In the middle of Pride Month, on the anniversary of the Pulse nightclub shooting and in the midst of a deadly pandemic, the Trump administration announced the finalization of the reversal of an Obama-era rule protecting transgender people from discrimination in healthcare.

A section of the Affordable Care Act states that insurance policies and healthcare regulated under the act cannot discriminate on the basis of sex. In 2016, the Obama administration issued a rule explaining that the protections regarding “sex” included gender identity, defined as “male, female, neither, or a combination of male and female.” 

Last month, the Trump administration finalized a reversal of the rule. The U.S. Department of Health and Human Services said in a statement that it would recognize “sex discrimination according to the plain meaning of the word ‘sex’ as male or female and as determined by biology.”

Under this rule change, trans people can still sue for discrimination in civil court, and the court may rule in their favor. Still, there are no standardized protections against medical discrimination based on a person’s trans status.

This kind of discrimination can kill.

Take the case of Robert Eads, for instance. A trans man living in Georgia, Eads, was diagnosed with ovarian cancer in 1996. Over a dozen doctors refused to treat him, as they feared treating a transgender person would harm the reputation of their practices. By the time he finally received treatment at the Medical College of Georgia hospital in 1997, the cancer had metastasized to other parts of his body, making any further treatments futile. Eads died in 1999 at just 53 years old. 

Or take the case of Tyra Hunter, an African-American trans woman living in Washington D.C. who died in 1995 after a car accident. According to witnesses, a rescue worker at the scene cut Hunter’s pants open and, upon seeing her genitals, recoiled in surprise. He made insulting remarks and stopped treatment for several minutes. A court later held the fire department he worked for liable and ordered the city to pay Hunter’s mother $2.9 million. Hunter was only 24 years old.

These cases are far from unique.

The 2008-2009 National Transgender Discrimination Survey found a disturbingly high percentage of transgender people have experienced discrimination in healthcare.  Out of the more than 7,000 transgender and gender non-conforming Americans surveyed, 19 percent had been denied treatment because of their gender identity. Twenty-eight percent reported having been verbally harassed in a medical setting, and two percent said they’d been physically assaulted in a doctor’s office. 

Such treatment discourages transgender people from seeking medical care. Twenty-eight percent of respondents reported delaying or avoiding necessary care when sick or injured due to discrimination and disrespect from providers. Thirty-three percent had delayed or avoided getting preventative care.

Even if they do go to the doctor, fear of discrimination leads many people to hide their transgender status. Only twenty-eight percent of respondents said they were out to all of their medical providers. Twenty-one percent said they were out to none of them. Such fears are unfortunately not unfounded: the survey found that when respondents were out to their medical provider, the likelihood of discrimination increased.

In an article for Slate, Evan Urquhart, a trans man, verbalizes such concerns. After detailing his previous experience with medical discrimination, he writes that if he were to be hospitalized for COVID-19, he would want to keep his trans status a secret from hospital staff out of fear his treatment would otherwise be deprioritized due to bigotry.

Keeping such information hidden is dangerous. Doctors need all medically relevant information about their patients in order to provide appropriate care. Not disclosing one’s trans status could lead to adverse medical outcomes. Trans people need to be able to feel safe when disclosing their status to doctors without fear of discrimination or bigotry.

Discrimination anywhere is terrible, but discrimination in the medical field can be deadly, and transgender people shouldn’t have to rely on a patchwork system to fight it.

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