Amy Barrier

Prism Health North Texas’ trans clinic offers healthcare in a safe environment

Tammye Nash | Managing Editor
nash@dallasvoice.com

The Affordable Care Act, commonly known as “Obamacare,” includes a provision — Section 1557 — that “prohibits discrimination on the basis of race, color, national origin, sex, age or disability in certain health programs or activities.”

According to Sara Rosenbaum, the Harold and Jane Hirsh Professor of Health Law and Policy and founding chair of the Department of Health Policy at George Washington University School of Public Health and Health Service, when issued in May 2016 under the administration of President Obama, Section 1557 did “what virtually no civil rights law has done before: It extend[ed] the principle of nondiscrimination to the content of health insurance, that is, coverage standards themselves.”

Section 1557, Rosenbaum explained, “provides that no individual shall be barred from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity, any part of which receives federal financial assistance.”

In issuing the regulations implementing Section 1557, the Obama administration noted specifically that the word “sex” in this case was to be interpreted to include gender identity. In other words, the Obama administration specifically said that Section 1557 protected transgender people from discrimination in health care.

In mid-June this year, however, the Trump administration rescinded those protections for transgender men and women, finalizing new regulations for Section 1557 that “restore the rule of law by revising certain provisions that go beyond the plain meaning of the law as enacted by Congress.”

“What they are saying is that the law recognizes ‘sex’ as being only biologically male and biologically female, as in a binary system, although that’s not how biology works,” said Amy Barrier, a nurse practitioner working with Prism Health North Texas’ transgender clinic.

“Because of this, there will be providers who refuse to care for someone who is transgender, because they ‘don’t believe in it’ or ‘don’t agree with it’ or whatever it is they say” to try and justify anti-trans bigotry and discrimination, Barrier said.

Three days after the Trump administration finalized its version of the Section 1557 regulations, the U.S. Supreme Court issued its 6-3 ruling in three employment discrimination cases that had been consolidated under Bostock v. Clayton County, declaring that the term “sex” in Title VII of the Civil Rights Act does, in fact, include sexual orientation and gender identity. The historic ruling provides, for the first time, federal protections against discrimination in employment for LGBTQ people.

The ruling also sets precedent for the word “sex” in other federal anti-discrimination laws to also protect LGBTQ people — including in the Affordable Health Care Act. But for now, the Trump administration’s interpretation of Section 1557 stands.

So, what recourse do transgender people have? “Basically,” Barrier said, “somebody’s civil rights have to be violated, and they file suit. It will have to go up through the courts — unless there is a change in Washington, D.C.”

The trans affirming option
Just knowing that the government has okayed anti-trans discrimination will “deter our trans population from seeking treatment,” Barrier said. “And trans people already traditionally have had trouble when seeking healthcare, and one bad experience with one person in the healthcare system will leave someone with a bad taste in their mouth for the whole system.”

That, Barrier continued, is what Prism Health North Texas hopes to change with its transgender healthcare clinic.

The clinic, which has had to suspend in-person care temporarily because of the COVID-19 epidemic, will re-open beginning in August, and will be open on the third Monday of the month, with evening hours starting at 5 p.m., offering hormone treatments. The evening hours, Barrier explained, “let the transgender patients access healthcare in a setting where they know the only other patients there will be trans persons.”

The clinic, located inside Prism’s Oak Lawn Center at 2801 Lemmon Ave., Ste. 200 where the agency plans to also open a pharmacy soon — is a “totally gender-affirming environment. We do have two gendered bathrooms with a couple of stalls each. But we also have multiple single-person bathrooms that anyone can use,” Barrier said. She added that all the clinic staff make sure to always use the proper pronouns and patients’ chosen names, and “We have made systemic changes in our record keeping processes to make it obvious what name [patients] use versus what name might be on their IDs.”

She continued, “Our providers, of course, make sure when we are dealing with a trans person that we are mindful of the healthcare they might need for the organs they were born with,” such as mammograms and checking female reproductive organs for trans men, while making sure that trans women have access to procedures for prostate health, etc.

And when it comes to procedures that require examinations of a patient’s genitalia, “we make sure we give our patients the privacy they need. We want to make sure we don’t cause any embarrassment for anyone involved,” Barrier said.

The Prism Trans Clinic is set up to provide hormone services at little to no cost to the patients themselves. “With outreach efforts to trans patients in the past, the patients themselves had to pay some cost. They had to pay for their labs, things like this,” Barrier explained.”Here, the testosterone is completely free. With the estrogen it depends on the modality; the injectible estrogens will have a fee, but the oral estrogens are free.

“For our patients who are uninsured, we can also provide some primary care services, too. We can treat their high blood pressure or their diabetes,” she added. “If someone has insurance and just want to use our clinic for their hormones, that’s fine. But if they need other services, we can do that, too.”

The trans clinic also offers free STI testing and free PrEP [pre-exposure prophylaxis for HIV] for those who fall under the income level cutoff set by Gilead, the pharmaceutical company which makes the PrEP drug Truvada.

“And most people who are uninsured fall under that cutoff,” Barrier said. “I always offer all my patients STI testing and PrEP. I am not going to push it on someone who doesn’t want it, but I want them to know it is available.”

Barrier said that while the trans clinic won’t re-open until August, transgender patients who need care now can contact the Oak Lawn Center (469-687-3200) or one of Prism’s other two clinics — the Oak Cliff Health Center at 219 Sunset Ave., Ste. 116-A (214-807-7370), or the South Dallas Health Center at 4922 Spring Ave. (214-421-7848) — to set an appointment. Patients can also submit an inquiry via the Prism Health North Texas website, PHNTX.org.

“Our other locations provide care for trans patients for HIV and PrEP, and all of our providers are trans-affirming,” she said.

While the COVID-19 epidemic has affected the way the Prism clinics operate, Barrier acknowledged that it has also had an impact on trans men and women who have lost their jobs, and with it, their insurance coverage.

“Going off your hormones during an insurance loss could certainly cause some backsliding” in terms of the bodily changes a trans person goes through when taking hormones,” Barrier said. “Technically, we are not seeing patients right now who are not sick, but we have worked with some people to help them make sure they get their meds. We have seen quite a few folks coming in and requesting care because of loss of insurance due to being laid off, temporarily or not. And we are absolutely here to serve as a place keeper, if necessary, until they are able to go back to work and their insurance kicks in again. But we are also happy to keep them on as patients if that’s what they need.”

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HUD proposes new anti-trans rule

U.S Housing and Urban Development Secretary Ben Carson on Wednesday, July 1, announced a proposed new rule that would allow discrimination against transgender people seeking access to shelter through HUD-funded services. The move comes just about two and a half weeks after the Department of Health and Human Services issued new regulations on Section 1557 of the Affordable Care that removed protections for LGBTQ people against discrimination in healthcare, and just a little more than two weeks after the U.S. Supreme Court issued its ruling in Bostock V. Clayton County declaring that Title VII of the Civil Rights Act protects LGBTQ people against discrimination in employment.

The National Center for Transgender Equality issued a press release Wednesday condemning the changes at HUG, saying that the Trump administration”is attempting to degrade the civil rights of transgender people and empower those who wish to do harm.

“Discrimination is never okay, but this proposal is particularly dangerous as our nation continues to struggle to suppress the coronavirus pandemic,” the emailed statement said, noting that 1 in 3 transgender Americans have been homeless at some point in their life. “Shelters are often a person’s best access-point to programs that provide safe, individual housing, a critical need during a global pandemic that endangers anyone who is forced to share living spaces with others, whether outdoors or elsewhere.”

— Tammye Nash