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CASE Patient has adverse effects from halted estrogen pills
JR twists her hands nervously as you step into the room. “They stopped my hormones,” she sighs as you pull up her lab results.
JR recently had been admitted to an inpatient cardiology unit for several days for a heart failure exacerbation. Her ankles are still swollen beneath her floral print skirt, but she is breathing much easier now. She is back at your primary care office, hoping to get clearance to restart her estrogen pills.
JR reports having mood swings and terrible nightmares while not taking her hormones, which she has been taking for more than 3 years. She hesitates before sharing, “One of the doctors kept asking me questions about my sex life that had nothing to do with my heart condition. I don’t want to go back there.”
Providing compassionate and comprehensive care to gender-nonconforming individuals is challenging for a multitude of reasons, from clinician ignorance to systemic discrimination. About 33% of transgender patients reported being harassed, denied care, or even being assaulted when seeking health care, while 23% reported avoiding going to the doctor altogether when sick or injured out of fear of discrimination.1
Unfortunately, now, further increases to barriers to care may be put in place. In late May of this year, the Department of Health and Human Services (HHS) proposed new regulations that would reverse previous regulations granted through section 1557 of the Affordable Care Act (ACA)—the Health Care Rights Law—which affirmed the rights of gender nonbinary persons to medical care. Among the proposed changes is the elimination of protections against discrimination in health care based on gender identity.2 The proposed regulation changes come on the heels of a federal court case, which seeks to declare that hospital systems may turn away patients based on gender identity.3
Unraveling rights afforded under the ACA
The Health Care Rights Law was passed under the ACA; it prohibits discrimination based on race, color, national origin, sex, age, and disability in health programs and activities receiving federal financial assistance. Multiple lower courts have supported that the rights of transgender individuals is included within these protections against discrimination on the basis of sex.4 These court rulings not only have ensured the ability of gender-diverse individuals to access care but also have enforced insurance coverage of therapies for gender dysphoria. It was only in 2014 that Medicaid began providing coverage for gender-affirming surgeries and eliminating language that such procedures were “experimental” or “cosmetic.” The 2016 passage of the ACA mandated that private insurance companies follow suit. Unfortunately, the recent proposed regulation changes to the Health Care Rights Law may spark a reversal from insurance companies as well. Such a setback would affect gender-diverse individuals’ hormone treatments as well as their ability to access a full spectrum of care within the health care system.
Continue to: ACOG urges nondiscriminatory practices...
ACOG urges nondiscriminatory practices
The proposed regulation changes to the Health Care Rights Law are from the Conscience and Religious Freedom Division of the HHS Office for Civil Rights, which was established in 2018 and has been advocating for the rights of health care providers to refuse to treat patients based on their own religious beliefs.5 We argue, however, that providing care to persons of varying backgrounds is not an assault on our individual liberties but rather a privilege as providers. As obstetrician-gynecologists, it may be easy to only consider cis-gendered women our responsibility. But our field also emphasizes individual empowerment above all else—we fight every day for our patients’ rights to contraception, fertility, pregnancy, parenthood, and sexual freedoms. Let us continue speaking up for the rights of all those who need gynecologic care, regardless of the pronouns they use.
“The American College of Obstetricians and Gynecologists urges health care providers to foster nondiscriminatory practices and policies to increase identification and to facilitate quality health care for transgender individuals, both in assisting with the transition if desired as well as providing long-term preventive health care.”6
We urge you to take action
- Reach out to your local representatives about protecting transgender health access
- Educate yourself on the unique needs of transgender individuals
- Read personal accounts
- Share your personal story
- Find referring providers near your practice
- 2015 US Transgender Survey. December 2016. https://www.transequality.org/sites/default/files/docs/USTS-Full-Report-FINAL.PDF. Accessed August 30, 2019.
- Musumeci M, Kates J, Dawson J, et al. HHS’ proposed changes to non-discrimination regulations under ACA section 1557. July 1, 2019. https://www.kff.org/disparities-policy/issue-brief/hhss-proposed-changes-to-non-discrimination-regulations-under-aca-section-1557/. Accessed August 30, 2019.
- Franciscan Alliance v. Burwell. ACLU website. https://www.aclu.org/cases/franciscan-alliance-v-burwell. Accessed August 30, 2019.
- Pear R. Trump plan would cut back health care protections for transgender people. April 21, 2018. https://www.nytimes.com/2018/04/21/us/politics/trump-transgender-health-care.html. Accessed August 30, 2019.
- U.S. Department of Health and Human Services. HHS announces new conscience and religious freedom division. January 18, 2018. https://www.hhs.gov/about/news/2018/01/18/hhs-ocr-announces-new-conscience-and-religious-freedom-division.html. Accessed August 30, 2019.
- American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women. Committee Opinion no. 512: health care for transgender individuals. Obstet Gynecol. 2011;118:1454–1458.
