More than 1 in 8 LGBTQ people live in states where doctors can refuse their treatment

South Carolina last month became the seventh state to allow health care providers to refuse care for people they felt would violate their religious beliefs.

As a result, more than 1 in 8 LGBTQ people today live in states where doctors, nurses and other health professionals can legally refuse to treat them, according to the Movement Advancement Project, an LGBTQ think tank. In addition to South Carolina, Mississippi, Alabama, Arkansas, Tennessee, Ohio and Illinois have similar measures in place.

“The conflict between patient needs and religious directives has been a serious problem in the past, and I see no evidence that this problem can be resolved quickly and easily.”

Jenny Pizer, Lambda legal

Advocates and legal experts say the laws will further raise barriers to healthcare for lesbian, gay, bisexual, transgender and queer patients.

“We are often concerned that the expansion of religious rights in these contexts is seen as a license to discriminate,” said Jenny Pizer, director of legal and policy at Lambda Legal, a LGBTQ advocacy group.

However, proponents of such laws say the measures do not allow providers to discriminate against or target LGBTQ people.

South Carolina State Senator Larry Grooms, who supported his state’s Medical Ethics and Diversity Act, told NPR in June that “it’s based on the procedure, not the patient.”

“This is America, where you should have the freedom to say no to something you don’t believe in,” he told NPR.

Although “religious freedom” or “conscience” measures, as they are often called, do not explicitly count LGBTQ people among those who might be denied treatment, advocates say they are disproportionately affected in practice.

Ivy Hill, director of the community health program for the Campaign for Southern Equality, which promotes LGBTQ equality in the South, said transgender people are among those who will be hit hardest.

“Of course, if we have laws that make it easier for vendors to discriminate, that’s only going to get worse,” said Hill, who uses gender-neutral pronouns. “The people who are already on the edge of margins are going to be the ones who will be hit the hardest by things like this.”

Even before the new law came into force, They said many trans people they work with in South Carolina have had difficulty finding gender-affirming health care providers in the state willing to help them access hormone therapy, leading some of them to travel to North Carolina to get treatment.

Hill said doctors don’t typically tell trans people they won’t treat them for religious reasons, making it difficult to know how often it happens. Research has found that LGBTQ people, particularly transgender people, are more likely to face medical discrimination.

A Study published in 2019 found that 16 percent of LGBTQ adults, or about 1 in 6, reported experiencing discrimination in healthcare. A Survey 2020 from the Center for American Progress, a liberal think tank, found that 16 percent of LGBTQ people, including 40 percent of transgender respondents, said they delay or avoid screening because of discrimination.

Maggie Trisler, who works in tech, said she had a great relationship with her family doctor in Memphis, Tennessee for about a year and a half in 2016 and 2017. He asked her lengthy questions about her health and the band she plays, and said he would take his wife to see her play.

Then, in March 2017, Trisler came out as transgender, and she said he suddenly went very cold and told her he knew “nothing about the standards of care” for transgender people. He started blaming the pain she was in on her weight, she said.

“It suddenly went from the best doctor-patient relationship I’ve ever had to the absolutely most unhelpful and frustrating relationship I’ve ever had,” she said.

Three months later, Trisler said, the doctor effectively — if not specifically — told her that he could no longer see her.

“He said he was deeply uncomfortable treating me with it [hormone replacement therapy]he wasn’t comfortable offering HRT and if I was looking elsewhere, maybe I should seek medical care elsewhere,” she said.

Trisler added that she was fortunate to have good insurance and that it was easy for her to switch doctors, although she acknowledged she came from “a pretty privileged position” and that what’s going on for her was just an annoyance, “critical could have been a roadblock” to others.

While LGBTQ people have long faced barriers to health care because of religious denials, Pizer said, in some cases, such religious denials could violate both state and federal law.

Pizer pointed to it a case from 2005 in which the North Coast Women’s Medical Care Group in Southern California denied their client Guadalupe “Lupita” Benitez infertility treatments because she is a lesbian. The providers argued that it was within their religious rights to deny treatment to Benitez, but the California Supreme Court ruled that religious rights, which are protected under California law, do not condone violations of the state’s nondiscrimination law.

The court found that when physicians “practice in a particular area and generally provide services according to the needs of patients in their area, they cannot select and select patients in a way that violates nondiscrimination law,” Pizer said.

Pizer said the problem with laws like South Carolina’s Medical Ethics and Diversity Act is that they use broad language that doesn’t provide examples of situations where a religious objection in medicine would violate medical standards or federal law. Many hospitals, including denominational ones, receive federal funding. As a result, if they offered fertility treatments to straight people rather than LGBTQ people, they would violate Section 1557 of the Affordable Care Act enacted by the Biden administration hopes for reinforcements to better protect access to abortion and gender-affirming services.

Pizer said the issue is becoming more prominent and controversial as Catholic institutions control a growing share of the US hospital system. As NBC News recently reported, more than 1 in 7 US hospital patients are cared for in Catholic facilities.

“The conflict between patient needs and religious directives has been a serious problem in the past, and I see no evidence that this problem can be resolved quickly and easily,” Pizer said. “A hospital operating in a community to serve the broader community should not impose its religious beliefs on people who are not part of those beliefs or who are in the hospital for medical services, not religious services.”

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