{"id":6342,"date":"2019-09-08T21:22:43","date_gmt":"2019-09-09T01:22:43","guid":{"rendered":"http:\/\/ncjolt.org\/?p=6342"},"modified":"2020-06-04T20:52:25","modified_gmt":"2020-06-04T20:52:25","slug":"how-tech-companies-can-help-combat-decreasing-protections-for-lgbtq-access-to-health-care","status":"publish","type":"post","link":"https:\/\/journals.law.unc.edu\/ncjolt\/blogs\/how-tech-companies-can-help-combat-decreasing-protections-for-lgbtq-access-to-health-care\/","title":{"rendered":"How Tech Companies Can Help Combat Decreasing Protections for LGBTQ+ Access to Health Care"},"content":{"rendered":"\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 In January of 2018, the Trump Administration founded a new division<\/a> within the Office of Civil Rights (OCR) known as the Conscience and Religious Freedom Division<\/a>, to \u201crestore federal enforcement of our nation\u2019s laws that protect the fundamental and unalienable rights of conscience and religious freedom.\u201d Since then there has been a regulatory trend of rolling back protections for LGBTQ+ access to health care. Tech companies have begun addressing this problem by developing apps to connect LGBTQ+ patients to care. <\/p>\n\n\n

             In May of 2019, the Conscience and Religious Freedom Division published a final rule to \u201cprotect individuals, providers and other health care entities from having to provide, participate in, pay for, provide coverage of, inform patients about or refer services concerning\u201d specific procedures such as abortion, sterilization, and assisted suicide as well as \u201cany procedures that are against [employees\u2019] religious or moral beliefs.\u201d The regulation expands 25 existing statutes protecting against discrimination and retaliation for refusing to take part in the delivery of care for religious and moral reasons. <\/p>\n\n\n

However, the broader implementation of these statutes is aimed at more forcefully protecting entity and individual rights to refuse care may cause significantly more discrimination barring access to care for LGBTQ+ patients, as it covers gender-affirming therapy and surgeries as well as HIV+ care. <\/p><\/blockquote>\n\n\n

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/p>\n\n\n

<\/a>\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 The language of the rule protects any service provider \u201cwith an articulable connection\u201d to the care provided. This means that not only doctors and nurses are covered, but also receptionists, pharmacists, EMS providers, and medical transporters within hospital walls. While the rule allows employers to require disclosure of all religious and moral objections before beginning work, it has no guidance for how healthcare providers can protect patient access to care with their existing workforce. Employers may provide alternative staff to replace an objecting employee, however in rural communities where hospitals are frequently understaffed, this may not be possible. <\/p>\n\n\n

            The\nimplementation of this final rule, originally scheduled for July 22, 2019, has\nbeen delayed<\/a>\nuntil November 22, 2019 amidst litigation<\/a>\nby several states. Opponents contend that the rule is \u201cunconstitutional under\nthe Spending Clause and the First and Fifth amendments as well as unlawful\nunder the Administrative Procedure Act (APA).\u201d LGBTQ+ patients, especially\nthose who identity as transgender, already face significant health disparities\nand difficulties accessing care free from discrimination. This regulation will\nlikely further exacerbate these problems and decrease access to care further. <\/p>\n\n\n

            The National Institute on Minority Health and\nHealth Disparities<\/a> (NIMHD), a sector of the NIH, studies health disparities\nand researches how to decrease their impact on underserved populations. Sexual\nand Gender Minorities were identified as an underserved minority population\nthat faces health disparities in 2015. Since then the Institute has focused on\nresearching origins and solutions for this disparity. On August 30th<\/sup>,\n2019 the NIMHD published a notice<\/a>\nthat they will be increasing<\/em> the\ndefinition of sexual and gender minorities in an effort to become more\ninclusive of those affected by this disparity. According to the NIMHD, \u201c[sexual\nand gender minorities] face unique health challenges, and a continually growing\nbody of evidence suggest that [they] suffer disproportionately from a variety\nof conditions and diseases.\u201d As continued and increasing amounts of\ndiscrimination against these populations is sanctioned by the Trump\nAdministration, this disparity will likely expand significantly.<\/p>\n\n\n

