Policy brief: Trump administration actions threaten access for LGBT patients

Lesbian, gay, bisexual and transgender adults are likely to encounter increased discrimination as they try to access health care services after a series of actions initiated by the Trump administration that articulate a right to refuse services to others based on religious beliefs, according to a policy brief issued by The Fenway Institute.

The institute, an interdisciplinary center advocating for LGBT issues, cited what it deemed several concerning policy positions outlined by the White House in recent months, including a May executive order authorizing religious conservatives to refuse services based on religious beliefs, a July decision by President Donald Trump to reinstitute a ban on transgender adults serving in the U.S. military, and documents published this fall by HHS that delete previous language regarding health care disparities experienced by LGBT people.

Additionally, in October, Attorney General Jeff Sessions issued a memorandum for all executive departments and agencies that authorizes faith-based health and service providers to “discriminate in service provision and hiring,” according to the institute. Sessions asserted that religious organizations “may choose to employ only persons whose beliefs and conduct are consistent with the organization’s religious precepts,” even for programming paid for with taxpayer funds.

“Under this definition of free exercise of religion, doctors could refuse to treat LGBT people, and social service providers could refuse to provide services to LGBT people based on religious objection,” Sean Cahill, PhD, director of health policy research at The Fenway Institute at Fenway Health, said in a press release. “These orders and memos take the concept of religious freedom and turn it on its head. True religious freedom protects an individual’s right to worship — or not — and harms no one. But these new measures are designed so that government employees and health care providers can deny service or treatment to LGBT people as a group by claiming that providing such service or treatment would violate their religious beliefs or sincerely held principles.”

In 2015 and 2016, hundreds of anti-LGBT bills were filed in states around the country, the institute noted. Ten states have religious refusal laws that limit the ability of LGBT people and same-sex couples to access services. In some states, these laws target access to health care.

The report noted that the administration’s support for a broader role for religious organizations in health care and social services is of “significant concern,” given the lack of a federal nondiscrimination law explicitly covering sexual orientation and gender identity.

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“It’s well-established that LGBT people experience greater disparities in health than the general population, and these disparities are rooted in stigma, discrimination and denial of civil rights,” Cahill said. “It is imperative that the language in these orders not be interpreted as a license to discriminate by those who use HHS funding to provide health care and other services to the public. If these executive orders and memos are interpreted and implemented as the religious refusal laws in Tennessee and Mississippi have been, LGBT people will be harmed and their access to health care diminished.”

In December, the Patient-Centered Outcomes Research Institute awarded The Fenway Institute more than $2 million to determine best ways to train community health center staffs in the collection of sexual orientation and gender identity information, as part of an effort to evaluate the impact of a series of educational programs on LGBT patient health care outcomes and improve provider competence in care.

Reference:

The Fenway Institute. Executive branch actions promoting religious refusal threaten LGBT health care access. Available at: http://fenwayhealth.org/wp-content/uploads/The-Fenway-Institute-Religious-Refusal-Laws-Policy-Brief.pdf.