According to a report from the National Transgender Discrimination Survey, transgender people tend to be poorer than other medical patients and tend to lack health insurance. Furthermore, there is a lack of medical providers who have worked with transgender patients or who accept transgender patients. In the report from the NTDS, 6500 transgender people were surveyed with nearly 1 in 5 (19 percent) reporting they had been refused care because they were transgender or gender non-conforming. There were very high levels, 26 percent, of transgender people postponing medical care when they were sick or injured because of discrimination in medical settings. Health care provider knowledge was a significant issue where 50 percent of the respondents had to teach their providers about transgender health care. The lack of medical care, according to the survey, has lead to high rates of HIV, alcohol and drug abuse, and suicide attempts among transgender people.
While discrimination clearly exists for transgender people, knowing your legal and medical rights can help you get the care you need. There are several laws and organizations that are significant to your receiving health care. The Health Insurance Portability and Accountability Act (HIPAA) protects the privacy of all patients and their medical records including information about transgender status and transition. It also gives you as a patient the right to look at and copy your private health information a hospital, clinic, or health plan keeps in its records. Medicaid and Medicare protect your right to choose your own visitors and medical decision-makers. This means hospitals that take money from these programs cannot discriminate against you, any LGBT person, or their families in allowing visits and must acknowledge your decision-maker if you are unable to give consent for medical treatment. If you are elderly or disabled, the Nursing Home Reform Act has established nursing home residents’ rights including the right to privacy, and visits from friends or loved ones. This Act gives such rights as choosing your physician, being free from abuse, mistreatment, and neglect, and the right to file grievances without retaliation. According to the National Resource Center on LGBT Aging, the Act addresses issues such as harassment by other residents and staff, refusal by staff to use preferred name and/or pronoun, refusal to give care, wrongful discharge or transfer, and staff refusal to accept medical power of attorney for your designated medical decision-maker.
There are many organizations that set standards for hospitals and these can be resources for transgender people experiencing discrimination. The nation's largest healthcare accreditation organization, The Joint Commission, prohibits discrimination regarding sexual orientation and gender identity in its member hospitals and has issued guidelines for transgender patient care in these hospitals.
Many gaps in coverage, however, exist for LGBT people not because of health care provider discrimination, but because they are more likely to be discriminated against in employment and are thus less likely to have healthcare coverage. The Affordable Care Act (ACA) fills many of the healthcare gaps commonly faced by LGBT people. The ACA gives transgender and LGBT people access to the health exchange where they can purchase health insurance or receive subsidized health insurance. This access has benefits such as coverage for pre-existing conditions, support for mental health care in addressing transgender-specific needs such as identity and coping with discrimination, and non-discriminatory provisions in the Act for transgender and LGBT people. The ACA in section 1557prohibits discrimination against individuals based on race, color, age, national origin, disability, sex, gender identity, and sex stereotypes. This section applies to health activities or programs for those receiving federal financial assistance including hospitals and other federally funded health care facilities. Section 1557 applies to any entity created under Title I of the ACA such as the state health insurance exchanges.
While there may be discrimination in healthcare against transgender people, your rights are assured under the law. Knowing what policies and agencies protect your rights will give you the ability to fight discrimination and access care when you need it.
Intown Primary Care is a certified member of the World Professional Association for Transgender Health (WPATH) and is one of the few primary care offices in the Atlanta area to provide comprehensive medical care to the transgender community. The staff offers a safe, caring, and supportive environment to transgender women and men.
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