A sixth TLC community conversation between Ash Stephens, Kayla Gore, and Milo Inglehart.
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>> Good afternoon every one. Myself and my colleague Alexia, we will be providing Spanish interpretation today.
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Hi all, my name is Ash, I am the policy coordinator. I just wanted to say hello to every one virtually. Today we will have a little conversation between myself and two of my comrades, Kayla and Milo as well as our interpreters. Thank you for joining us here.
Today’s title is protect trans health, our bodies and our rights. We will get into that a little more, but I appreciate you all following us on social media and being a part of this conversation and website as well. Please continue to follow those to get more information. We’re doing these virtual gatherings every week on Thursday.
We know a lot is happening right now, particularly for transgender, non conforming, non binary and all of our intersex family in this moment of COVID 19, so we are sending love to every one now.
Before we get into the topic today around protect trans health, I just wanted to name as well that disability justice holds access as a necessary practice for disrupting isolation and ensuring the participation and leadership of disabled folks.
So access is meaningful when it includes a commitment to the radical transformative demands of disability justice. Disability justice charters us to identify, interrupt and disrupt all form of supremacy including ableism, antiblack racism, misogamy and so much more.
By committing to building accessible spaces we are following through to have a conversation with critical conversations.
Today again our conversation is going to be around trans health and so I will chat with the two folks I mentioned, Kayla and Milo and I will give you little bios on them.
We will chat about the state of trans affirming health care but more specifically about Section 1557 of the Affordable Care Act. As we’re learning at transgender law center, the final rule of Section 1557 hasn’t come out yet. It may not come out until July, but since we’re learning that the department of health services has sent a proposed rewrite, we wanted to share some information with you all. So we wanted to just provide broadly what Section 1557 is and just folks experiences on what we’re seeing, hearing and some examples of what folks are doing around access to health care.
>> I will first introduce Kayla. Kayla uses she/her pronouns. She is a southern regional organizer for TLC. Her organizing work has included fighting for housing equity for all folks who are experiencing chronic homelessness. She has worked for years for the right of trans folks, in particular in the south. And she also supports my sister’s house, which is a local house for trans and non conforming adults in Memphis who have recently been released from incarceration or experienced homelessness.
And also we have Milo who is on our legal team at TLC. Milo uses he and him pronouns. He is a red stone fellow at TLC working with the legal team to improve access to health care for trans and gender non conforming people through a mix of direct legal services and litigation support. He is based in New York and dreams of a world where wholistic affirming health services are accessible to every one. Those are the two folks who will be hearing from.
So I just wanted to pose a few questions to those folks, to my colleagues, and then we will take some questions from you all and then at the end just invite you again back to these conversations that we had.
My first question is if you can explain what Section 1557 of the Affordable Care Act is, and that can include how does the rule work. I will give Milo a nod on this one.
>> Milo: Thank you for that wonderful introduction, and yes, I can take that.
Just to sort of start at the very beginning. The Affordable Care Act is the 2010 law that was a health care reform law that aimed at expanding access to health care and health insurance in the United States. And as part of that, there was a provision of the law focused on preventing discrimination and that’s 1557. 1557 prohibits discrimination on the basis of race, sex, national origin, disability and age.
And so there was this law which is still the law and can only be changed by congress but part of the Affordable Care Act said that the department of health and human services can create regulations for those and enforce those parts of the law.
So under the Obama administration, they clarified that discrimination on sex, trans people, and includes discrimination based on like reproductive health. And the Obama interpretation also included clarifications like language access should be part of what’s covered by those provisions and usability is also part of that and sort of clarified it in broader ways.
Now the trump administration wants to issue their own interpretation and that’s where we are today, waiting for them to narrow that to change their interpretation so that it limits what and who would be protected by the law.
Does that sort of answer the basic background, Ash?
>> Ash: Yes, that is helpful. I am wondering if Kayla has anything to add. Thank you for framing that, Milo, like what is at stake. If and when we get this sort of rewrite, which again hasn’t happened yet, but could happen between now and what we’re hearing, like July, just what is at stake.
