Dr. John Carlo

Trump administration close to removing anti-discrimination protections from the ACA

Tammye Nash | Managing Editor
nash@dallasvoice.com

With almost everyone’s attention fixed on the ongoing COVID-19 crisis and the many dramas springing up around it, LGBTQ activists are warning that the Trump administration is quietly moving forward with its efforts to remove anti-discrimination protections from the Affordable Care Act.

According to a recent report by Politico, the Department of Health and Human Services is removing Section 1557 of the ACA, which explicitly mandates protections for LGBTQ individuals in healthcare. DHHS, the Politico report said, wants to exclude protections based on sex stereotyping and gender identity.

Dr. John Carlo, CEO of Prism Health North Texas, explained that Section 1557 of the ACA is “an important civil rights provision intended to prohibit discrimination on the basis of sex in federally funded programs. It gave the Office of Civil Rights the authority to investigate any medical facilities receiving federal money — including Medicare, which means almost everyone. In 2016, HHS issued a clarifying rule that defined the basis of sex to include gender and sexual minorities.

“We [at Prism] were privileged to be involved with the regional Office of Civil Rights task force that at the time conducted a series of listening sessions and community engagements in order to better understand the importance of the rule for gender and sexual minorities.” Carlo said.

Carlo added that the American Medical Association, which governs the ethics of the practice of medicine in the U.S., “has a strong policy against discrimination based on sexual orientation. It has also issued strong public statements against this new interpretation of the rule by the Trump administration, as well as the other recent rule changes that would permit physicians to opt out of providing care based on religious grounds.”

According to the Human Rights Campaign, nearly 320,000 transgender adults in the U.S. are at risk of serious COVID-19 illness. And, HRC President Alphonso David said, “Time after time, the Trump-Pence administration has methodically worked to undermine the rights and welfare of LGBTQ people by rolling back existing protections. Amid a global pandemic — which is already disproportionately affecting LGBTQ people — the Trump administration’s efforts to remove existing non-discrimination protections for the LGBTQ community is unacceptable, blatantly offensive and cruel.”

The organization Accountable for Equality also has denounced the effort to remove those protections from the legislation, with spokesperson Chris Fleming pointing out that DHHS chief Roger Severino formerly worked for the anti-LGBT Heritage Foundation and has “a long history of seeking to marginalize the LGBT community, notably criticizing bans on ‘reparative therapy,’ which has been repeatedly discredited by science and by publicly sharing his discriminatory views on same-sex marriage and protections for transgender people.”

“The way Roger Severino and the Trump Administration are blatantly taking advantage of this crisis to push forward their hateful agenda and strip away common sense LGBT protections is despicable and nonsensical,” Fleming said.

“We are facing an unprecedented health crisis, and rather than lead our country through this with dignity, Severino is focused on stripping away the rights of LGBT Americans and putting up additional hurdles to health care,” he continued. “Severino, who has made his anti-LGBT views crystal clear, has no place leading the civil rights office of HHS. In the midst of a global pandemic, HHS should be focused on more urgent issues than marginalizing a segment of Americans.”

Mara Keisling, executive director of the National Center for Transgender Equality agreed, saying, “The COVID-19 pandemic has shone a bright and unflattering light on the disparities that already exist in our healthcare system, including the barriers to care faced by the LGBT community. This move by Severino will make seeking health care even less safe for vulnerable members of the LGBT community.

“Implementing this HHS rule change at any time, but especially in the middle of a global health crisis, is an act of particular cruelty by Trump and Roger Severino,” she said.
Erin Duhaime, a certified physician’s assistant with North Texas Infectious Disease Consultants who works with most of the office’s transgender patients, said that anti-LGBTQ discrimination is “absolutely” a significant problem when it comes to healthcare.

“Outright discrimination and the subsequent health disparities for the LGBTQ community continue to be a problem, and the lack of access to culturally competent care is well documented and continues to be a significant barrier,” Duhaime said. “Although LGBTQ patients deal with many of the same health conditions as their heterosexual peers — diabetes, hypertension, heart disease, etc. — the LGBTQ community additionally suffers from disproportionately increased rates of HIV infection and other sexually transmitted infections, psychiatric disorders, substance abuse and homelessness, to name a few.”

“The effect and degree of discrimination in healthcare settings for gender and sexual minorities is extremely complex,” Carlo said, adding that most such incidences of discrimination these days are not as overt as in the past, but are “more insidious.”

He continued, “Definitely we know our transgender patients have nearly uniformly bad experiences when accessing healthcare in their past. These experiences carry forward and often create reluctance to seek out care or remain out of care. The effect on our health as a community is not fully known, as we do not collect enough good data on this, but from the people we see and hear from, we know these negative experiences do have an impact.”

Removing anti-discrimination regulations from the ACA, especially in the midst of the COVID-19 pandemic, “could be devastating, especially from a psychosocial aspect,” Duhaime said. “Again, access to care is pivotal here, and I think that out of many important things that we have learned as providers during the COVID-19 pandemic, the importance of access to care is coming to a forefront.”
Duhaime said that, like the African-American community and other minority communities, the LGBTQ community is being especially hard hit by the novel coronavirus, “especially in our aging LGBTQ patients.”

Carlo said that LGBTQ individuals’ previous bad experiences with the healthcare system often make them more reluctant to seek care and to not maintain consistent care, and for people with chronic diseases — like diabetes, hypertension, heart disease and asthma — “not being in care will result in worse outcomes. In the current situation with COVID-19, we know that these chronic illnesses are risk factors for more severe illness and death. The severity is also likely worsened when these conditions are less in control.

“So, for minority communities who have been marginalized by our healthcare system, the risks of untreated chronic medical conditions are higher, and thus the outcomes for COVID-19 infections are going to be worse,” he said.

“We have yet to see whether this dynamic of discrimination leading to inadequate healthcare leading to a more severe COVID-19 infection will have a greater impact on gender and sexual minorities. Data collection and study remains unfortunately limited to the point that we may never know to what degree this had an underlying impact,” Carlo continued. “I personally believe it does, given what we have seen in other areas in the U.S. and throughout the world with COVID-19 infection severity. It remains an important component for us to be looking at.”