Few minority groups in American history have experienced such pervasive animus and state-sanctioned discrimination as transgender, intersex, and nonbinary people (in the rest of this blog, I am going to use transgender as an umbrella term to include intersex, nonbinary, and gender diverse people).
In the United States, there are zero federal civil rights protections for transgender people. In the states, there is a patchwork of laws protecting transgender people. Below is a summary of those laws.
In all 50 states and D.C. marriage equality is legal.
The current federal government under President Trump’s Administration and GOP (Republican Party) led state governments to continue to attack transgender people.
In 2018, Kansas and Oklahoma passed bills to allow adoption agencies to refuse LGBTQIA+ couples looking to begin families. In Massachusetts, a group of anti-LGBTQIA+ advocates put transgender, intersex, and nonbinary protections on the November 2018 ballot. The voters in Massachusetts voted to keep those protections in place. In Montana, anti-LGBTQIA+ advocates have gathered signatures to put an initiative on the ballot in 2019 to prevent transgender people from using the restrooms that correspond to their gender identity. In South Dakota, the GOP Governor Kristi Noem has promised to sign an anti-transgender “bathroom bill.”
Further, there has been a large flood of lawsuits filed by parents of cisgender children to attack transgender students and vilify school districts that have implemented transgender affirming policies.
The following are the most recent Iowa and federal actions that legitimize anti-transgender bias and discrimination:
- April 27, 2019: The DHS budget bill passed the Iowa House with the “Costello” amendment which amended the Iowa Civil Rights Act to ban state or local government unit or tax-supported district from using public funds for “sex reassignment surgery” or “any other cosmetic reconstructive or plastic surgery procedure related to transsexualism, hermaphroditism, gender identity disorder, or body dysmorphic disorder.” The bill passed on a vote of 52 to 47. The following week the Governor signed the bill into law, effectively reversing the Iowa Supreme Court’s unanimous decision ending the Medicaid ban on covering gender-affirming surgery.
- April 26, 2019: The “Costello” amendment to HF 766, the DHS budget bill passed the Iowa State Senate, by a vote of 31 to 19.
- April 12, 2019: The Department of Defense (DOD) implemented its ban on transgender troops.
- January 23, 2019: The Department of Health and Human Services’ (DHHS) Office of Civil Rights granted an exemption to adoption and foster care agencies in South Carolina, allowing religiously-affiliated services to discriminate against LGBTQIA+ caregivers.
- June 11, 2018: Attorney General Jeff Session ruled that the federal government would no longer recognize gang violence or domestic violence as grounds for asylum, which could lead to rejecting most LGBTQIA+ asylum-seekers.
- May 11, 2018: The Bureau of Prisons in the Department of Justice (DOJ) adopted a policy of housing transgender people in federal prison facilities that match their sex assigned at birth.
- February 18, 2018: The Department of Education (DOE) announced it will summarily dismiss complaints from transgender students.
- January 26, 2018: DHHS proposed a rule that encourages medical providers to use religious grounds to deny treatment to transgender people and people who need abortions.
- January 18, 2018: DHHS’ Office of Civil Rights opened a “Conscience and Religious Freedom Division” to promote discrimination by health care providers who can cite religious or moral reasons for denying care.
- December 14, 2017: Staff at the Centers for Disease Control and Prevention (CDC) were instructed not to use the words “transgender,” “vulnerable,” “entitlement,” “diversity,” “fetus,” “evidence-based,” and “science-based” in official documents.
- October 6, 2017: DOJ released a “license to discriminate” allowing federal agencies, government contractors, government grantees, and even private businesses to engage in discrimination, as long as they can cite religious reasons for doing so.
- October 5, 2017: DOJ released a memo instructing DOJ attorneys to take the legal position that federal law does not protect transgender workers from discrimination.
- September 7, 2017: DOJ filed a legal brief on behalf of the United States in the U.S. Supreme Court, arguing for a constitutional right for businesses to discriminate based on sexual orientation and, implicitly, gender identity.
- May 2, 2017: DHHS announced a plan to reverse regulations interpreting the ACA’s nondiscrimination provisions to protect transgender people.
- April 14, 2017: DOJ abandoned its lawsuit challenging North Carolina’s anti-transgender law.
