Fight Back Against Trump's Anti-LGBTQ Health Care Discrimination

Tomorrow, August 13, is the deadline for public comment on a bundle of proposed Trump administration changes to health care regulations that are best described with one word: cruel.

If enacted, the changes will dismantle provisions painstakingly enacted over more than a decade that prohibit anti-LGBTQ discrimination in health care settings. Such discrimination correlates with poorer health and well-being for LGBTQ people, and makes them less likely to seek out health care. The issue is so serious that the Joint Commission, a nonprofit organization that accredits hospitals and other health care organizations, requires sexual orientation and gender identity nondiscrimination policies in health care institutions as a requirement for accreditation.

Still, the Trump administration wants to replace the existing rule in Section 1557 of the Affordable Care Act that prohibits discrimination in health care settings with a new one that drops protections based on gender identity, sex stereotypes, and a women's status of having previously received an abortion.

Other proposed regulatory changes would eliminate anti-LGBTQ discrimination provisions now included in the rules governing Medicaid enrollment, Medicaid services, qualified health plans, and the health insurance exchanges, which include 34 federally facilitated exchanges and 17 state exchanges. Language highlighting the importance of providing health care to LGBTQ patients in a culturally competent manner would be eliminated from Medicaid regulations. Finally, regulations governing access to health care and services for older adults provided by the Program of All-Inclusive Care for the Elderly (PACE) would also be changed to remove anti-LGBTQ discrimination provisions.

There is a reason why health care professionals and policymakers have insisted on regulatory provisions banning anti-LGBTQ discrimination. Such discrimination is widespread and does significant harm, and undoing these protections will have a terrible impact on the community. But the proposed changes to PACE regulations calls to mind Atlantic writer Adam Serwer's observation that cruelty is not a side effect of Trump administration policies, it is the point of them. Services provided by PACE are for the most vulnerable among us and they range from Meals on Wheels to hospice care.

LGBTQ seniors came of age when being out or crossing gender boundaries was subject to imprisonment or institutionalization. Homosexuality was classified as a mental illness by the psychiatric profession, and many LGBTQ people were shamed and shunned by their families of origin. These seniors are more likely than their heterosexual peers to be growing old alone without a spouse, partner or adult children. Most of them worry not just that they won't have the support and assistance they will need as they age, but that they will face harassment, abuse, or neglect by professional caregivers.

Unfortunately, these concerns are warranted as 8 percent of LGBTQ seniors report being abused by elder service or healthcare providers. Meanwhile, all of these issues are exacerbated for LGBTQ older adults of color or those who are living with disabilities as they are even more vulnerable to discrimination.

But we do not have to simply accept these proposed changes. We can do something about it. Government agencies are required by law to consider public comments when instituting regulatory changes. If it can be shown that an agency has failed to adequately consider these public comments, a judge can invalidate the rule.

That is why it is incredibly important for members of the public to participate in this process by submitting comment on these proposed changes. Even if the public comments do not stop these proposed changes from being implemented, they will create a public record that could be invaluable in future efforts, including litigation, to undo the damage.

If you believe that discrimination has no place in health care or health care settings, we encourage you to share that opinion as a public comment online. The Trump administration has already succeeded in implementing numerous other anti-LGBTQ policies. It is vital that we continue to speak up and act out on behalf of LGBTQ people.

Lisa Krinsky, LICSW, is the director of The LGBT Aging Project, a program of Fenway Health. Carl Sciortino is Vice President of Government & Community Relations at Fenway Health.