Can you talk a little bit about experiences either you have heard that you had or folks have had in trying to access health care and maybe discrimination there?
>> Kayla: Yes, thank you Ash and Milo. Milo, especially for breaking it down for folks who are kind of not super clear on what that means. To your question, Ash, about the experience and very unique experience of southerners when trying to access health care. And taking care into people identifying as transgender in the rural south. A lot of people are traveling anywhere from 30 to 50 miles at the least to access an emergency room, and that should be readily available to anybody.
But to think of this rule being taken back and us not being able to be protected if we drive 30 miles to an emergency room for an emergency situation, more specifically like something that is COBRA related in this political moment, and being denied those services.
I think that is happening so much, we just don’t hear about those isolated incidents happening. That is why it is very important for places like the law center to bring attention to the fact that these are things that people in the south are experiencing daily.
Even with the protection in place, where people can actually file a complaint against agencies who decide they’re going to refuse services. Like I said, it happens a lot which causes people to have to drive over 30, maybe 100 miles to access any particular type of Health care services.
Because their local area, they’re in such a rural area where their privacy isn’t protected if they come to a certain agency, it will be out in the community. So they’re forced to access things that are not local and are forced to travel far distances only to possibly be denied that service because of how they identify or present when they arrive at this facility. I hope that answers your question.
>> Ash: Yes, completely. Also to reiterate, we obviously all know we’re in this moment of COVID 19 so obviously this will have potentially a very devastating impact. Especially in this moment even more devastating as folks could be going to seek all types of care, and could be denied, trans folks could be denied when what we need to be doing is making sure all people can receive the care that they need and care that is affirming and not discriminatory. So I appreciate you bringing that to us as well, Kayla.
I also just wanted to ask Milo to maybe what you raised about language to access and the other points. If you had any more to say there? So not just trans affirming care, but also the expansiveness that you brought in, if you had some other points on that.
>> Milo: Yes, thank you, Ash. I really appreciate you reading that. I think it is so important to think about the ways in which isn’t just what affects trans people, something that affect people who may need access to abortion or reproductive care. There is also ‑‑ the data we’re seeing with the rule that may be released it will limit the rights people have to get interpretation, to get translation of materials, which will further limit access to health care for another really vulnerable population. And for people maybe who are trans and English isn’t their primary language, that will really sort of hammer down on this vulnerable group.
I really appreciate what you said about how sort of extra cruel and heinous it is that this change in the law making ‑‑ well, not change in the law, I should be clear, the law hasn’t changed. But the changes in the interpretation of the law is coming down potentially during a pandemic where we are already seeing the ways in which people of color, immigrants, all kinds of people are facing the brunt of the harm of COVID.
>> Milo: Thank you for that. Just a note I want to repeat to folks, this doesn’t change the law but it may encourage discrimination any way, which is important to note.
I am curious also about maybe what folks are doing locally, especially where you are, Kayla, in the south. What folks are doing, maybe what TLC is doing if you have comments on that.
>> Locally in Memphis we’re trying to get to the point where we can get our commission to change the policy within our local health department and our county funded hospital, which serves as our trauma center here. It is like a world renowned trauma center. They have a lot of different services that people can get who don’t have access to insurance or are under insured. Or are trans. People go through particularly. So we’re trying to get them to change their policy around how they identify people when it comes to gender and sex and how they respect people’s gender and sex. We know that if you’re ailing from something and you go to the emergency room and people are constantly misgendering you, even if you had your name legally changed or gender mark legally changed, they’re still referring back to older records they have on you. That can be very triggering to some folks and that will cause people to not seek treatment or not go to a place because it is the only place that’s free and that will actually accept you, or who should affirm you in your transition but they’re not because there isn’t an internal policy. So we’re trying to work to get the internal policy changed at the local health department, in our county funded trauma center.
>> That is good to hear. I also want to encourage folks to send us question as well. Milo, same for you, what can folks do and any thoughts you have around that?
