New York City-based Human Rights Watch ( HRW ) issued a report on July 23 addressing the many healthcare barriers faced by LGBT individuals in the United States.
Among the issues discussed in the 34-page report are access to services, discrimination in healthcare settings and decisions by LGBT persons to delay or forego care outright.
According to HRW Researcher Ryan Thoreson, who authored the report, the project arose from an initial investigation into the impact of so-called "religious refusal" laws.
"We kept hearing stories about how difficult it was to access healthcare," he said, noting that researchers realized that the access issue was "a larger piece of the narrative that kept getting lost."
The report documents a number of degradations to LGBT healthcare that have taken place in the wake of the Trump administration, but Thoreson said that one of the most significant degradations was the administrations lack of commitment to LGBT rights.
"The religious refusal piece is part of it, but I think this [lack of commitment] is much bigger than that," he added. "The Obama administration committed to putting up resources on LGBT and women's health, and FAQs, saying that they were taking discrimination seriously and interpreting rules to fight discrimination robustly. We've seen the Trump administration back away from all of that. That, combined with the strong embrace of religious refusals, sends a strong signal that the Trump administration is not on LGBT people's side."
The report documents how transgender individuals are particularly vulnerable. Thoreson said, "When you are unable to access services, it is not just a denial of health and well-being generally, it's also an attack on who you are and get care that affirms your identity."
Although the report centers on issues facing, among others, LGBT individuals who are poor, or live in underserved settings, Thoreson pointed out that even individuals who have robust insurance in places with strong legal protections may face the issues at some point.
"One of the issues that others have done research on is the way these issues play it in elder care settings," he explained. "There may be a time in their life down the road where they are dependent on Medicare or Medicaid, where their options on mobility and choice are limited."
Thoreson added, "You can't look at the health care issues without looking at the whole universe of religious-refusal arguments. ... We're seeing a very aggressive promotion of the principle that someone's religious beliefs trump any other responsibilities that they have under the law. I think that's a very dangerous principle."
The complete report is at www.hrw.org/report/2018/07/23/you-dont-want-second-best/anti-lgbt-discrimination-us-health-care .