This post was updated Nov. 13 at 11:56 p.m.

“Beyond the Statute” is a series created by Sierra Benayon-Abraham, an assistant Opinion editor and third-year public health student. In these columns, she will be exploring various public health policies, laws and experiences that different marginalized communities encounter, along with the truths behind them. It is her goal to share the importance of understanding health care on a universal level while highlighting both the disparities and inequities that exist for distinct marginalized groups. With UCLA’s campus abounding in students interested in health care, law and public policy, Bruins who have either an interest in or experience with the topic are welcome to submit op-eds or letters to the editor to be published as part of this series to represent the many facets of health care policy.

When a medical student graduates from medical school, they take a Hippocratic oath to do no harm and swear to use their knowledge to provide the best care possible. Similarly, when a doctor dons their stethoscope each morning, they agree to leave all personal biases at the door.

Why is it then the case that LGBTQ+ individuals across America are constantly refused medical care or denied treatment based on their sexual orientation and gender expression alone?

LGBTQ+ individuals face substantial barriers when accessing non discriminatory and quality health care, often experiencing challenges in preserving autonomy and receiving respect for their gender identity and expression in health care settings.

The systemic health disparities and inequalities experienced by LGBTQ+ individuals result in an inability to receive timely and reliable medical care, leading to overall mistrust in the health care delivery system.

Will Tentindo, a staff attorney at the UCLA School of Law Williams Institute, a leading research center studying public policies and laws relating to LGBTQ+ identity and expression, explained the inadequacy of current laws and practices in addressing the needs of the LGBTQ+ community.

“Our research has found about 40% of LGBTQ people worry about being negatively judged because of their sexual orientation or gender identity when seeking health care,” Tentindo said in an emailed statement.

LGBTQ+ individuals are often repeatedly forced to endure intense social stigma and heteronormativity when seeking medical attention, leading to higher rates of mental health struggles, increased rates of sexually transmitted infections and greater overall health care needs.

It is not uncommon for LGBTQ+ adults to have to grapple with the decision of whether to travel to a health care provider who will see them for a gender-affirming surgery, or to forgo their health needs because they cannot afford to lose that day’s salary.

“In our research, we found that people have to travel two hours or more to a provider,” said Dannie Ceseña, director of the California LGBTQ Health and Human Services Network.

This discrimination affects not only those who identify with the LGBTQ+ community but also their loved ones.

In 2015, a lesbian couple took their 6-day-old daughter to see a pediatrician in Michigan but were turned away because they were same-sex parents. This occurred five years after the Affordable Care Act established federal civil rights protections for health care, including a ban on discrimination based on gender identity that was rolled back under the Trump administration but reintroduced during Joe Biden’s presidency.

“We’ve had these laws passed,” Ceseña said. “But no one has actually worked on the implementation piece.”

Whether a law that prevents discrimination on the basis of gender identity and sexual orientation exists and whether that law is actually enforced are two different stories entirely.

Those identifying as transgender or gender nonconforming are disproportionately impacted to an even greater degree, facing a considerably larger disadvantage when it comes to accessing health care.

According to the Center for American Progress, 29% of transgender patients reported that a doctor or health care provider refused to see them or provide medical care based on their gender identity.

“Our research shows that over-three quarters of transgender youth in the U.S. — about 237,500 youth — live in states that have proposed or passed a law restricting access to gender-affirming care for minors,” Tentindo said in the emailed statement.

Two common additional forms of discrimination experienced by the transgender community include misgendering and deadnaming. The term misgendering refers to providers using pronouns or gendered language that fail to align with the patient’s gender identity. Deadnaming occurs when a provider uses a name assigned at birth that is no longer used by the patient.

According to a study performed by the John Hopkins Bloomberg School of Public Health, 25% of transgender participants described experiences of deadnaming or misgendering, often intentionally, in a health care-related environment by a medical staff member.

If health care providers are supposed to offer unbiased and respectful care, then why is it that we are experiencing an influx of transgender individuals neglecting treatment based on the fear of being discriminated against?

Now this is not to leave the exceptional health care providers that do exist and advocate for the highest level of care for those within the LGBTQ+ community unrecognized.

Nonetheless, it is unfortunate that such a substantial number of medical professionals do not fall into this category.

According to Ceseña, the health care providers at fault point to a lack of personal expertise underlying their inadequate health practices for the LGBTQ+ community.

However, whether LGBTQ+ individuals require medical treatment or not, the diagnosis, care and treatment for most medical conditions do not change. If diseases do not know how to distinguish between those sexualities, then neither should doctors.

Insurance coverage is another significant barrier, as LGBTQ+ individuals are less likely to have health insurance compared to their heterosexual or cisgender counterparts. Many employers do not offer coverage for unmarried domestic partners.

Members of the trans community lack health insurance at particularly high rates.

“Some states have laws that allow health insurance companies and Medicaid to exclude coverage of gender-affirming care, while others require coverage—in full or in part,” Tentindo said in an emailed statement.

There are currently 25 states that have no laws ensuring LGBTQ+ inclusive insurance protections. Two states explicitly permit insurers to refuse coverage for gender-affirming care altogether. Twenty-six states have laws on the books banning best practice medical care for transgender youth.

“Many pieces of legislation include professional and or civil penalties for health care providers who provide gender affirming care. Six states have included felony penalties,” said a representative of the LGBTQ Campus Resource Center at UCLA in an emailed statement.

According to a publication from the Williams Institute, the anti-discrimination statutes enforced in most states fail to unequivocally safeguard sexual orientation and gender identity.

When California providers who are misinformed or have preconceived notions about the LGBTQ+ community observe the laws and practices implemented in other states such as Florida and Texas, their personal beliefs that are discriminatory toward LGBTQ+ individuals are reaffirmed, Ceseña said.

With some present-day politicians attempting to eliminate the minimal public health laws in place to protect members of the LGBTQ+ community, it is more imperative now than ever that the right to equality for all individuals on the basis of health care is actively maintained.

As we approach the 10th anniversary of the legalization of same-sex marriage in the U.S. and the 25th anniversary of the federal government’s recognition of Pride Month, it is time that we enforce comprehensive federal protections declaring that every human being, regardless of sexual orientation or gender expression, has a right to access and receive the highest quality of health care available.