CASE Patient has adverse effects from halted estrogen pills
JR twists her hands nervously as you step into the room. “They stopped my hormones,” she sighs as you pull up her lab results.
JR recently had been admitted to an inpatient cardiology unit for several days for a heart failure exacerbation. Her ankles are still swollen beneath her floral print skirt, but she is breathing much easier now. She is back at your primary care office, hoping to get clearance to restart her estrogen pills.
JR reports having mood swings and terrible nightmares while not taking her hormones, which she has been taking for more than 3 years. She hesitates before sharing, “One of the doctors kept asking me questions about my sex life that had nothing to do with my heart condition. I don’t want to go back there.”
Providing compassionate and comprehensive care to gender-nonconforming individuals is challenging for a multitude of reasons, from clinician ignorance to systemic discrimination. About 33% of transgender patients reported being harassed, denied care, or even being assaulted when seeking health care, while 23% reported avoiding going to the doctor altogether when sick or injured out of fear of discrimination.1
Unfortunately, now, further increases to barriers to care may be put in place. In late May of this year, the Department of Health and Human Services (HHS) proposed new regulations that would reverse previous regulations granted through section 1557 of the Affordable Care Act (ACA)—the Health Care Rights Law—which affirmed the rights of gender nonbinary persons to medical care. Among the proposed changes is the elimination of protections against discrimination in health care based on gender identity.2 The proposed regulation changes come on the heels of a federal court case, which seeks to declare that hospital systems may turn away patients based on gender identity.3
Unraveling rights afforded under the ACA
The Health Care Rights Law was passed under the ACA; it prohibits discrimination based on race, color, national origin, sex, age, and disability in health programs and activities receiving federal financial assistance. Multiple lower courts have supported that the rights of transgender individuals is included within these protections against discrimination on the basis of sex.4 These court rulings not only have ensured the ability of gender-diverse individuals to access care but also have enforced insurance coverage of therapies for gender dysphoria. It was only in 2014 that Medicaid began providing coverage for gender-affirming surgeries and eliminating language that such procedures were “experimental” or “cosmetic.” The 2016 passage of the ACA mandated that private insurance companies follow suit. Unfortunately, the recent proposed regulation changes to the Health Care Rights Law may spark a reversal from insurance companies as well. Such a setback would affect gender-diverse individuals’ hormone treatments as well as their ability to access a full spectrum of care within the health care system.
Continue to: ACOG urges nondiscriminatory practices...
ACOG urges nondiscriminatory practices
The proposed regulation changes to the Health Care Rights Law are from the Conscience and Religious Freedom Division of the HHS Office for Civil Rights, which was established in 2018 and has been advocating for the rights of health care providers to refuse to treat patients based on their own religious beliefs.5 We argue, however, that providing care to persons of varying backgrounds is not an assault on our individual liberties but rather a privilege as providers. As obstetrician-gynecologists, it may be easy to only consider cis-gendered women our responsibility. But our field also emphasizes individual empowerment above all else—we fight every day for our patients’ rights to contraception, fertility, pregnancy, parenthood, and sexual freedoms. Let us continue speaking up for the rights of all those who need gynecologic care, regardless of the pronouns they use.
“The American College of Obstetricians and Gynecologists urges health care providers to foster nondiscriminatory practices and policies to increase identification and to facilitate quality health care for transgender individuals, both in assisting with the transition if desired as well as providing long-term preventive health care.”6
We urge you to take action
- Reach out to your local representatives about protecting transgender health access
- Educate yourself on the unique needs of transgender individuals
- Read personal accounts
- Share your personal story
- Find referring providers near your practice
CASE Patient has adverse effects from halted estrogen pills
JR twists her hands nervously as you step into the room. “They stopped my hormones,” she sighs as you pull up her lab results.
JR recently had been admitted to an inpatient cardiology unit for several days for a heart failure exacerbation. Her ankles are still swollen beneath her floral print skirt, but she is breathing much easier now. She is back at your primary care office, hoping to get clearance to restart her estrogen pills.
JR reports having mood swings and terrible nightmares while not taking her hormones, which she has been taking for more than 3 years. She hesitates before sharing, “One of the doctors kept asking me questions about my sex life that had nothing to do with my heart condition. I don’t want to go back there.”
