As Daily Kos continues to cover, the LGBTQ+ community, and particularly trans folks, have been the target of legislative attacks via Republicans in recent months. State lawmakers have pushed a number of transphobic, exclusionary bills that seek to silence and discriminate against openly trans people, and in some cases, particularly trans girls. For example, the bills aiming to bar trans girls from participating in girls’ sports. There is also a small but loud movement aiming to keep trans folks from updating their birth certificates. And in the health care world, some Republicans are eager to try and bar trans youth from accessing safe, age-appropriate, gender-affirming medical care.
Most recently, Mike DeWine, the Republican governor of Ohio, signed a bill into law that could allow physicians, insurers, hospitals, and other medical professionals to deny (or refuse to pay for) medical services if they object on the basis of their moral, religious, or ethical beliefs. This medical refusal language was nestled into a 2,400-page 2022-2023 $74 billion budget bill as a last-minute provision, as reported by LGBTQ+ outlet them. Though DeWine did veto some line items in the bill, he left that one included.
The language in the state budget bill allows medical professionals to “decline to perform, participate in, or pay for any health care service which violates the practitioner’s, institution’s, or payer’s conscience.” This refusal clause is “limited to conscience-based objections to a particular health care service.” Medical professionals would still be on the hook for providing “all appropriate” services other than the one in conflict with their beliefs “until another medical practitioner or facility is available.”
What does this mean in theory? For example, a physician could deny gender-affirming treatment, like hormones, to a trans person, but could not refuse to treat them for cancer or a sprained wrist. But, as we all know, gender-affirming care is just as important as any other form of health care—just like abortion, for example—is as valid and legitimate as seeking treatment for a broken foot.
DeWine, mind you, also compared the situation to providers refusing to perform abortions, as reported by Cleveland.com. Of course, his argument goes in the opposite direction, as he suggested, “Let’s say the doctor is against abortion. If the doctor is not doing abortions, if there’s other things that maybe a doctor has a conscience problem with, it’s worked out. Somebody else does those things.” Given how incredibly difficult it is to access an abortion in this nation, the idea that it’s “worked out” so easily would be laughable if this person wasn’t in a position of power.
In the big picture, we also know that many marginalized folks, including LGBTQ+ people, experience abuse and discrimination in medical settings as it is. Trans people, for example, report feeling exhausted at having to educate medical professionals on the basics of identity or feeling like they’re a lesson for the hospital floor while they’re just trying to receive health care unrelated to gender identity. As it is, studies show LGBTQ+ people already delay or skip some recommended health services and screenings to avoid feeling abused or discriminated against in these settings.
Even so, in an interview with the local outlet WEWS-TV, DeWine insisted this language will not result in discrimination. “People are not going to be discriminated against in regards to medical care,” DeWine stated. “This is not a problem, has not been a problem, in the state of Ohio and I do not expect it to be a problem.”
Again, just like with DeWine’s own abortion comparison, it’s not easy to simply find another provider. There are a number of potential barriers, ranging from insurance coverage; out-of-pocket cost; literal access if you live with a disability, don’t have a car, or live in an area with poor public transit; and finding yourself in the position where every provider you can find tells you the same thing: They object. There’s also the question of sheer time that goes into research and potential hours wasted going to appointments only to be turned down. If you’re juggling jobs, child care, or live with chronic health issues, wasted appointments (or even just reading up on potential providers) can quickly add up.
Unsurprisingly, LGBTQ+ groups and allies are horrified by this language and are calling it what it is: discriminatory. In a statement, Human Rights Campaign (HRC) President Alphonso David said DeWine “enshrined LGBTQ discrimination into law” and that medical practitioners can “deny care or coverage for basic, medically-necessary, and potentially life-saving care to LGBTQ people simply because of who they are.”