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Denied Medical Care Because You’re Trans? Not Under the ACA

Denied Medical Care Because You’re Trans? Not Under the ACA

A trans woman from Illinois is pursuing a federal legal case after being denied transition related health care — something that under the Affordable Care Act is now unlawful.

Lambda Legal filed the suit in the District Court for the Central District of Illinois, Urbana Division, on behalf of Naya Taylor after Taylor was refused medical care by a doctor following her request for hormone replacement therapy.

Taylor, who lives in Mattoon, Illinois, contends that one Dr. Aja Lystila had been her primary physician for a number of years but, when Taylor asked to start hormone replacement therapy (HRT) as a necessary component of treatment for her gender realignment and to treat her gender dysphoria, †Dr. Lystila allegedly refused. Taylor†contends that Lystila originally claimed she was not experienced with the treatment and so could not give it, despite the fact that HRT has a number of medical uses that most if not all doctors should be familiar with.

Things took a turn for the even more discriminatory when, after pressing the matter, the clinic allegedly told Taylor that the clinic “does not have to treat people like you.”

And there’s the rub. Actually, under the Affordable Care Act health care providers that receive federal funds, like Dr. Lystila’s clinic, cannot discriminate on the grounds of sex, thanks to provision 1557 which reads:

an individual shall not…be excluded from participation in, be denied the benefits of, or be subjected to discrimination under, any health program or activity, any part of which is receiving Federal financial assistance, including credits, subsidies, or contracts of insurance, or under any program or activity that is administered by an Executive Agency or any entity established under this title (or amendments) [on grounds of their sex].

This is the first time that federal law has expressly protected people from sex discrimination in health care, and the Obama administration has made it very clear that, as with Title VI of the Civil Rights act, this provision extends to preventing discrimination on grounds of perceived or actual gender identity, as well as discrimination on grounds of stereotypes about how men or women “should” act.

Lambda Legal contends that the alleged discrimination that Taylor†faced clearly violates these provisions and demonstrates the kind of problems trans people can have when it comes to accessing health care.

Kenneth Upton, Senior Counsel for Lambda Legal, is quoted as saying, “Ms. Taylor asked for her doctor to provide services similar to those provided to other clinic patients who are not transgender and the doctor and clinic refused, posing a significant risk to Ms. Taylorís health. The ACA’s non-discrimination provisions were intended to ensure appropriate medical care for transgender people, a community that already faces a disproportionate amount of discrimination, violence and suicide rates.”

Taylor herself has also pointed out that the clinic has provided hormone treatment to people who aren’t trans, further emphasizing that, if her version of events is proved in court, the way she was treated was arbitrary and discriminatory.

“When they said, ‘we don’t have to treat people like you,’ I felt like the smallest, most insignificant person in the world,” said Naya Taylor. “The doctor and office provide hormone replacement therapy for others at the same clinic, they just refused to do that for me.”

Lambda Legal has also filed a complaint with the state’s Human Rights Commission.

While there remain a number of issues with how the ACA is interpreted, and what is and isn’t covered, the ACA does provide significant protection for trans people so they can be confident they are supported should they face this kind of discrimination.

If these issues matter to you, below is a list of resources that may be helpful in understanding trans health care issues and finding out more about gender confirmation treatment.

Know Your Rights: Transgender Health Care Resources:

Read more: , , , ,

Photo credit: Thinkstock.

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70 comments

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2:30PM PDT on Jul 20, 2014

You can't get an abortion but you can change your gender? Wow

4:29PM PDT on Apr 27, 2014

I am so glad Ms. Taylor is pursuing legal remedies, hope she owns them when it's done.

7:41PM PDT on Apr 26, 2014

Medical treatment is medical treatment. If some issue is not your forte or expertise, find someone who can help and refer the patient.

10:10AM PDT on Apr 26, 2014

thanks for sharing

2:26PM PDT on Apr 24, 2014

"First, do no harm." Dr. Lystila is even in violation of *that* medical law.

10:50AM PDT on Apr 23, 2014

Charlene R. “No doctor or medical person has the right to refuse care to anyone”

Absolutely, agree 100%

10:45AM PDT on Apr 23, 2014

From a medical point of view, prescribing hormone therapy is dependent on several factors. HRT is not confined to trans patients, but is used to treat a variety of conditions which require a rebalance of hormone levels. Most physicians will be familiar with the general application of HRT, but in some cases will also require guidance from a a specialist (Endocrinologist). My field is child mental health and HRT does have a role in psychiatry. However, I would not prescribe without a report from an Endocrinologist colleague. What I would never do is simply tell the patient that I didn’t know enough about the treatment and send them away.

There Is no place in medicine for moral judgement which determines whether a patient receives treatment or not. For example, I am against abortion, other than in certain exceptional cases, but nevertheless, I would treat a patent who was considering a termination by referring her to a specialist. I must also add that another reason to refer on to a specialist is that prescribing estrogen to patients who are anatomically male is the risk of coronary atherosclerosis, Most transwomen take a range of other medication (the preferred general anti-androgen is Spironolactone (Aldactone) and under specialist care this prescription is safe. Most medical problems that arise in the transgender patient are not secondary to cross-sex hormone use.

9:31PM PDT on Apr 22, 2014

No one would choose to make such a change in their life, unless it was completely necessary.
No doctor or medical person has the right to refuse care to anyone, PERIOD. If you have a problem with people of a different lifestyle, you should not be in the practice of medicine.

9:13AM PDT on Apr 22, 2014

ty

5:48AM PDT on Apr 22, 2014

well said, Katherine May

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