When Grecia Magdaleno first came out as a lesbian, it wasn’t to a family member, close friend or confidant. Magdaleno was at an appointment at a Planned Parenthood clinic in her native Arizona when a practitioner was asking her routine questions about her relationship, and asked her if the relationship she was in — a relationship with a man — was the right one for her.
“I said ‘I don’t think I like men.’ They were able to give me counseling services and start the conversation I hadn’t been able to have,” Magdaleno, now a University of Chicago graduate student, told NBC News.
At the time, Magdaleno didn’t have health insurance and qualified for Title X, a federal grant for family planning services for low-income people. After coming out, when she went to other clinics, she said she felt doctors treated her differently due to her sexuality, and she said they discouraged her from getting screenings because they didn’t understand she still needed reproductive care.
In the three years since that first appointment at Planned Parenthood, Magdaleno said she has relied on the nonprofit organization for low-cost care from practitioners who don’t see her as different.
“When I was sexually assaulted, it was actually someone of the same gender. When I went to Planned Parenthood, they didn’t bat an eye,” Magdaleno, who last year worked as a community organizer for the health provider, added.
In order to address some of the unique health needs of the community, Planned Parenthood provides LGBTQ health training programs to its affiliates across the country. For example, the organization offers transition-related health care at approximately 65 of its locations.
Magdaleno is one of countless LGBTQ Americans who rely on Planned Parenthood for their their unique health care needs. However, the federal funding the organization receives is on uncertain ground. Though the Republican bill to repeal and replace the Affordable Care Act (ACA), or “Obamacare,” failed to garner enough support earlier this week, the Senate is expected to vote Tuesday on a health care bill that would either repeal the ACA alone or repeal and replace it. The latest version of the Senate bill defunds Planned Parenthood for a year, which could be disastrous for LGBTQ people on Medicaid and those who, like Magdaleno, rely on it for discrimination-free health care.
Since 2011, Republicans have repeatedly sought to slash Planned Parenthood funding because some of its clinics offer abortion services. However, the half billion dollars it receives in federal reimbursements does not fund abortions, due to federal law. In March, Vice President Mike Pence cast a tie-breaking vote to allow states to withhold Title X family planning grants from clinics that offer abortions.
Given that LGBTQ people are more likely to rely on federally funded programs like Medicaid, which most Planned Parenthood health centers accept, “the repeal would stand in their way of access to care,” June Gupta, associate director of medical standards at Planned Parenthood, told NBC News.
“A larger number of LGBTQ people would not be able to get through our doors,” she explained. These patients could be barred not only from family planning and preventative health care, but from accessing health care specific to LGBTQ people, such as transgender hormone therapy.”
The repeal would also lead some Planned Parenthood health centers to close, especially in rural America, forcing patients in those areas to travel further for care, regardless of insurance.
“I hear frequently about lesbian and bisexual-identified women and transgender patients who report the only place they can get safe care in areas where there isn’t some kind of designated LGBTQ practice is often Planned Parenthood,” Dr. Alex Keuroghlian, the director of the National LGBT Health Education Center and an assistant professor of psychiatry at Harvard Medical School, told NBC News.
About 30 percent of transgender patients report delaying or not seeking care due to discrimination, according to a report published in the June 2016 edition of the journal Medical Care, and one in four say they were denied equal treatment in health care settings. And, according to Sean Cahill, director of health policy research at the Fenway Institute, lesbian, gay and bisexual women are less likely to get preventive screenings at all.
Being able to treat LGBTQ patients means “understanding that LGBT people in our society experience discrimination, victimization and bullying,” Cahill told NBC News.
On average, medical students and nurses receive just five hours of training about LGBTQ issues, according to Dr. Keuroghlian. Due to the dearth of doctors with training in transgender issues, trans people frequently have to act as their own health experts.
“When they meet a trans patient for the first time, it blows their mind,” Brooke Baxa, a non-binary trans person who identifies as neither male nor female, told NBC News.
Baxa lives in Nebraska but gets their hormones from a Planned Parenthood in Denver, Colo., where they formerly went to college. “Everywhere else to get hormones is a ridiculously long waiting list, because there aren’t enough doctors for how large the trans community is in Denver. It takes six months to get in,” Baxa said. Given how hard it is to find a doctor in Nebraska, Baxa makes the 400 mile drive back to Denver once a month to get their hormones from Planned Parenthood.
LGBTQ people don’t leave their identities behind when it comes to reproductive health, either. Similar to Baxa, Cazembe Jackson, a transgender man, said he has relied on Planned Parenthood because other providers don’t understand the intricacies of treating trans people.
“A lot of the frustration for me as a trans man is the lower exams. Doctors not having experience dealing with trans bodies [means] they have misgendered you in the front office, and then when you get to the back, they’re expecting your anatomy to be different,” Jackson, who lives in Atlanta, told NBC News.
“I won’t act like Planned Parenthood is perfect and like everyone knows everything. The difference is that folks have made some type of attempt to respect the experience of everyone walking through the door,” he added.
When Sarah Toce and her wife were trying to conceive and didn’t have insurance, they turned to Planned Parenthood to help with complications from a pregnancy. Toce had to have an abortion because she had a blighted ovum, where an embryo doesn’t develop but the body still experiences the signs of pregnancy. To get pregnant again, she had to go on birth control to regulate her hormones.
When Toce, who lives in Seattle, would go to other health care professionals, she said they usually assumed she was in a straight relationship. “[They ask] are you sexually active? What birth control are you using? Then you get into this whole spiel with the doctor about why you aren’t using it. A lot of women will not even go to the doctor because they don’t want to deal with it,” Toce, the founder and publisher of The Seattle Lesbian, told NBC News.
Aside from the challenges of finding medical providers who can address their needs, LGBTQ people and those living with HIV would be among the millions who would become uninsured as a result of a potential ACA repeal. Compared with the general population, both groups would be disproportionately affected. According to data from the Urban Institute, the uninsurance rate for lesbian, gay and bisexual adults was cut by nearly half between 2013 and 2015, the years spanning the first two open enrollment periods of the ACA.
With uncertainty over the the repeal and replacement, some LGBTQ people are contemplating what the future of their health care could look like. “I’m scared of losing basic care,” Magdaleno told NBC News. “I’m scared of losing options. I’m also scared for those around me, because those are their only options.”