- March 10, 2017: The Department of Housing and Urban Development (HUD) announced it would withdraw two major agency – proposed policies designed to protect LGBTQIA+ people experiencing homelessness.
- March 1, 2017: DOJ declined to appeal a nationwide preliminary court order temporarily halting enforcement of the ACA’s nondiscrimination protections for transgender people.
- February 22, 2017: DOJ and DOE withdrew 2016 guidance explaining how schools must protect transgender students under the federal Title IX law.
Furthermore, since President Trump took office, his Administration has rapidly outpaced the previous administration’s in the number of confirmed circuit court nominees. President Trump’s Administration confirmed 30 circuit court nominees in the past two years and two Supreme Court Justices. Nearly double the number of circuit court nominees than at the same point under President Obama.
This is a significant issue for transgender people because one in three of Trump’s circuit court nominees has a demonstrated history of anti-LGBTQIA+ bias.
The following are the top six worst nominees of 2018:
Nominated October 2, 2017, to the U.S. Court of Appeals for the Fifth Circuit; Confirmed April 24,2018
Questioned the legitimacy of the U.S. Supreme Court after ruling for marriage equality in Obergefell v. Hodges.
Retained by the Gloucester County School Board to defend its policy singling out transgender students from their peers by requiring them to use separate “alternative, private” facilities.
Nominated July 13, 2017, to the U.S. District Court for the Western District of Tennessee; Confirmed October 11, 2018
Supported legislation that would prohibit teachers from providing any information to students regarding homosexuality, limiting efforts to protect LGBTQIA+ students.
Nominated September 7, 2017, to the U.S. District Court for the Northern District of Texas; Still pending
Argued that the State’s interest in defending against sexual orientation-based discrimination was not enough of a reason to justify burdens on a wedding cake baker’s “constitutionally protected religious freedom.”
Authored an article that denigrates as “problematic” the very idea of gender identity.
Nominated June 18, 2018, to the U.S. Court of Appeals for the Sixth Circuit; Still pending
Led DOJ team in defending Trump’s transgender military service ban
Authorized a brief arguing that Title VII’s prohibition of sex discrimination did not cover sexual orientation discrimination.
Nominated June 18, 2018, to the U.S. Court of Appeals for the Sixth Circuit; Still pending
Served as counsel in Obergefell v. Hodges, personally arguing against marriage equality at the 6th Circuit Court of Appeals as lead counsel, and as counsel of record for the State of Ohio in the Supreme Court. He argued that same-sex marriage was “disrupting to our democracy.”
Nominated April 12, 2018, at U.S. Court of Appeals for the Third Circuit; Confirmed October 11, 2018
Sat on the board of an anti-LGBTQIA+ think tank that advocated for conversion therapy and argued against marriage equality and protections for transgender people.
Transgender people experience significant discrimination, harassment, and assault across the United States and in the states that do guarantee civil rights protections for LGBTQIA+ people. Specifically, several large-scale studies demonstrated that 77% of transgender students (K-12) experienced some form of mistreatment, such as being verbally harassed, disciplined more harshly, or physically assaulted.
Additionally, over 90% of transgender people report experiencing harassment, mistreatment, or discrimination on the job. Over 45% of transgender people have experienced an adverse job outcome because of their nonbinary identity, and 26% have lost their job for that reason.
One in three transgender individuals reported negative experiences – including harassment – in seeking medical care. And 19% of respondents in a separate study reported being refused medical care due to their transgender status.
Over 40% of transgender persons live without IDs that match their gender identity. These inaccurate IDs effectively “outs” transgender people, exposing them to harassment, refusals of service, and even potential violence. When transgender people are forced to present their ID in the ordinary course, 40% report being harassed, 15% report being asked to leave, and 3% report being attacked.
Additionally, over 31% of transgender individuals lack regular access to health care according to an NPR poll. In the same NPR poll, 22% of transgender individuals reported that they avoided doctors or health care for fear of being discriminated against.
For transgender people, they find it very difficult to find a primary care provider who is sufficiently knowledgeable about transgender health care. Other issues that impede transgender individuals from accessing health care include financial, discrimination, the health system, and socioeconomic status.
Similarly, one in four transgender people has been assaulted because of being transgender. This deadly violence against transgender people is fueled by government action that legitimizes anti-transgender bias by perpetuating the idea that a transgender person’s identity is not “real.”
