegal.
Addressing a crowd of several thousand people who turned out to a march organized by Black Visions Collective to demand the city of Minneapolis defund its police department, Representative Ilhan Omar reminded us that in the fight for social justice, each step forward triggers a wave of backlash: “with each progress, there is regression.” This regression will always most severely impact those who are already the most vulnerable to discrimination and state violence. What the Trump administration is currently doing is waging war on transgender people by attempting to legally define us out of existence, while leaving our BIPOC (Black, indigenous, and people of color) siblings to die. There is much work that remains to be done.
Projects and organizations that support & advocate for the transgender community:
Local Resources –
- Trans* Awareness Project MN: A list of resources and organizations for trans-identified folks in the Twin Cities area.
- MN Transgender Health Coalition: The Minnesota Transgender Health Coalition is committed to improving health care access and the quality of health care received by trans and gender nonconforming people through education, resources, and advocacy.
National Resources –
- Trans Lifeline (877-565-8860): Peer support service run by trans people, for trans and questioning callers.
- The Okra Project: The Okra Project is a collective that seeks to address the global crisis faced by Black Trans people by bringing home cooked, healthy, and culturally specific meals and resources to Black Trans People wherever we can reach them.
- The National Center for Transgender Equality: Provides information on advocacy at the national, state, and local level. They also offer information on transgender peoples’ rights and legal protections across various areas of life.
- The Transgender Law Center: Largest trans-led organization advocating self-determination and community-driven strategies to keep transgender and gender nonconforming people alive, thriving, and fighting for liberation.
Milo Due (they/them) holds a Master’s degree in psychology from the New School for Social Research in NYC, where they worked as a sex educator and studied the therapeutic alliance. As a current PsyD student at Saint Mary’s University of Minnesota, they are passionate about improving access to competent and affirming mental health care for queer and trans communities and exploring the ways in which the practice of counseling psychology can advance social justice.