Hilde Hall left the doctor’s office and headed to the local CVS pharmacy carrying her first prescriptions for hormone therapy. The pharmacist refused to fill the prescription and would not provide Hall with a reason.
“He just kept asking, loudly and in front of other CVS staff and customers, why I was given the prescriptions,” she wrote in a statement shared by the American Civil Liberties Union.
“Embarrassed and distressed, I nearly started crying in the middle of the store. I didn’t want to answer why I had been prescribed this hormone therapy combination by my doctor,” Hall added. “I felt like the pharmacist was trying to out me as transgender in front of strangers. I just froze and worked on holding back the tears.”
Hall has since received an apology from CVS, which fired the pharmacist who refused Hall’s prescriptions, but her experience facing health care barriers is not unique. A new 34-page report from Human Rights Watch, an international non-governmental human rights group, documents the high rates of discrimination LGBTQ people in the U.S. face when attempting to access health care — discrimination that it says will be exacerbated by policy changes implemented and promoted by the Trump administration.
DISCRIMINATION AND BARRIERS TO ACCESS
LGBTQ people — particularly transgender individuals — face high rates of discrimination in health care settings, previous research has shown. A 2017 report by the Center for American progress found 8 percent of lesbian, gay and bisexual people, and 29 percent of trans people reported that a provider had refused to see them because of their sexual orientation or gender identity in the previous year. Over that same period, 9 percent of lesbian, gay and bisexual people and 21 percent of trans respondents said a provider had used harsh or abusive language when they sought medical care.
HRW conducted interviews with 33 individuals who said they had been discriminated against in medical settings and 48 advocates and providers working with these affected individuals to better understand and document these barriers.
One of the report’s findings was the difficulty many LGBTQ people — especially those outside liberal metropolitan areas — face just to access affirming health care.
“Interviewees described LGBT individuals driving two hours from Tennessee to attend a weekend support group for gender-expansive youth in Birmingham, traveling two hours from Arkansas or Mississippi to attend therapy or meet with a trans-affirming doctor in Memphis, driving across Michigan to find a friendly nurse practitioner or medical practice, or driving from East Tennessee to North Carolina for regular hormone injections,” the report states.
Other interviewees recounted discriminatory treatment by health care providers. A Memphis man, for example, described homophobic treatment when he took an HIV test at his annual checkup.
“They sat down and started preaching to me — not biblical things, but saying, you know this is not appropriate, I can help you with counseling, and I was like, ‘Oh, thank you, I’ve been out for 20 years, and I think I’m OK.’ It’s almost like they feel they have the right to tell you that it’s wrong,” he said.
Other LGBTQ patients related stories of being refused service altogether.
“Interviewees 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 6-day-old child,” the report states.
That child belongs to Jami Contreras. Her daughter was denied service by a pediatrician because Contreras and her partner are same-sex parents.
“It wasn’t violent, they didn’t attack us, but your sense of security is gone. Is it going to be violence next time? You just don’t know,” Contreras said. “And it’s on all levels — health care, signing [our daughter] up for soccer, you make sure the coach and parents are OK. It’s just sad that in 2018 we have to think about those things.”
Contreras’ pediatrician did not violate any law. Michigan is one of 37 states that does not protect LGBTQ patients from discrimination. Furthermore, 10 states exclude transition-related care from Medicaid coverage “limiting options for low-income transgender people,” the report states. And in 2016, Illinois, Tennessee and Mississippi enacted state laws that provide broad religious exemptions to providers.
The report found that health care refusals, or even simply fear of refusals, can lead LGBTQ people to postpone or forgo necessary medical care.
One interviewee told HRW her same-sex partner, a registered nurse, had never visited the gynecologist for fear of poor treatment, despite knowing the risks of forgoing preventative care.
Previous research found lesbians and bisexual women — especially those who are gender-nonconforming — are less likely to see a gynecologist, less likely to be screened for preventable and treatable diseases, and therefore face higher rates of breast and cervical cancer than heterosexual women.
Ryan Thoreson, an LGBTQ-rights researcher at Human Rights Watch and author of the report, said discrimination puts LGBTQ people “at heightened risk for a range of health issues, from depression and addiction to cancer and chronic conditions.
“Instead of treating those disparities as a public health issue,” he added, the Department of Health and Human Services (HHS) under the Trump administration “is developing politicized rules that will make them much worse.”
TRUMP ADMINISTRATION PROVIDING A “LICENSE TO DISCRIMINATE”?
The report claims two regulatory changes advanced by the Trump administration “are likely to exacerbate” the discrimination and barriers LGBTQ people face when seeking health care and give insurers and providers a “license to discriminate against them.”
In May 2017, HHS began the process of rolling back an Obama-era rule that clarified the nondiscrimination provision of the Affordable Care Act, section 1557, to include discrimination based on gender identity as sex discrimination.
“Rolling back the rule would have practical consequences, leaving transgender people less certain of their rights, providing little guidance to insurers or providers about their responsibilities under section 1557, and signaling that federal agencies will not advance trans-inclusive interpretations of section 1557 in their rule-making and enforcement capacities,” the report states.
Then in January 2018, HHS announced the creation of a religious freedom division that would defend health care providers who refused care on the basis of their religious or moral beliefs, and proposed a rule that would that would expand the ability of insurers and health care providers to deny service on the basis of religious or moral objections.
“Retreating from anti-discrimination protections while expanding exemptions that permit insurers and providers to deny care based on their moral or religious convictions is a dangerous combination,” the report states.
At the conclusion of its report, Human Rights Watch shared seven recommendations for improving the experience of LGBTQ people seeking health care.
Among its recommendations are that HHS “preserve and enforce protections on the basis of sexual orientation and gender identity” and “withdraw the proposed rule expanding religious exemptions” for insurers and providers. HRW also recommended Congress enact legislation that would prohibit anti-LGBTQ discrimination in all federally funded health care programs.
“When LGBT people seek medical care, the oath to do no harm too often gives way to judgment and discrimination,” Thoreson said. “Lawmakers need to make clear that patients come first, regardless of their sexual orientation or gender identity.”