A survey study conducted by the Center for American Progress in 2017 verified and revealed that LGBTQ people experience discrimination when seeking health care services. Also, if they are turned away from service due to discrimination, harassment, and mistreatment LGBTQ people may have trouble finding alternative avenues for health services. Those experiences discourage them from seeking needed care. This data demonstrates the importance of protecting LGBTQ people from discrimination in health care.
When needing to see a doctor, whether for routine care or emergency services no one should have to consider if they will be refused service, or be subject to discrimination, harassment or be mistreated under any circumstance. In the United States, the Affordable Care Act (ACA) addressed this concern by prohibiting insurance providers and health care facilities and professionals from discriminating. Under the Obama administration, LGBTQ people were explicitly protected against discrimination in health care on the basis of gender identity and sexual orientation. Since the current administration continues to attempt to dismantle the ACA leaving many to wonder how they’ll cover health costs in addition to how their now discrimination protection may be affected.
Health care discrimination endangers the lives of LGBTQ people
This endangerment happens through delays or denials of medically necessary care based on the learned prejudices and biases of the medical professional staff.
- While at a hospital, a patient with HIV disclosed that he was gay and therefore has sex with other men. Those who were supposed to be there to provide care refused to provide his HIV medication.
- A transgender teenager who struggled with thoughts of suicide and followed through attempts of self-harm was subject to being repeatedly called by both genders by medical team members and discharged sooner than normal standards for no apparent reason. Not long after the teen committed suicide.
- An infant was turned away from a pediatrician’s office because she had same-sex parents. Half the US states, such as Michigan, lack statewide laws against LGBTQ discrimination. However, Section 1557 of the ACA provides federal protections for LGBTQ people overriding state laws.
LGBTQ discrimination and mistreatment primary care doctor offices
Despite protections now in place, for the time being, LGBTQ people still face an alarming rate of health care discrimination, harassment, humiliation, to outright being turned away by hospitals, pharmacists, and doctors. The Center for American Progress study data outlines the types of discrimination that many LGBTQ people endure when seeking medical care.
Data below is from those gay, lesbian, bisexual, and queer (LGBQ) who responded and had visited a doctor or health care provider in the year just prior to the survey:
- 8% indicated that a doctor or other health care provider refused to see them because of their actual or perceived sexual orientation.
- 6% responded that a doctor or other health care provider refused to give them health care related to their actual or perceived sexual orientation.
- 7% replied that a doctor or other health care provider refused to recognize their family, including a child or a same-sex spouse or partner.
- 9% said that a doctor or other health care provider used harsh or abusive language when treating them.
- 7% indicated that they experienced unwanted physical contact from a doctor or other health care provider (such as fondling, sexual assault, or rape).
Among transgender people who had visited a doctor or health care providers’ office in the past year:
- 29% said a doctor or other health care provider refused to see them because of their actual or perceived gender identity.
- 12% responded a doctor or other health care provider refused to give them health care related to gender transition.
- 23% indicated doctor or other health care provider intentionally misgendered them or used the wrong name.
- 21% replied a doctor or other health care provider used harsh or abusive language when treating them.
- 29% indicated that they experienced unwanted physical contact from a doctor or other health care provider (such as fondling, sexual assault, or rape).
Discrimination discourages LGBTQ people from seeking health care
Discrimination, even the perceived potential for discrimination, can create anxiety and trepidation in LGBTQ people making seeking care when they need it difficult and scary. The Center for American Progress survey data validated that past actual and the perceived potential of discrimination played a factor in discouraging or preventing a large number of LGBTQ people from seeking health care.
- 8% of all LGBTQ people reported avoided or postponed needed medical care because of the perceived potential of being disrespected or discriminated against from health care staff.
- Further for those who have experienced direct negative experiences in their past, the number jumped to 14%.
- Among transgender people, 22% reported such avoidance.
- When it came to preventative screenings such as for HIV or cholesterol, 7% of LGBTQ respondents reported avoiding or postponing care in the year prior to the survey, while 17 percent of LGBTQ respondents who had experienced discrimination that year and 19% of transgender people reporting avoidance during that period.
