Analysis
5 min

Why trans folks are terrified about Trump’s withdrawal of health care protections

In the midst of a deadly pandemic, the Trump administration eliminated trans-specific discrimination protections in health care, leaving millions vulnerable

Activists for trans rights protest outside the White House in Washington, D.C. in 2018.
Advocates for trans rights protest outside the White House in Washington, D.C. in 2018. Credit: Jim Lo Scalzo/STREPA; CP Images

On Friday, the Trump administration put into effect a new regulation that would essentially permit all American medical personnel—doctors, nurses, anyone who works in the field—to refuse care to transgender people and those in other marginalized communities based solely on the medical provider’s personal beliefs.

Section 1557 of the Obama administration’s Affordable Care Act prohibits discrimination in health care on the basis of identities such as race, age and sex. And, as of 2016, the ban on sex discrimination was interpreted to include discrimination on the basis of gender identity. But the U.S. Department of Health and Human Services (HHS) announced in a statement on Friday that it will reverse some provisions in the Affordable Care Act, including “returning to the government’s interpretation of sex discrimination according to the plain meaning of the word ‘sex’ as male or female and as determined by biology.”

What this means, in practical terms, is that trans and non-binary people, who already experience a dire lack of access to health care in U.S., can now legally be misgendered, mistreated and denied medical care.

If you don’t quite understand the horror being inflicted on transgender and non-binary people and why we’re scared about this new rule, let me tell you a story.

On the morning of August 7, 1995, a 24-year-old Black trans woman named Tyra Hunter was on her way to work, riding as a passenger in a friend’s car when it collided at an intersection in Washington, D.C. She and her friend were pulled from the wreckage, and paramedics were called.

Hunter was nearly incapacitated on the ground when paramedics and EMS arrived and began treating the injured. A male fireman cut open her pants—consistent with protocol—and, upon discovering she had a penis, stopped treating her and began ruthlessly mocking and misgendering her.

The firefighter, Adrian Williams, joked with other department personnel while Hunter continued to struggle for breath. All refused to treat her. Bystanders pleaded with them, one saying (and misgendering): “It don’t make any difference, he’s a person, he’s a human being.”

The firefighters—who were also EMS personnel—continued to joke, one reportedly saying: “Look, it’s a cock and balls.” Her treatment was delayed as none would approach her and begin triage. Finally, a supervisor arrived and administered first aid.

Hunter’s battered body was taken to D.C. General Hospital, where she was neglected. Tests were supposedly taken but the results lost.

She was admitted as “combative transgendered ‘John Doe’ with breasts and male genitalia, makeup and female clothes.” Later, analysis showed obvious symptoms of hypovolemic shock, the result of extreme blood or fluid loss. And yet, what should have been a straightforward course of treatment seemed to be intentionally obfuscated.

Hunter’s pulse and blood pressure fell as she lay on a gurney, ignored by the attending physician and other medical staff. She was paralyzed by a muscle relaxant and an expert physician would later testify in court that she would have experienced “sheer terror” in that state.

She had arrived at the emergency room at 4:10 p.m. and died at 5:20 p.m., virtually alone, suffocating from a lack of oxygen in her blood. Post-death CPR and heart massage were administered, but by that point they seemed like boxes to be checked for paperwork. Her death was preventable.

At trial, medical experts testified that Hunter would have had an 86 percent chance of survival with appropriate medical treatment. A jury found that D.C. fire personnel violated the D.C. Human Rights Law and that D.C. General was liable for medical malpractice—her mother was awarded $2.9 million in damages.

This is arguably the most infamous case of anti-transgender discrimination by medical providers in the United States. It led to a revolution in transgender rights in the D.C. metropolitan area and became a rallying cry for LGBTQ2 patients in general.

But here’s the thing: Discrimination of this kind is not rare, nor is it a condition of the past. We don’t know how many LGBTQ2 people have died after being refused treatment on the basis of their sexual orientation or gender identity, but we know discrimination that can potentially enable death is common.

A 2010 study by Lambda Legal found that 56 percent of lesbian, gay and bisexual respondents and 70 percent of transgender respondents in the U.S. have experienced discrimination from health care providers, commonly being turned away or refused medically necessary care because of the provider’s personal or religious beliefs.

This is already a scary environment for LGBTQ2 patients, so imagine how it felt last year when Trump and Pence proposed this new regulation through the HHS. And it doesn’t just affect trans people: All LGBTQ2 people, folks who are pregnant and other marginalized communities can be denied medical care by providers if the provider feels treating them would go against their personal or religious beliefs. This is all real.

Donald Trump and Mike Pence are pandering to religious extremists who feel doctors and nurses—even hospital receptionists—should be able to refuse recognizing transgender patients, even when it comes to life-saving care to treat heart attacks, cancer, anything.

This new rule essentially guts Section 1557 of the Affordable Care Act—the part that says discrimination on the basis of “sex” should include gender identity and sex stereotyping.

What is “sex stereotyping”? It’s discrimination because you don’t “look the right way” for your gender: A woman who wears more masculine clothing or a man who is even a little effeminate; a boy who paints his nails or a girl that has a really short haircut. All these people, regardless of their sexual orientation or gender identity, violate the conformity that society expects for gender.

In theory, anyone is vulnerable under this rule, even if they’re not transgender—even if they’re heterosexual. But folks who are transgender? We will suffer most because of this. That’s not a theory, that’s not a guess. That’s reality, a reality that’s now government-sanctioned.

That this has been implemented during a pandemic—and during Pride Month—cannot help but feel intentionally cruel. It is a sign from Trump and Pence that they seek to wipe out trans people from the public square. If they can convince the public we don’t deserve medical care, everything else—all other rights and protections—are now on the table.

Trump and Pence won’t stop with health care. This is just the start. Other protections are being stripped away; they are coming after trans people with everything they’ve got. And when they’ve convinced the public this is all fine, they’ll come for others, too. Guaranteed.

The U.S. election in November is not theoretical on any level for transgender and non-binary people. Our future—every bit of it—is on the ballot. We have to defeat Trump, and we have to take back the Senate.

So, you’re a cis person in the U.S. asking what you can do?

Register to vote. Now. Don’t wait.

Support pro-equality candidates who believe health care should be available to all people. Vote for Biden. Vote for Democrats. Don’t play around with this.

Support trans advocacy organizations, especially ones for Black trans folks.

I am scared today. Trans and non-binary people are scared today. LGBTQ2 folks in general are scared today.

We need you to step up and realize that lives are literally on the line in this election. Trump and Pence and their supporters want you to be distracted and become complacent.

Don’t.