It was a routine appointment. I had taken a few hours off work and an Uber across town to get to the doctor. I wasn’t able to schedule with my general physician — she is one of the only two doctors at the only LGBTQ clinic in Iowa City and I swear that every queer I know there goes to her — so I scheduled with someone else instead. I checked in with the nurses who gave questioning glances at my paperwork which were sometimes followed by disdainful glances at me. I sat in the waiting room and tried to read without thinking about the worst-case scenarios, of being in a strange room, and having a new doctor touching me. I wondered how much I would have to explain and how helpful he would actually be.
When the doctor finally came in, he seemed friendly enough. He asked in a flat but friendly voice about the medications I was on, and I answered comfortably until the discussion turned to my breasts. “Have you,” he asked, “had breast implants?” I was still. It didn’t seem like a pertinent question and was surely something my chart would have had on it if it were relevant at all, and surely it wasn’t. “They’re coming along very nicely” he said, with a little wink, and in that moment, I knew that I would never return to him again. It reminded me why so often my queer friends accompany each other to appointments, for safety and comfort. Even when we don’t go with each other we all talk about them because, inevitably, high-quality LGBTQ healthcare is difficult to attain. In a country where there is no guarantee that a doctor will be accessible to us, where if they are accessible there is no guarantee that they will understand our unique needs and risks, where federal policy is unpredictable and the federal government has been removing information regarding our bodies from their websites, referral and what otherwise might be called “herd immunity” are our greatest resource.
Healthcare is a political issue because according to the American College of Obstetricians and Gynecologists lesbian and bisexual women are more likely to lack access to health insurance and medical care. This, exasperated by the intersections of race and class, means that queer women (especially queer women of color) are at greater risk of all sorts of health problems including lung cancer, diabetes, heart disease, and psychological conditions due to the pressure of discrimination and isolation and consistent oppression. The frequent use of bars as LGBTQ spaces means that queer women are also more likely to engage in substance use and abuse. This pattern holds consistent and leads to worse for outcomes for transgender women as well who suffer from similar and exacerbated health concerns. As the Trump administration continues their assault on the Affordable Care Act and LGBTQ health, these issues will only get worse. Federal Regulation and resources are already unpredictable.
In Jan. 2017, the Trump administration removed LGBTQ content and information from the White House’s and the Department of State’s websites. While the Center for Disease Control’s LGBTQ website remains up, much of the information is a decade out of date. In Jan. 2018, Office for Civil Rights director Roger Severino announced the new Health and Human Services’ Conscience and Religious Freedom department saying, “no one should be forced to choose between helping sick people and living by one’s deepest moral or religious convictions.” In the eyes of this administration queer people are morally disposable ill or not. As of that same month, according to Human Rights Watch, “thirty seven states do not expressly ban health insurance discrimination based on sexual orientation or gender identity.”
The Trump administration has also long-sought to remove Section 1557 of the Affordable Care Act, which prevents discrimination “basis of race, color, national origin, sex, age, or disability in certain health programs or activities.” In an April, Robert Pear of the New York Times reported that “the rule covered ‘almost all practicing physicians in the United States’ because they accept some form of federal remuneration or reimbursement. It applies… to hospitals that accept Medicaid and doctors who receive Medicaid payments as well as to insurers that participate in health insurance markets.” As the law is currently understood, health insurers cannot deny services that help a person transition from gender to another. The Trump administration has made clear though, that none of these laws or restrictions can be taken at face value anymore and may not be relied on in the future.
In the meantime, many people choose to go to LGBTQ health centers where the treatment is likely to be safer and more inclusive. There are thirteen states (mostly clustered around the Midwest) which do not have a single one, finds Shabab Ahmed Mirza and Caitlin Rooney of American Progress citing a 2017 College of American Pathologists report. This means that queer people must take the risk of seeking healthcare wherever they can, and when they do there is no guarantee that there will be healthy outcomes. In their review of more than one-thousand studies examining the interactions between LGBTQ and their doctors Adekemi Oluwayemisi Sekoni, Nicola K. Gale and others, published in the 2017 Journal of the International AIDS Society, write that “Discrimination in healthcare settings against LGBT people can manifest as outright denial of care, disrespect and abuse, low-quality care, negative attitude and behaviour of providers, and lack of confidentiality and privacy in service provision.”
Mirza and Rooney also report that eight percent of LGBTQ people “said that a doctor or other health care provider refused to see them because of their actual or perceived sexual orientation” and another six percent were denied healthcare related to that aspect of their identity. Among transgender people, the CAP found that twenty-nine percent were turned away from healthcare services and twelve percent more were denied relevant care. Human Rights Watch reports that interviewees from that same study “described being denied counseling and therapy, refused fertility treatments, denied a checkup or other primary care services, and in one instance, told that a pediatrician’s religious beliefs precluded her from evaluating a same-sex couple’s six-day-old child.”
When the Trump administration removed information about LGBTQ healthcare from government websites they announced an ongoing disinformation campaign which coincides with their legislative and social attacks on LGBTQ people. This administration is aware that if people are not counted in the census they can be misrepresented later. This administration knows that if they can colour public perception of LGBTQ people, the attacks against us will grow from the larger population. Healthcare, like every other political issue is an LGBTQ issue. While there are a lot of things we can do now, like support and accompany each other as we attend doctor’s appointments, drive each other to far away clinics, and support pro-queer health organizations and local institutions, we must also remember to vote in the midterm elections in November.