So last week the Department of Health and Human Services announced they were starting up a division to shield health care workers who object to providing certain types of care on account of “moral objections”. Among the covered refusals would be refusing to treat LGBT people. Put simply, a doctor could refuse to treat an LGBT person just because of who they are as long as they can muster some claim of it being against their morals.
For me as a trans woman, having to worry about access to care wouldn’t be just about possibly facing longer times looking for a doctor. Not just about the possible consequences of an infection not treated as promptly as it should be. Not the possible effects of having to skip on preventative care. And keep in mind outside of two prescriptions and blood work to monitor hormone levels, any care I might need is no different than from the care anyone else might need.
What it would be about, is another consequence. One that doesn’t come up in discussions of larger society. Something that goes for me and many others in the LGBT community. Take a look at the map:
The red dot is Chicago, where I live. The blue dots are New York City, Los Angeles, San Francisco, Portland and Seattle. Those would be the places where I could live and work and be pretty sure I’d not have to worry about access to medical care. As well as not having issues with trans specific care.
Now you could think I’m overreacting a bit. After all plenty of other cities are places where I wouldn’t need to worry about finding regular medical care. That may be true, but there’s another issue, housing security:
All those states in grey? Those are states where it would be perfectly legal to deny me a place to rent because of my gender identity and sexual orientation. The light yellow? In those two it would be legal to deny me a place on account of my gender identity. Between the grey and light yellow, that’s 30 states.
There is one more issue, employment:
The states in grey are where I could be denied or fired from a job for being trans or gay. Indeed it’s only the dark purple states where I could not be fired from any form of employment for being trans or gay. The other shades offer varying level of protection but not full protection in all jobs.
Take those two maps together and there are 20 states where I couldn’t be denied housing or a job on account of being trans or gay. That’s just 20 states where I could live and work and know that legally I have equal tanding. Now factor in things like ready access to trans care, and what’s left is the cities I named. That’s it.
I know it would be easy to say that I’m being overly cautious or irrationally afraid of being denied a place to live or job. That just because someone could, doesn’t mean they would. But that’s the issue, I wouldn’t want to live somewhere it could happen. No matter how unlikely it is that it would happen. It’s a matter of basic security and not having extra things to worry about. Which the move by HHS adds to.
It’s worth remembering that for those of us in the LGBT community there’s also what we know has happened. Partners thrown out of homes after a death when the deceased’s family doesn’t approve of their “lifestyle”. Issues about child custody when a partner dies, no matter how much paperwork was drawn up. Having a marriage that was valid in one state but not another. That and myriad other things is why it’s hard to have much faith in “just because someone could do it, doesn’t mean they would”.
What makes the issue of medical care access particularly troubling is that it enforces a second class status upon the LGBT community. That we can’t count on getting care from any doctor of our choosing like others. That our health can be seen as not worth dealing with if someone can drum up some objection they claim is based in morals. That treating us as second class is seen as morally acceptable. That our potential lack of well being is not seen as contrary to someone else’s claimed morals.
And while yes large cities are generally better than other places, even their own suburbs, for LGBT issues, it would be wrong to think they’d all be equally fine places. Just on the subject of health care, a city in a conservative area could find itself with access to health care curtailed for LGBT people. To say nothing of what some states might do with things. So while on a social level a city might be alright, that doesn’t mean there isn’t a possibility of other issues.
I could go one about the health side of things, the deleterious effects of not getting prompt care, the consequences of further marginalization and so on. But while all that is a factor here, there’s something bigger. That without assured access to even just basic health care, the United States becomes a much smaller country not only for myself, but the entire LGBT population. Instead of increasing certainty, we’d rely on hope and whatever certainty sympathetic populations can provide. Instead of gaining in where we could be without worry, we’d lose. And that is something we desperately don’t want. We shouldn’t have to be afraid of what could happen on account of others’ morals. We shouldn’t have to be afraid.