Providing compassionate and comprehensive care to gender-nonconforming individuals is challenging for a multitude of reasons, from clinician ignorance to systemic discrimination. About 33% of transgender patients reported being harassed, denied care, or even being assaulted when seeking health care, while 23% reported avoiding going to the doctor altogether when sick or injured out of fear of discrimination.1
Unfortunately, now, further increases to barriers to care may be put in place. In late May of this year, the Department of Health and Human Services (HHS) proposed new regulations that would reverse previous regulations granted through section 1557 of the Affordable Care Act (ACA)—the Health Care Rights Law—which affirmed the rights of gender nonbinary persons to medical care. Among the proposed changes is the elimination of protections against discrimination in health care based on gender identity.2 The proposed regulation changes come on the heels of a federal court case, which seeks to declare that hospital systems may turn away patients based on gender identity.3
Unraveling rights afforded under the ACA
The Health Care Rights Law was passed under the ACA; it prohibits discrimination based on race, color, national origin, sex, age, and disability in health programs and activities receiving federal financial assistance. Multiple lower courts have supported that the rights of transgender individuals is included within these protections against discrimination on the basis of sex.4 These court rulings not only have ensured the ability of gender-diverse individuals to access care but also have enforced insurance coverage of therapies for gender dysphoria. It was only in 2014 that Medicaid began providing coverage for gender-affirming surgeries and eliminating language that such procedures were “experimental” or “cosmetic.” The 2016 passage of the ACA mandated that private insurance companies follow suit. Unfortunately, the recent proposed regulation changes to the Health Care Rights Law may spark a reversal from insurance companies as well. Such a setback would affect gender-diverse individuals’ hormone treatments as well as their ability to access a full spectrum of care within the health care system.
Continue to: ACOG urges nondiscriminatory practices...
ACOG urges nondiscriminatory practices
The proposed regulation changes to the Health Care Rights Law are from the Conscience and Religious Freedom Division of the HHS Office for Civil Rights, which was established in 2018 and has been advocating for the rights of health care providers to refuse to treat patients based on their own religious beliefs.5 We argue, however, that providing care to persons of varying backgrounds is not an assault on our individual liberties but rather a privilege as providers. As obstetrician-gynecologists, it may be easy to only consider cis-gendered women our responsibility. But our field also emphasizes individual empowerment above all else—we fight every day for our patients’ rights to contraception, fertility, pregnancy, parenthood, and sexual freedoms. Let us continue speaking up for the rights of all those who need gynecologic care, regardless of the pronouns they use.
“The American College of Obstetricians and Gynecologists urges health care providers to foster nondiscriminatory practices and policies to increase identification and to facilitate quality health care for transgender individuals, both in assisting with the transition if desired as well as providing long-term preventive health care.”6
We urge you to take action
- Reach out to your local representatives about protecting transgender health access
- Educate yourself on the unique needs of transgender individuals
- Read personal accounts
- Share your personal story
- Find referring providers near your practice
- 2015 US Transgender Survey. December 2016. https://www.transequality.org/sites/default/files/docs/USTS-Full-Report-FINAL.PDF. Accessed August 30, 2019.
- Musumeci M, Kates J, Dawson J, et al. HHS’ proposed changes to non-discrimination regulations under ACA section 1557. July 1, 2019. https://www.kff.org/disparities-policy/issue-brief/hhss-proposed-changes-to-non-discrimination-regulations-under-aca-section-1557/. Accessed August 30, 2019.
- Franciscan Alliance v. Burwell. ACLU website. https://www.aclu.org/cases/franciscan-alliance-v-burwell. Accessed August 30, 2019.
- Pear R. Trump plan would cut back health care protections for transgender people. April 21, 2018. https://www.nytimes.com/2018/04/21/us/politics/trump-transgender-health-care.html. Accessed August 30, 2019.
- U.S. Department of Health and Human Services. HHS announces new conscience and religious freedom division. January 18, 2018. https://www.hhs.gov/about/news/2018/01/18/hhs-ocr-announces-new-conscience-and-religious-freedom-division.html. Accessed August 30, 2019.
- American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women. Committee Opinion no. 512: health care for transgender individuals. Obstet Gynecol. 2011;118:1454–1458.
- 2015 US Transgender Survey. December 2016. https://www.transequality.org/sites/default/files/docs/USTS-Full-Report-FINAL.PDF. Accessed August 30, 2019.
- Musumeci M, Kates J, Dawson J, et al. HHS’ proposed changes to non-discrimination regulations under ACA section 1557. July 1, 2019. https://www.kff.org/disparities-policy/issue-brief/hhss-proposed-changes-to-non-discrimination-regulations-under-aca-section-1557/. Accessed August 30, 2019.
- Franciscan Alliance v. Burwell. ACLU website. https://www.aclu.org/cases/franciscan-alliance-v-burwell. Accessed August 30, 2019.
- Pear R. Trump plan would cut back health care protections for transgender people. April 21, 2018. https://www.nytimes.com/2018/04/21/us/politics/trump-transgender-health-care.html. Accessed August 30, 2019.
- U.S. Department of Health and Human Services. HHS announces new conscience and religious freedom division. January 18, 2018. https://www.hhs.gov/about/news/2018/01/18/hhs-ocr-announces-new-conscience-and-religious-freedom-division.html. Accessed August 30, 2019.
- American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women. Committee Opinion no. 512: health care for transgender individuals. Obstet Gynecol. 2011;118:1454–1458.