Denied: LGBTQ+ People and Medicine in the Time of COVID-19
Illustrator: Holly Turner

The Trump administration is posing a huge threat to the healthcare of LGBTQ+ individuals. On the 12th of June 2020, the government passed an administrative rule with the Department of Health and Human Services to allow for discrimination. This rule has been changed because some healthcare providers argued that having to provide care for LGBTQ+ was against their First Amendment right to freedom of religion. Both during the COVID-19 outbreak and afterwards, this is an appalling attack on the LGBTQ+ community and one that may only be the start of a longer campaign of discrimination.

This law will directly affect how Section 1557 of the Affordable Care Act, which was passed in 2010 under the Obama administration, is implemented. This meant that everyone, including LGBTQ+ patients, would be protected from discrimination. This new rule allows healthcare providers to decide whether or not someone looks LGBTQ+, and as a result, choose whether or not to treat them. This change passed on the four-year anniversary of the Pulse Nightclub shooting. This attack on a  a gay nightclub displayed the deep-rooted homophobia that continues to exists in American society. To mark this anniversary with a legislative rule allowing legal discrimination towards the LGBTQ+ community is a sign of the marginalisation that still persists. 

Even without this change in place, the Center of American Progress’ 2017 Survey showed that 8% of LGB patients and 29% of transgender or gender non-conforming patients had already been refused by doctors in some capacity. Discrimination is prevalent within the healthcare sector already, and now the prejudices that many queer people already encounter have been legalised.

This legal rollback on antidiscrimination laws is especially alarming considering the LGBTQ+  community already faces barriers when accessing healthcare. A study in 2015 shows that undergraduates in medicine received, on average, five hours of LGBT specific training. Discrimination within LGBT healthcare starts in medical school. The lack of education given to healthcare providers prohibits their ability to provide comprehensive care, and fully understand some of the needs of these patients. 

The Transgender community face particularly prevalent discrimination already, and this rule change will lead to further marginalisation. The National Centre for Transgender Equality found that in 2015, 33% of gender non-conforming individuals had faced a negative interaction with a healthcare provider due to their gender. The change now allows for further negligence of Transgender individuals healthcare. It allows doctors to house Transgender patients under their birth-assigned sex, and will also permit a blanket ban on transition care from insurance companies. In 2016, 23% of Transgender respondents said they did not seek care due to fear of being incorrectly treated; it is likely that this change will cause a rise in this number due to fear of being mistreated, or because it’s prohibitively expensive.

The psychological impact of being discriminated against by healthcare providers is another barrier that deters LGBTQ+ people from seeking help. The Centre for American progress study shows that 68.9% of people who were discriminated against said it negatively impacted their mental well-being. It is likely that legal provisions for discrimination could cause a widespread mental health crisis. A study in 2018 by Mary Dallas supports this, showing that the implementation of religious refusal laws across three states led to a 46% increase in emotional distress amongst LGBT people. This change in federal implementation could cause a significant rise in mental health issues amongst an already vulnerable group.

This new administrative rule has been passed amidst the COVID-19 chaos, and is set to come into force by mid-August. Legalising discrimination at this time could perhaps mean LGBTQ+ patients with coronavirus could be at risk of having delayed treatment or even be refused care. Bre Kidman is a non-binary candidate for US Senate in Maine, and they told VOX news that “I’m afraid that trans people will face things like being deprioritized for ventilators or for care”. The endurance of this discrimination, even through a pandemic, is alarming to the LGBTQ+ community. 

In New York, the Samaritan’s Purse, a charity run by Franklin Graham runs a 68-bed coronavirus field hospital targeting COVID-19 patients. Franklin Graham is an evangelist preacher who has previously labelled gay people as “the enemy”. This hospital has sparked controversy due to the statement of faith they give to their volunteers. Particular criticism has been attracted by the declaration that: “marriage is exclusively the union of one genetic male and one genetic female”. This dismisses not only same-sex marriage, but also denies the marriages of Transgender and non-binary individuals. As a result, this field hospital saw protesters and activists outside daily, campaigning that it be closed down.

The Senator from New York, Brad Holyman, argued that this allocation of control sets a dangerous precedent because it could be an opportunity to “legitimise his homophobia”. As an openly LGBTQ+ senator, he asked for a nondiscrimination agreement to be signed and has also requested the removal of his aid as soon as it is reasonable to do so. In his press release, he calls Graham a “bigot” and that asking him “to stay on longer is an insult to LGBTQ New Yorkers and sends the dangerous message that homophobia and transphobia are acceptable.” 

Discrimination against the LGBTQ+ community is not reflective of all of society. The House Democrats have been vocal about their opposition to this rule change. A statement was issued by Speaker Nancy Pelosi in May, describing the change as a “shocking attack on the health and well-being of the LGBTQ community at a time when access to quality health care is more important than ever”. From the moment the change is issued, Congress has a 60-day window to review this act.

 Alongside potential intervention from the Democrats in Congress, there are also human right activists groups that are looking to file lawsuits. Lambda Legal is an organisation that adovcates for LGBTQ rights.They responded quickly to the rules change, stating:: “we will be challenging the rule because at a time when the entire world is battling a dangerous pandemic…it is critical for everyone to have ready access to the potentially life-saving health care they need”. There is a sense of hope for the community and it is clear that efforts are being made to fight this discrimination and protect what should be considered basic human rights.

By changing the implementation of Section 1157, a powerful message is being sent on the government’s stance regarding the LGBTQ+ community.. This creates a precedent for future laws to be passed along the same premise; adoption agencies are also demanding the right to refuse LGBTQ+ people from being able to adopt. The regression of LGBTQ+ rights under the Trump Administration is distressing. The openly discriminative policy is further segregating the queer and gender non-conforming people in society, making it clear that they are not a concern of their government.