>> Milo: Definitely. I think the kind of local advocacy that Kayla is talking about is so important right now. Because even if you have federal protections, you can have state and local protections that can still provide you with those antidiscrimination laws to fall back on, those policies that will protect trans people. And so seeing that local organizing work is really important right now.
Just on TLC and like the legal policy work we have been doing, we have been preparing for this rule for a while now. I don’t know if some of you will remember the protecting trans health care rule, it was a website that was by TLC and some coalition partners that worked on this law. And they proposed the changes they wanted to make, and then asked for comments from the public and a whole bunch of people submitted comments, which is really great because we bring litigation to challenge this, we can point to the comments, we can point at all the good reasons people gave for why this is a terrible change. And we’ll say you ignored all of this, you really should have known. So that was super helpful for building that case against it.
And sort of on that, we’re looking into bringing a challenge into litigation that will challenge this new interpretation of the law. And hopefully stop it from going into effect.
And I think collaboration with different organizations, different partners and with all of those organizers to hopefully be working with us to bring the best challenge that we can. That’s what we’re doing on litigation and policy side of things.
Ash: Thank you so much for explaining that. Again, for folk who is are listening in, just I would encourage you all to send in any questions in the chat if you have questions for us.
But if not, that is okay too. We’re always around to answer stuff. You can always do that later and we can come back and answer them as we get them.
I wanted to see if you all had any closing thoughts, or if you had questions for each other as well on things that might have stuck out that you might want each other to elaborate on.
I will start with you, Kayla. Never last words, but anything that is on your mind right now?
>> Kayla: Of course there are things on my mind. So one particular thing is the complaint process for folks. Because like you said, Ash, this is not a thing now but this is a big possibility. And with COVID 19 it is ridiculous that this is something we’re talking about. It seems everything else in the world has completely stopped, except for attacks on transgender people.
I would like to talk to Milo to explain more about the complaint process, filing a complaint with HHS. How does that work, if you can give us a play by play or a synopsis of what it may look like for folks.
>> Milo: Yes. So you can submit complaints if you suspect discrimination to the department of health and human services website. If you just search it online, you can go through. It is really helpful if you can be as specific as possible in these complaints. Saving any documents you might have from the discriminatory provider, giving specifics about sort of who and where and when.
I also want to flag that for people that live in areas that have their own dependent antidiscrimination laws, you can file sometimes with a state or local department of human rights, or ‑‑ they have different names, but it is whoever enforces the antidiscrimination laws in the state or local entity.
And usually it is a similar process where you’ll want as much specific information as you can gather. And then if they go through the registration, the agency goes through and reviews the complaint and doesn’t find that they think there was discrimination, there is also still chances that you can go through, which some are more difficult and require lawyers.
That is the basic process.
TLC is also working on a resource that sort of giving more information on this process and has lists of places you can go to find this information. So look out for that on our website.
Ash: Thank you all, and Kayla for posing that question.
Again, as we have been mentioning, the rewrite of the proposed rule hasn’t come out yet, but let’s say that if and when it does, the question is just sort of what can folks do when it comes out? What should we be doing? And that’s just for either one of you. Any of you have any thoughts or comments on that point?
>> Milo: I can say a little about that. Just to reiterate from before. I think staying local and organizing will be very important just ‑‑ you know, it is not all on the federal government. Doing that kind of work, talking to local officials, hospitals, all kinds of entities will be important. And also Ash sort of emphasizes this already, but the law is still the law. So there have been a bunch of court cases that say discrimination on the basis, and that affects trans people. So even if the trump interprets and says on the basis of sex doesn’t include trans people, that doesn’t reverse all of the court rulings. So I think ‑‑ and as Ash said before and Kayla said, it is likely that it will sort of confuse people or encourage discrimination, but yes, I just want folks to know that under the law they can still make an argument that discrimination is prohibited, so knowing your rights can be useful if you’re advocating for yourself or looking to sue or pursue other legal action.
So that will still be an avenue if and when this law comes around. I am interesting in hearing what Kayla says.
