Lara Americo knows first-hand how hard it is to find adequate care as a transgender patient. Image via subject Rollback on Nondiscrimination Protections in the ACA
Lara Americo knows first-hand how hard it is to find adequate care as a transgender patient. Image via subject

The Trump administration is working—amid a global pandemic—to make it even harder for LGBTQ Americans to feel like they can obtain quality health care without bias or discrimination. 

Lara Americo learned firsthand how difficult it can be to find adequate care as a transgender patient when she began seeking transition-related care through the Department of Veterans Affairs. 

It was 2012, and Americo—an Air Force veteran living in North Carolina at the time—was accessing care at the W. G. (Bill) Hefner VA Medical Center in Salisbury. 

“They didn’t have anyone that would see me for transition [related care],” Americo told COURIER. Her primary physician referred her elsewhere, she said, but ultimately no one would agree to take her on as a new patient, arguing they didn’t have the proper training. 

She was forced to go “off campus,” but had difficulty finding anyone who would take VA health coverage. Eventually, she was able to connect with a provider located in Charlotte who has dedicated much of his practice to caring for trans patients.

Now living in New York City several years later, Americo still finds herself enduring barriers to quality care, including being misgendered by healthcare professionals. As she and her partner attempted to conceive, Americo had to have a procedure that required her to go under anesthesia. She recalled one provider telling her that they wouldn’t see her unless she consented to being labeled “male” and as the prospective “father” on her medical records.

When the day came for the procedure, Americo said she met with an anesthesiologist who asked her insensitive questions that were unprofessional, unnecessary, and showed a lack of knowledge when it comes to gender identity. 

“This guy was about to put me to sleep, and I’m depending on him for my life,” she said. “And he starts asking me about my transition … He was like, ‘I’m a medical professional. Why did you become a woman if you wanted to make a baby as a man?’ I just didn’t know what to say.”

RELATED: LGBTQ Southerners Say Stigma Is a Barrier to Quality Medical Care

Americo’s experience is far from an anomaly. The 2015 U.S. Transgender Survey found that one-third of respondents said they’d had at least one negative experience in a healthcare setting related to their gender identity, including verbal harassment or the refusal of treatment. 

Now, the Trump administration is working—amid a global pandemic that’s killed more than 135,000 Americans—to make it even harder for LGBTQ Americans to feel like they can obtain quality health care without bias or discrimination. 

The Rule That Will Hurt LGBTQ Patients

Last month, the Department of Health and Human Services (HHS) finalized a rule to roll back the Obama administration’s expansion of the Affordable Care Act’s nondiscrimination provisions to cover LGBTQ patients. Finalized in 2016, the expansion was carried out in accordance with pre-existing civil rights law protecting, in part, on the basis of sex, which the previous administration interpreted as including gender identity. 

The Trump administration’s attempt to gut those protections would hit transgender individuals particularly hard, allowing healthcare workers to deny their services to the community. 

In a press release announcing the rollback, HHS was critical of the Obama administration’s decision in 2016 to implement Section 1557, the ACA’s nondiscrimination provision, characterizing it as “[redefining] sex discrimination to include termination of pregnancy and gender identity, which it defined as ‘one’s internal sense of gender, which may be male, female, neither, or a combination of male and female.’”

Those provisions were struck down by a federal court in October of last year, and HHS said it would be “returning to the government’s interpretation of sex discrimination according to the plain meaning of the word ‘sex’ as male or female and as determined by biology.”

As a result of this decision, several groups have filed suit against the Trump administration.

‘Legally Indefensible’

On June 22, Lambda Legal and Steptoe & Johnson LLP filed suit against the Trump administration on behalf of a number of LGBTQ organizations and healthcare professionals, including, but not limited to, Whitman-Walker Health, the TransLatin@ Coalition, the AGLP: The Association of LGBTQ+ Psychiatrists, and others. 

“While HHS’s health care discrimination rule cannot change the law, it creates chaos and confusion where there was once clarity about the right of everyone in our communities, and specifically transgender people, to receive health care free of discrimination,” said Omar Gonzalez-Pagan, senior attorney and health care strategist for Lambda Legal.

“For years, the Trump administration has utilized HHS as a weapon to target and hurt vulnerable communities who already experience alarming rates of discrimination when seeking care, even now, during a global pandemic. Their actions are wrong, callous, immoral and legally indefensible.”

RELATED: Trans Southerners Don’t Feel Safe Seeking Health Care. That’s a Huge Problem in a Pandemic.

On July 9, another suit was filed in response to the Trump administration’s interpretation of civil rights law. 

The National Women’s Law Center, Transgender Law Center, the Transgender Legal Defense & Education Fund, the Center for Health Law and Policy Innovation of Harvard Law School, and law firm Hogan Lovells filed suit on behalf of Darren Lazor, a transgender man who experienced discrimination in health care, and a number of LGBTQ and health care groups.

“I have experienced feeling like a doctor doesn’t care if I live or die—which is just shameful,” said Lazor in a press release. “No one should be denied life-saving health care or be discriminated against the way I have simply because of who they are. I hope that sharing my story can help others understand that transgender people are who we are, and we deserve to be treated fairly under the law.”

Adam Polaski, communications director at Campaign for Southern Equality, notes that the anti-LGBTQ healthcare rule aligns with the Trump administration’s actions toward the community to date. He also points out: “It’s not like people who are trans already have amazing access to health care and don’t face discrimination already, because they do.” 

“This move basically takes an already vulnerable population and just pushes it down even further,” Polaski told COURIER. “It’s a really irresponsible decision and is clearly rooted in a fundamental misunderstanding of who transgender people are.”

A transgender woman in a hospital gown being treated by a doctor
Photo via The Gender Spectrum Collection

Recent SCOTUS Ruling on Workers Could Set Important Precedent  

The Supreme Court handed a win to the LGBTQ community last month when it ruled that existing civil rights law protects the community against workplace discrimination. That decision, which came down on the side of including gender identity under “sex” protections, sets a precedent advocates hope will prove useful in making their cases.

“Our analysis is because it’s federal law now to prohibit discrimination based on sex in employment, and that covers the LGBTQ community, the theory goes, and the logic follows, that if employment discrimination based on sex covers LGBTQ people, then other federal laws should as well,” Polaski said.

RELATED: Why the Supreme Court Ruling on LGBTQ Workplace Protections Is a ‘Watershed Moment’

But while he said he is “optimistic about the prospects of a legal case,” he is also quick to point out that “it shouldn’t be understated that there’s a triggering and traumatizing effect that policies like these have when they’re announced.”

“It’s great that we’re pretty sure that this will fail in court, just because of the way the Supreme Court ruled [on worker protections], but at the same time it has a damaging impact that can’t really be measured by the specific legal impact.”