             To further compound the issue of LGBTQ+ heath\ndisparities, should a transgender patient wish to challenge the discrimination\nthey face due to their gender identity, the Affordable Care and Patient\nProtection Act will no longer protect them. On June 14, 2019 the Department of\nHealth and Human Services (DHHS) proposed substantial revisions to \u00a71557 of the\nACA, that would \u201celiminate the general prohibition on discrimination based on\ngender identity as well as specific health insurance coverage protections for\ntransgender individuals.\u201d This proposed rule rolls back the 2016 expansion of\nthe definition of \u201csex discrimination,\u201d challenged and immediately enjoyed by\ncourts after its implementation for incongruence with Title IX. The comment\nperiod for DHHS\u2019 proposed rule closed on August 13th<\/sup>, and DHHS is\nexpected to publish their final rule in the coming weeks. If finalized, this\nrule could be implemented concurrently with the final conscience rule. <\/p>\n\n\n

            To combat this\nlack of access to care, tech companies are coming to the rescue. Pennsylvania\nmedical students developed the app SpectrumScores<\/a>\nin late 2017 with the goal of connecting patients to LGBTQ+ competent medical\nproviders. This app allows you to search for providers according to practice\narea or ailment and, similar to Yelp, a list of providers appears with scores\ncompiled from reviews left by app users. <\/p>\n\n\n

            LGBT MD is an app currently in development (demo version here)<\/a> that maps out LGBTQ+ friendly health care providers. Users can use the app to find a provider and filter by public insurance, trans-friendly providers or mental health providers. All the providers on the app are either certified by Health Professionals advancing LGBTQ Equality (formerly known as GLMA: Gay and Lesbian Medical Association)<\/a>  or recommended by app users. While the demo concentrates on the San Francisco area, this model, if developed on a much broader geographic scale, could become an incredibly functional LGBTQ ally in narrowing health disparities. <\/p>\n\n\n

            Information is power, and further development of applications that connect those seeking care to safe and reliable care will be crucial in the current regulatory landscape that is working to increase disparities further. <\/p>\n\n\n

Nicole Angelica <\/p>\n\n\n

September 8, 2019 <\/p>\n","protected":false},"excerpt":{"rendered":"

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 In January of 2018, the Trump Administration founded a new division within the Office of Civil Rights (OCR) known as the Conscience and Religious Freedom Division, to \u201crestore federal enforcement of our nation\u2019s laws that protect the fundamental and unalienable rights of conscience and religious freedom.\u201d Since then there has been a regulatory trend …<\/a><\/p>\n","protected":false},"author":1,"featured_media":6348,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[51],"tags":[],"_links":{"self":[{"href":"https:\/\/journals.law.unc.edu\/ncjolt\/wp-json\/wp\/v2\/posts\/6342"}],"collection":[{"href":"https:\/\/journals.law.unc.edu\/ncjolt\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/journals.law.unc.edu\/ncjolt\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/journals.law.unc.edu\/ncjolt\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/journals.law.unc.edu\/ncjolt\/wp-json\/wp\/v2\/comments?post=6342"}],"version-history":[{"count":1,"href":"https:\/\/journals.law.unc.edu\/ncjolt\/wp-json\/wp\/v2\/posts\/6342\/revisions"}],"predecessor-version":[{"id":6810,"href":"https:\/\/journals.law.unc.edu\/ncjolt\/wp-json\/wp\/v2\/posts\/6342\/revisions\/6810"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/journals.law.unc.edu\/ncjolt\/wp-json\/wp\/v2\/media\/6348"}],"wp:attachment":[{"href":"https:\/\/journals.law.unc.edu\/ncjolt\/wp-json\/wp\/v2\/media?parent=6342"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/journals.law.unc.edu\/ncjolt\/wp-json\/wp\/v2\/categories?post=6342"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/journals.law.unc.edu\/ncjolt\/wp-json\/wp\/v2\/tags?post=6342"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}