>> Kayla: Thank you, Milo. So in addition to those things Milo mentioned, I would say just like community mapping is a great tool that organizers can use locally to map out places that are safe and that are affirming and that we know are tried and true and will not discriminate against us regardless of what happens with 1557. Because I think that’s super important. And I had a lot of my regional organizing developed, was going to different places and partnering with different organizations and groups and building our resource list for trans folk to be able to access affirming things. Not just health care, but all kinds of things, kind of like a yellow book if you will. But being able to point people in the right direction if they are in an emergency situation where they need access to health care, they can actually know that they’re going to a place that is affirming. Especially if they’re in a rural area and they’re traveling to a major city, maybe 50 plus miles away, it is better knowing where you can go. And there are plenty of resources that you can just Google, like Milo said, as far as like the complaint process. If you Google 1557, just those four numbers, the first thing that pops up is the HHS website. It will show you where you can file those complaints. That would be my number one strategy. In addition to advocacy work on campaign, trying to work with local power to make local changes or put protections in place that supercede what is happening on the federal level.
Community mapping, I think it is something easily done and doesn’t cost a lot of resources. And we know that for trans organizing, we have a very small amount when it comes to funds to do anything, when it comes to protecting our community. So community mapping is like one of the easiest most cost effective ways to protect folks in situations like this.
>> That is super helpful. Thank you for that.
We have a question that came in as you were talking about the importance of the local level and advocacy. The question is: So how have you witnessed black trans folks in the south, in particular, supporting one another and sharing with them when they have been shut out of health care institutions? I know we’re talking about 1557 and always bringing in the outside perspective that black trans folks in the south have been historically pushed out and sort of not welcome and not having equitable access to health care, let alone affirming trans health care.
So just the question is about ways that you witness black trans folks in the south supporting one another? And that can look, you know, in all the beautiful ways. So if you have comments and reflections on that, Kayla?
>> Kayla: Oh, wow. I will give you the raw truth of the matter. And that’s people are being who they are, and they’re being resourceful, black trans folk, brown trans folk, people of color, we’re being resourceful, doing what we have always done and that is take care of each other. And that can look a number of ways, like you said a number of beautiful ways. And that is sharing medication, that is having treatments done on the black market which are very, very dangerous things. Like administering your own hormone replacement therapy is very dangerous. Trying to bandage a wound from being assaulted versus going to the emergency room is very, very dangerous. And something minor can become something super major because you don’t have that access. But we have been resourceful in making sure we have what we need, trying home remedies and things like that that don’t necessarily serve us, but these hospitals and these places where they’re saying they’re going to protect our health, they’re not actually upholding to that.
So we’re having to resort to doing things that might cause us more harm than good because we can’t access insurance because we don’t have employment, because we don’t have access to employment either.
So it is a lot of things coming together that makes us do things we really necessarily wouldn’t do, and that the average American wouldn’t have to endure or even have the thought process to even think to do things we’re doing to keep ourselves safe and to remedy things that we just can’t control, which is people discriminating and living in their truth of being discriminatory, from people that are different from them.
>> Thank you so much for that, Kayla. Yes, people are very resilient, resourceful, communal people even if, you know, we shouldn’t have to be. We should have access to things we need.
So I just want to again encourage folks to send any questions you might have. And this will not be the last time that you can do that. Like I said, we have virtual gathering every week and they are on Thursdays so look out for those on all of our social media platforms, also on our Websites. And leave comments if you have questions that might come up, and folks will try to answer those.
Yes, I just want to give a moment for some more questions and then if we don’t have any questions, I just want to say thank you to my colleagues here.
>> All right. Thank you all for joining us virtually. Like I said, thank you so much, Kayla, Milo and to all of our interpreters. We really, really appreciate it.
We appreciate you all being a part of these gatherings. Again, just submit your questions, send feedback and that would also be helpful for us. Again every week on Thursdays we’re together. We appreciate you all and really hopes that folks are feeling supported right now, especially in the moment that we’re in, I know that can be hard but we are here. We want to continue to try and get out information to our folks as best we can. And so the virtual gatherings have just been one way we have been doing that, and we appreciate you all.
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