Transgender ballot measure could affect public health, medical experts say

A Massachusetts ballot measure may have serious public health implications if it repeals a state law preventing discrimination against transgender people in public places, health policy experts are warning.

"If people are not getting care when they should, delaying care, it's going to be expensive -- way higher health care costs, making hospitals more overburdened," said Pam Klein, nurse liaison for Boston Medical Center’s Center for Transgender Medicine and Surgery and the Transgender Program Manager for the Boston Health Care for the Homeless program. "When the law was passed, it was really exciting. If we actively remove those protections, what kind of message does that send to people? In that context, any additional reason to not feel like you're welcome or to be professionally kicked out of a public place is a real concern.”

Question 3, on the ballot next month, would reverse the 2016 state law that banned discrimination based on gender identity in any place where the general public is allowed —including health clinics and hospitals, along with stores, restaurants, museums, movie theaters, hotels, parks and any other place open to the public. A Yes vote on the measure would maintain the law, while a No vote would repeal it.

Repealing the law could undermine public health in the state, says the one of the state’s largest health associations.

"From a general public health perspective, MHA is concerned that reversal of the transgender protections could limit transgender individuals’ rights and ability to comfortably use certain public facilities based on their declared gender," said Massachusetts Hospital Association Vice President of Clinical Affairs Pat Noga. "Failure to seek appropriate medical care could result in dangerous worsening of an individual’s health, and in the case of recommended public health initiatives like flu shots, could also increase illness risks for the larger community.” 

"When you think about all the people that interact with the transgender population -- family, friends, coworkers, etc. -- that’s when you see the true implications of not protecting someone’s access to health care," said Desiree Otenti, associate director of medical policy at Blue Cross Blue Shield of Massachusetts (above, left).

Blue Cross, the state’s largest insurer, has publicly backed a Yes on 3 vote, along with many of the state’s business groups.

Sara Schnorr painfully recalls what it was like to avoid medical care for fear of feeling unwelcome and misunderstood in a doctor’s office.

 During a visit to her doctor with chest congestion, remembers Schnorr (above, right), she told him she was taking herbal feminizing supplements -- and he mocked her, insisting she was a man.

She didn't go to a doctor again for the next 10 years.

"I felt utterly shamed," said Schnorr, who transitioned in 2009 and is an attorney with Locke Llord LLP. "When I finally shared a secret that was very hard to share, he made me feel like I was worthless. I know the same thing happens today for millions of transgender people across the country."

Discrimination can have far-reaching health consequences, experts agree.

"The non-discrimination law doesn't guarantee a welcome, but it guarantees they have a tool to protect their rights,” said Carl Sciortino, a spokesman for Fenway Health, which was founded to care for lesbian, gay, transgender and other community members. “Without that, you can experience discrimination with no recourse."

"Any time you have a marginalized population, it puts everyone at risk when they're not getting sufficient care," Otenti said. "When they get sick, it impacts everyone's work." 

A study commissioned by Fenway Health in 2013, before passage of the law, found that 65 percent of transgender residents reported discrimination in public accommodations in the past year.

The study found that discrimination was associated with increased health problems including stress and asthma, and led to some respondents not being able to get health care. Five percent of respondents said they had been refused treatment outright because of their gender identity, and 24 percent said they did not seek routine health care because of discrimination.

Asked to comment on the public health implications of the ballot measure, No on 3 spokeswoman Yvette Ollada issued a brief statement: "We are concerned about predators in women's bathrooms and locker rooms. The law needs to be repealed to protect women. The legislature needs to start from scratch to protect everyone and their health."

The law makes clear the anti-discrimination protections cannot be abused for improper purposes. A study this year of Massachusetts police records by the Williams Institute at UCLA School of Law  found no link between anti-discrimination legislation and bathroom-related crimes. Such incidents, the study said, “are rare and unrelated to the laws.”

The current law gives transgender patients the ability to legally push back against discrimination -- which Schnorr said could be a literal life-saver.

"It helps people's self-esteem, but also makes people feel more willing about going out in public, getting all sorts of health services everyone needs in order to live," she said.

Today, Schnorr said, she gets thoughtful treatment from her health care providers, but spending a decade away from regular check-ups was dangerous, with her family history of early death and heart disease. Avoiding professional care leads to self-medication and undiagnosed problems, and not being able to rely on professional help leaves transgender people with nowhere to go.

"Being sick while transgender,” she said, “for a lot of people in the community, is seen as a death sentence."