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01/17/2017

Fallout: From Healthcare Equality to Existential Threat

by Jenji Cassandra Learn

This New Year’s Day—Sunday the 1st, 2017—was supposed to be the first day that I and people like me had equal access to healthcare in America. It was supposed to the first time we were regarded as equal to our fellow citizens and not required to pay out-of-pocket for basic healthcare needs, or even surgery, without any help from insurance providers that the rest of America depends on and that we are never the less obliged to give our money to even while they regard us as non-entities and less-than. After decades of struggle and misery, all of that was finally about to change. It didn’t.

There is a tragic irony in the fact that, after a century of stigmatization and repression, trans*, intersex, and genderqueer people have finally come to be understood, respected, and treated humanely within much of the medical and scientific community… only to at the same time find ourselves in the most hostile, oppressive, and socially regressive political environment the United States has seen since beginning of the Cold War.

The assault on the civil-rights protections and the legal and political gains made by trans, intersex, and genderqueer Americans in recent years began at the state level even before Donald Trump was inaugurated, and his top rival in the Republican primary was openly demagoguing trans* and intersex women as a danger to children, advocating the segregationist HB 2 law in North Carolina, and having his guards lay hands on a trans teen and his mother at one of his campaign events while an angry mob cheered, for no reason other than his identity.

On New Year’s Eve, a federal district judge (the lowest level of federal judge) named Reed O’Connor issued a nationwide injunction against regulations that were due to go into effect on January 1st, finally ending the long-standing, discriminatory practice by many insurance companies, local or state governments, and private businesses of excluding the coverage of any transition-related healthcare.

Because these regulations were implemented pursuant to the provisions of the Affordable Care Act, which the new President and Congress have sworn to repeal, this has the net effect of ensuring that not one single day will elapse in America wherein trans* and intersex Americans were allowed to enjoy full equality in healthcare. The tragic effects are already being seen, as state governments and universities rush to reinstate their discriminatory policies, in defiance of the law, now that they know the law will never be enforced, and may be repealed. The only thing more cruel than arbitrarily and endlessly denying someone access to a medical treatment that will vastly improve their quality of life and ability to function in society, is to tell them that at long last they will be regarded as fully human, only to yank that promise of equality only a few weeks later.

The administration’s stated intention is not just to allow discrimination against us in insurance coverage, but in every facet of healthcare coverage and delivery (indeed, in every facet of American life and society such as protection from violent crime, as well as housing, education, and employment) including essential public services and basic human rights like emergency medical attention (where we face enough danger and abuse already. On March 28th, the Supreme Court is slated to hear a case that could strip trans* and intersex Americans of the protections of the 14th Amendment and render us second-class citizens for a generation, leaving us in a position where any form of discrimination against us is not only legal (as it already is in most states) and encouraged in the private sector, but where an emergency room doctor or nurse may legally be allowed to turn us away or let us bleed to death on the floor of the hospital if they claim that our mere existence ‘violates their religious beliefs’. Such a ruling will also virtually guarantee the ratification and adoption into law of what proponents call (in a fashion that would make Orwell blush) the “First Amendment Defense Act” or FADA, which President Trump has vowed he would sign. FADA would codify into law the ability of any private entity, institution which receives public funding, or governments and government employees themselves to freely discriminate not only against LGBTQIA Americans, but women who use birth-control, divorces, Muslims, Jews or anyone else claim one claims to have a ‘religious’ objection to interacting with. This would even apply to first responders like EMTs or police, leaving sex and gender minorities in a position where we are not even safe calling 911 if we are injured. This would exclude us from the protections of hate-crimes laws to prosecute violent crime and from police who could refuse to protect us. Any actions we take to protect ourselves from assault would be criminalized and we would be threatened with incarceration and rape for daring to defend ourselves from assault and an astronomical murder rate all because of a biodivergence with which we were born. The irony is that the very same people who lobby to deny us insurance coverage for transition are the same people who say that we have to be excluded and discriminated against because we look different or have ‘the wrong genitalia’ as a result of that denial.

For anyone who has taken the Hippocratic Oath, or who would call themselves a medical scholar or ethicist committed to health, human values, and saving lives, it falls to you now to ask yourself what action is required to uphold your vows and affirm your principles. You must ask yourself whether you have contributed to a state of affairs in which trans, intersex, and genderqueer patients are already afraid to seek medical care even before such discrimination becomes legal and actively encouraged and vindicated by the government. What would you have done, for example, if you were working at the prestigious Virginia teaching hospital where I was first refused admission under my legal name (which is on all my identification) only to then be inspected by a nurse who interrogated me about my genitals and breasts before branding me with a bracelet that said “Sex: U” for ‘undetermined’ (when all of my legal identification correctly says ‘F’) and then told me that I needed to be kept apart from other patients? Because that’s what happens to us right now. And now we are told that that is not vicious enough. Now we are told that not only will be forever denied insurance coverage for our care, punished for the very condition that we are denied treatment for, and casually treated with disdain and disrespect… we are told that for the crime of being born, we may be denied any and all medical care and basic human rights.

Words are not enough. If you are reading this, you are not in a position to claim neutrality in the face of this moral crisis. If you would truly claim to stand for the dignity and preservation of all human life, then it is your action that is required now. We must all speak out in public about these issues and be willing to confront our professional peers in medicine, nursing, insurance and ethics that discriminate irrespective of whether such behavior is legal. And we must work to ensure that discrimination is not ensconced into law: Contact your Congressional and state elected officials to let them know you are against FADA and that you stand for trans*, intersex, and queergender equal rights.

 

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