So when it comes to casting my ballot, you best believe I’m paying attention to a candidate’s health care policy. President Donald Trump has failed LGBTQ Americans in that respect — and in so many other ways. The current administration imposed a ban on transgender folks serving in the military. It rolled back protections within the Department of Health and Human Services (HHS), ones that previously banned the discrimination of LGBTQ couples seeking adoption. And lest we forget, it also rescinded Obama-era guidance on how schools should treat transgender students’ bathroom usage.

In terms of health care, the Affordable Care Act, passed in 2010 by the Obama administration, was a landmark victory for so many. It insured and extended coverage for 20 million Americans and also clarified and extended protections for the LGBT community. One study found that after the ACA was implemented, the rate of uninsured LGB adults decreased significantly, dropping from 19 percent in 2013 to 10 percent in 2016.

Ever since the ACA passed, though, the Republican party has been trying to tear it down. Most recently, they’ve urged the Supreme Court to declare the bill unconstitutional. Bottom line: Under the Trump administration, we’ve seen a litany of changes in health care legislation that specifically, and negatively, affects folks in the LGBTQ community.

LGBTQ Folks Are Discriminated Against, Underinsured, and More Often Ill

Unsurprisingly, marginalized people are marginalized. That includes the LGBTQ community — an estimated 11 million U.S. adults, according to a 2018 Gallup report.

In May 2018, the Kaiser Family Foundation (a non-partisan, non-profit organization focused on analyzing national health issues) released a comprehensive report on the state of health and access within the community, and found that, overall, LGBTQ folks are more likely to face challenges finding adequate care and to experience physical health issues, chronic conditions, and early onset of disability. That’s not all. They also found: LGBTQ folks are two and a half times more likely to have depression, anxiety, or substance abuse disorders; almost one in six bisexual women reported experiencing “serious psychological distress” in the past 30 days, with a little over a quarter having considered suicide; bisexual adults are significantly less likely to have adequate access to care compared to other sexual orientations; and almost half of transgender folks postponed medical care because they couldn’t afford it.

In addition, the Human Rights Campaign, an LGBTQ advocacy group, released a research brief on the status of LGBTQ folks and COVID-19. It found that they’re more likely to work in at-risk environments such as food service (see: the cute blue-haired barista at your local coffee shop who knows your order by heart, or me, the bartender who asks if you want to do a shot together). LGBTQ folks are also more likely to be poorer than those of other sexualities, and as a result not be able to afford regular medical care.

Finding adequate care goes beyond considering financial means — it includes navigating a minefield of discrimination. In a survey conducted by Lambda Legal (an LGBT legal and advocacy organization), 56 percent of lesbian, gay, and bisexual respondents reported instances of providers denying care, using harsh language, or blaming their sexual orientation or gender identity as the cause of an illness; that jumps to 70 percent for transgender and gender-nonconforming individuals.

It’s pretty clear: Queer folks are far more likely to need the healthcare system and are more likely to be failed by it. While the ACA helped millions of Americans, for so many queer folks, it still didn’t do enough.

Attacks On LGBTQ Protection via Section 1557

The ACA was one step forward for LGBTQ health care, but the Trump administration continues to go after its policies — most importantly, those that prevent medical discrimination.

For folks in the LGBTQ community, one of the most important changes from the ACA was that Section 1557 added language to include gender identity and sexuality toward the protected class of “sex.” This is significant because the Civil Rights Act of 1964 declared it unlawful to discriminate against people on the basis of sex, and thus, adding gender identity and sexuality to the definition of sex protects LGBTQ folks from discrimination as well. It specifically addressed important aspects of care, such as: health care providers must treat individuals consistent with their gender identity, they cannot deny sex-specific treatment due to gender identity (ex: trans men cannot be denied care for HPV or ovarian cancer, etc.), and the explicit exclusion of trans-affirming care (ex: hormone therapy or gender-affirming surgeries) is considered discriminatory.

So, you know, treat people like people. Make sure they don’t die and whatnot. While it seems wild to think that doctors would deny life-saving health care like prostate exams for trans-feminine individuals… some folks would rather see trans folk die. In these cases, a transgender person would need to find care from alternative providers. While this sounds simple, they risk having to go out-of-network or go without.

The HSS, under President Trump, eliminated these protections and others related to LGBT care, which means trouble for queer folks all around. The Supreme Court and a few district courts have sought to uphold some of these protections or block the new regulations, but the chipping away at these protections allows room for anti-queer action by local, state and federal governments, as well as by individual medical providers.

This isn’t the only way the current administration has undermined the ACA, and thus, put marginalized folks at risk. It also passed a ruling to allow “short-term health insurance,” which could leave those faced with sudden health issues to deal with massive medical bills. Short-term health insurance allows people to feel like they have coverage, but in reality, these plans are allowed to bypass ACA requirements like covering pre-existing conditions. This is notable not only because of the community’s predisposition to chronic illness but also because HIV is an especially large concern in the LGBTQ population.

In the 2020 election, we must hold leaders accountable. Vice President Biden says he plans to uphold the Affordable Care Act if elected — and also promises to build on the act and make it even more accessible, according to his campaign. He told NBC News he wants to create a public insurance option and allow Americans to keep their private insurance if they choose, as well as cap medication prices and out-of-pocket costs.

If that’s the case, members of my community will be hoping for the resolution of other health care hurdles as well. Many insurance providers still do not cover facial feminization (cosmetic procedures to affirm gender) for trans-feminine individuals. This can be lifesaving medical care considering the rate at which trans women are murdered; allowing someone to affirm their gender via procedures like this not only allows them to outwardly present the way they identify, but also helps protect them from hate crimes or acts of intolerance. Not to mention, the intersection of religious freedom and LGBTQ rights is consistently used as justification to discriminate against queer folk. In 2018, the current administration created an office of “Conscience and Religious Freedom” within the HHS, which gives individual people, providers, and health care entities more leeway to discriminate against LGBTQ people based on religious beliefs.

Maybe these issues don’t affect you. Maybe you could care less. But think about your loved ones and peers, as well as your fellow Americans. If this country is as great as it’s proclaimed to be, shouldn’t everyone feel comfortable walking into a doctor’s office? Imagine your child couldn’t receive a pap smear because of who they date or how they identify. Then imagine your child gets HPV, the most commonly transmitted STI, which can become cancerous without care. Or imagine your child was like me, faced with the knowledge that an ex-boyfriend’s partner received an abnormal pap (meaning he could have then transmitted potentially-cancerous HPV to me), but unable to receive care due to lack of insurance. This shouldn’t be the reality. Yet, it prevails.

Advocating for equality is a frustrating, exhausting, and terrifying fight. I dream of the day I can walk into my doctor’s office and not fear the details of my sex life will impact the quality of my treatment. Until then, I’m looking for rainbows on the door of my doctor’s office and looking toward this election for a glimmer of hope.

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