An earlier CAP analysis reported other findings from this survey that also indicated the effect of discrimination on LGBTQ people’s willingness to seek out health care. In that analysis, 6.7 percent of LGBTQ people reported that they avoided doctor’s offices in the past year out of fear of discrimination. This avoidance behavior is even more common among LGBTQ people who reported having experienced discrimination in the past year: 18.4 percent reported avoiding doctor’s offices to avoid discrimination, nearly seven times the rate of LGBTQ people who had not experienced discrimination in the past year, at 2.7 percent.
These Center for American Progress findings are consistent with other research. The 2015 U.S. Transgender Survey found that nearly 1 in 4 transgender people (23 percent) had avoided seeking needed health care in the past year due to fear of discrimination or mistreatment.
Finding another doctor is not an answer for all LGBTQ patients
The expansion of legislation, lawsuits, and administrative rule-making allowing for broad learned religious beliefs exemptions from providing services puts another hurdle in the way of LGBTQ people receiving medical care. For those patients that do seek medical care and are turned away by providers, alternatives may not be easily accessible depending on where they live and their travel abilities. This concern is exacerbated by a shortage of medical providers in key areas of treatment such as mental health care and specialty services. Not all LGBTQ people live in metro areas and the shortage of LGBTQ friendly medical providers in rural areas is common.
The Center for American Progress survey data illustrate that many LGBTQ people would face significant difficulty neding to locate an alternative provider if they were turned away by a health care provider, such as a pharmacy, hospital, community clinic or primary care provider.
- 18% of LGBTQ people indicated it would be “very difficult” or “not possible” to find the same type of service at a different hospital.
- 17% of LGBTQ people responded that it would be “very difficult” or “not possible” to find the same type of service at a different community health center or clinic.
- 8% of LGBTQ people said it would be “very difficult” or “not possible” to find the same type of service at a different pharmacy.
LGBTQ people living outside of a metropolitan area report a high rate of difficulty accessing alternative services, which may be because such services could be further away and lack transportation or related costs is a hinderance.
- 41% of nonmetro LGBTQ people responded stating it would be “very difficult” or “not possible” to find the same type of service at a different hospital.
- 31% of nonmetro LGBTQ people indicated it would be “very difficult” or “not possible” to find the same type of service at a different community health center or clinic.
- 17% of nonmetro LGBTQ people said it would be “very difficult” or “not possible” to find the same type of service at a different pharmacy.
Transgender people also report difficulty accessing alternatives at a high rate:
- 31% of transgender people said it would be “very difficult” or “not possible” to find the same type of service at a different hospital.
- 30% of transgender people responded stating it would be “very difficult” or “not possible” to find the same type of service at a different community health center or clinic.
- 16% of transgender people indicated it would be “very difficult” or “not possible” to find the same type of service at a different pharmacy.
Where available, some LGBTQ go to a LGBT focused community health center to avoid such discrimination and many do not provide comprehensive services. For the states that have them, such LGBT comunity health centers are normally located in large metropolian areas. A total of 13 states—mainly those in the central United States—do not have any LGBTQ community health centers at all. On the U.S. Transgender Survey, 29 percent of respondents seeking transition-related care reported having to travel 25 miles or more to access such care.
Despite the importance of protecting people from discrimination in health care settings, current regulations are under attack by the current White House administration, state governments and organization based on their learned reliougous beliefs. On August 23, 2016, a group of conservative religious organizations and eight states filed a lawsuit against the U.S. Department of Health and Human Services (HHS), challenging the 1557 rule. They made dubious claims that the nondiscrimination protections would require doctors to provide treatment that violated their learned religious beliefs while they see and treat othe patients who don’t adhere to all the laws of their religious docturine such as adulturers and persons who where clothing of mixed fibers.
Even though numerous courts have ruled that laws such as 1557 protect LGBTQ people, in December 2016, a single federal judge issued a nationwide injunction prohibiting HHS from enforcing the 1557 rule’s prohibition on discrimination on the basis of gender identity. On May 2, 2017, the Trump-Pence administration filed a motion indicating that the 1557 rule was under review, and in August, it announced that HHS had already written a draft proposal to roll back the rule. Given the Trump-Pence administration’s record on LGBTQ issues, new regulations will likely deny the existence of protections to LGBTQ people and make equal health care access and treatment more difficult to obtain for this historically marginalized community. While the administration cannot change the protections for LGBTQ people that exist under the law, a regulatory rollback would cause fear and confusion for patients and promote discrimination by providers and insurers.
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