LGBTQ health care: How to get what you need as concerns rise over new division at HHS

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Health care can be challenging for anyone these days, but getting the right services is especially daunting for the LGBTQ community, which has faced decades of discrimination and misunderstanding.

The creation last month of a Conscience and Religious Freedom Division in the U.S. Department of Health and Human Services is raising concerns among some health care and legal experts who fear the new division will have a negative impact on LGBTQ patient care.

“My best advice is to keep Lambda Legal on speed dial,” said Ulysses W. Burley III, a physician and founder of UBtheCURE, a social justice consulting company with a particular focus on HIV and AIDS awareness. “They are committed to fighting any cases of discrimination related to the establishment of this new division in court,” he said.

The Conscience and Religious Freedom Division was created to “restore federal enforcement of our nation’s laws that protect the fundamental and unalienable rights of conscience and religious freedom,” according to an HHS news release. In that same news release, Roger Severino, director of the department’s Office for Civil Rights, said, “No one should be forced to choose between helping sick people and living by one’s deepest moral or religious convictions, and the new division will help guarantee that victims of unlawful discrimination find justice.”

As The Washington Post noted in a recent story on the new HHS division, “‘Conscience protections’ have become a flash point in culture war debates, especially about contraception and LGBT rights, in recent years.”

Burley said it is “still unclear how this new division will play out in public,” but he noted, “All fingers point to protections for the health care provider’s beliefs over that of the care and safety of women, members of the LGBTQIA community, and people living with HIV.”

Andie Baker, vice president of Howard Brown Health’s Center for Education, Research, and Advocacy, said the Chicago-based health care organization is concerned that the new HHS division may encourage some health care providers to deny “essential” health care to LGBTQ patients and that it will lead to “increased stigma and discrimination.”

“People are definitely scared because of the uncertainty of the situation,” said Scott A. Schoettes, counsel and HIV project director at Lambda Legal, a civil rights organization that works on behalf of the LGBTQ community and people living with HIV/AIDs.

Schoettes and Burley were members of the President’s Advisory Council on HIV/AIDS until last June, when they and four others resigned in protest over the Trump administration’s position on health issues.

While noting people are fearful because of what they’re seeing in the federal government, Schoettes said in a recent interview that people should not panic. There are, he said, “good people” still in the federal government and HHS who know what needs to be done to combat the HIV epidemic. They will, he predicted, “keep pushing back and implementing programs. … A lot of people are fighting on your side.”

While people who are lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual or pansexual, and their allies, are watching what develops with health care on a federal level, decisions made by state and local governments can also affect health care options and legal protections.

There is a “tremendous difference” between living in a “progressive” state with support and multiple health care choices and living in a state where there are fewer options, said Brian Mustanski, director of Northwestern University’s Institute for Sexual and Gender Minority Health and Wellbeing.

“Do what you can to support organizations that work to advance LGBTQ health and LGBTQ rights,’’ he said.

Here are some tips to safeguard access to health care — and what to do if you are denied services:

1. Choose health care providers that support you.

“First of all, the best solution is having a good doctor,” Mustanski said. Look for a doctor who will affirm your sexual orientation and gender identity, he said.

Howard Brown suggests people use the Human Rights Campaign Healthcare Equality Index and RAD Remedy’s provider ratings help search for “LGBT-affirming health care providers in your area.”

Look, too, for providers who self-identify as LGBTQ or as allies, Howard Brown suggests.

2. Get health insurance if you can.

The open enrollment window is officially closed for 2018, but Schoettes said you can take advantage of a “qualifying event” that allows you to apply, such as loss of a job or moving to a new location.

No insurance? Reach out to your local community health organizations, said Baker, who notes Howard Brown offers enrollment services.

3. Be prepared.

“If you are partnered, but not married or in a civil union, seek legal information about you and your partner’s rights in case of a medical emergency,” Howard Brown recommended.

As for parents who identify as LGBTQ and have children, “take documentation with you when traveling and especially take note of safeguards available when traveling between states,” the agency advises.

4. Keep detailed records.

Howard Brown recommends writing down the names and titles of people you encounter during a health care visit, along with the date, time and location. You’ll need this information n case if you are denied care.

5. Speak up.

Speak out against discrimination, Howard Brown urges, because “several grant-funded programs and services require health care entities to define core patient rights and publicize how patients may lodge a grievance to enforce those rights.”

6. Know your rights.

Howard Brown suggests looking to state and local anti-discrimination ordinances and filing grievances with state or local agencies if necessary.

Schoettes said Lamba Legal has five regional offices across the country (including Chicago) and a health care “tracker” to help chart the impact of the new Conscience and Religious Freedom Division.

wdaley@chicagotribune.com

Twitter @billdaley

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