Florida’s transgender community already struggles with obstacles and flat-out prejudice when it comes to accessing quality health care.
But now there’s more to fear: The Trump administration is rolling back health care protections for transgender people, a complex situation that intersects health care with religious freedom.
Earlier this month, the U.S. Department of Health and Human Services (HHS) issued a final rule expanding health care workers’ ability to refuse services on religious grounds.
That means those health care workers can claim religious objections in treating transgender people — which is extremely problematic, says Gina Duncan, director of transgender equality with Equality Florida, a leading LGBTQ group in the Sunshine State.
“What does that look like in real life?” Duncan asks. “That a transgender person could be hit by a car, could be in ambulance with their life hanging in the balance, and due to one’s religious ideology, they could refuse to treat a transgender person who is in vital need at that moment of health care and procedures to save their lives?”
Religious conservatives in Florida applauded the development, which was announced earlier this month by President Trump at a ceremony celebrating the National Day of Prayer.
“This rule ensures that health care entities and professionals will not be bullied out of the health care field because they decline to violate their conscience by taking a human life,” said Matt Staver, with the Orlando-based Liberty Counsel. Staver specifically referred to health care workers’ objections to providing abortion-related services.
Opponents of the new rule say it empowers health care providers, nurses, receptionists and even aides preparing a room for surgery to say they don’t want to provide any care for a transgender person without suffering any negative consequences.
“One of the things we’re afraid is that a hospital will go ahead in a choice between patient care and accommodating a conscientious objection, even if the conscientious objection isn’t necessarily covered by a regulation. They will yield to the conscious objection at the expense of the patient,” says Robin Maril, the assistant legal director with the Washington D.C.-based Human Rights Campaign.
Gina Duncan, of Equality Florida, transitioned from male to female a decade ago. She says the new rule threatens to exacerbate a growing lack of trust between the transgender community and health care organizations.
According to a 2016 report from the Williams Institute — a think tank at UCLA Law in California — there are about 100,000 transgender people in Florida. Most live in Broward, Miami-Dade, Orange, Pinellas and Hillsborough counties. The Institute estimates that 50 percent of transgender Floridians are white; 26 percent, Latino and 19 percent, black. Four percent fall into other categories.
A history of health care challenges
There’s been a history of prejudice for transgender people.
Their health care challenges have been documented in a landmark study in 2016 by the National Center for Transgender Equality in Washington, D.C.
That report found that out of more than 27,000 transgender people interviewed nationwide, one in four experienced a problem in the previous year with their insurance related to being transgender, such as being denied coverage for care or being denied routine care. In addition, a full one-third who saw a health care provider reported having at least one negative experience.
A much narrower study of 125 transgender women in Miami-Dade and Broward counties, conducted by Human Rights Watch, found that 45 percent had no health insurance. In detailed survey responses, many women described their extremely negative experiences with medical providers.
“When I transitioned, my doctor wouldn’t see me after that,” a 22-year-old woman named Susan was quoted in the report. “I couldn’t get in to see them. I had an infection and they wouldn’t call in the antibiotics. It was an ordeal. It was scary. I just felt bad about how they treated me.”
The Phoenix spoke with one doctor in South Florida who preferred to remain anonymous and has been treating transgender patients since 2013. She says such patients face numerous barriers to care.
“Discrimination, stigma, misgendering,” the physician recounts. “There’s health insurance issues in terms of not only access to care, but is gender-affirming care covered by their insurance, or do they have to pay out of pocket?”
She adds that it’s important for doctors to try to make such patients feel as comfortable as possible, including having single-sex restrooms.
“Anything we can do to make them feel more comfortable is important, because the more comfortable, the more likely they are to come back.”
Tallahassee resident Janel Diaz says it’s disheartening to hear about the rule change the Trump administration is pushing when it comes to transgender people. She has friends who suffer from depression because of a lack of health insurance, which prevents them from being able to pay for the kind of physical work needed for a successful transition.
“This is what’s causing a lot of people to go into the black market and causing a lot of deaths because people are going about it in the wrong way because they can’t do it any other way.”
And Diaz says that the “harsh reality” is that there are some in the transgender community who ultimately have to resort to sex work to pay the bills because businesses are reluctant to hire them.
“I’ve been blessed and fortunate where I work for an agency where I can get health insurance and have doctors who understand, but there are still a lot of others who suffer,” she says.
Some new developments
For transgender people in Florida suffering from a lack of care, there’s some hope.
Planned Parenthood began offering hormone therapy and other services for the transgendered at two clinics in Miami last week, and intends to spread similar care to its locations in ten other counties in the state.
Lillian Tamayo is president and CEO of Planned Parenthood of South, East and North Florida.
“The transgender community faces some of the greatest health challenges (and) some of the most significant health outcomes,” Tamayo says.
The Phoenix also spoke to Joey, through Planned Parenthood.
Joey, who is transitioning from female to male, is 17 and attending high school in Broward County. Joey will soon begin receiving testosterone injections in his transition to becoming a male. He’s felt some backlash from friends in what has at times been a “toxic” environment.
“It’s not kind of a ‘new, reckless teenager’ kind of made up upbringing,” Joey says. “It’s real and trans people are valid in everything that we do, and we abide by the same laws that you do, and we’re just trying to get the help that we need.”
Joey says that the experiences with doctors and hospitals have been “very accepting and very open and somewhat specialized in helping trans people.”
Joey says he has never been refused care.
But with the new rule in place on religious freedom, other transgender people may not have Joey’s experience.
In fact, another HHS rule is expected to be announced soon. It would weaken or eliminate an anti-discrimination provision enshrined in the Affordable Care Act. That provision says patients cannot be turned away because they are transgender, nor can they be denied coverage if they need a service that’s related to their transgender status.
“This is a big deal because it’s the first time in history that sex discrimination has been prohibited in the context of health care,” says Robin Maril, of the Human Rights Campaign.