In Iowa, this animus has been furthered by the GOP-controlled General Assembly’s recent action when they passed the DHS budget with a discriminatory amendment that effectively overruled the Iowa Supreme Court’s unanimous ruling affirming transgender Iowan’s right to medically necessary gender affirming surgery to be covered under Medicaid.
The General Assembly did this despite the support of all the significant medical and mental health professional organizations support of transgender people in health care.
Professional medical and mental health organizations that support transgender people, their civil rights, and equal access to healthcare:
American Medical Association
Our AMA supports public and private health insurance coverage for treatment of gender dysphoria as recommended by the patient’s physician.
Our AMA believes that the physician’s nonjudgmental recognition of patients’ sexual orientations, sexual behaviors, and gender identities enhances the ability to render optimal patient care in health as well as in illness.
American Psychiatric Association
The APA: 1. Recognizes that appropriately evaluated transgender and gender diverse individuals can benefit greatly from medical and surgical gender-affirming treatments. 2. Advocates for the removal of barriers to care and supports both public and private health insurance coverage for gender transition treatment. 3. Opposes categorical exclusions of coverage for such medically necessary treatment when prescribed by a physician. 4. Supports evidence-based coverage of all gender-affirming procedures which would help the mental well-being of gender diverse individuals.” “The APA urges the repeal of laws and policies that discriminate against transgender and gender diverse individuals; and opposes all public and private discrimination against transgender and gender diverse individuals in such areas as health care, employment, housing, public accommodation, education, and licensing.
American Psychological Association
The APA opposes all public and private discrimination on the basis of actual or perceived gender identity and expression and urges the repeal of discriminatory laws and policies…[and] calls upon psychologists in their professional roles to provide appropriate, nondiscriminatory treatment to transgender and gender variant individuals and encourages psychologists to take a leadership role in working against discrimination towards transgender and gender variant individuals[.]… [The] APA recognizes the efficacy, benefit and medical necessity of gender transition treatments for appropriately evaluated individuals and calls upon public and private insurers to cover medically necessary treatments.
American Academy of Child and Adolescent Psychiatry
The Academy believes that transgender youth must have access to all educational and recreational programs and services available to the general youth population.
The Academy believes that transgender youth in correctional systems are entitled to access to comprehensive psychiatric and other medical care consistent with prevailing national standards and guidelines.
The Academy rejects all public and private discrimination based on sexual orientation or gender identity of persons of any age particularly in areas of employment, military service, housing, public accommodations, licensing, education, marriage, adoption, parenting, foster care, or qualification as an expert in a court of law.
The Academy affirms the right of all people to their orientation and identity without interference or coercive interventions attempting to change sexual orientation or gender identity. Further, the Academy condemns any restriction on employment or service based on sexual orientation or gender identity of services or treatments to children and adolescents.
American Academy of Family Physicians
The AAFP declared that the association has a policy opposing any form of patient discrimination and stated its opposition to the exclusion of transgender health care.
The AAFP support efforts to require insurers to provide coverage for comprehensive care of [transgender] individuals including medical care, screening tests based on medical need rather than gender, mental health care, and, when medically necessary, gender reassignment surgery.
American Academy of Pediatrics
The AAP recommends the following: 1. That youth who identify as TGD [transgender and gender diverse] have access to comprehensive, gender-affirming, and developmentally appropriate health care that is provided in a safe and inclusive clinical space. … 3. That electronic health records, billing systems, and clinical research be designed to respect the asserted gender identity of each patient while maintaining confidentiality and avoiding duplicate charts. 4. That insurance plans offer coverage for medical, psychological, and when indicated, surgical gender-affirming interventions.
American College of Obstetricians and Gynecologists
Opposes discrimination on the basis of gender identity and urges public and private health insurance plans to cover the treatment of gender dysphoria.
The Endocrine Society
Medical intervention for transgender individuals (including both hormone therapy and medically indicated surgery) is effective, relatively safe (when appropriately monitored), and has been established as the standard of care. Federal and private insurers should cover such interventions as prescribed by a physician as well as the appropriate medical screenings that are recommended for all body tissues that a person may have.
National Association of School Nurses
All students – regardless of their sexual orientation, gender identity, or gender expression – are entitled to a safe, supportive and inclusive school environment with equal opportunities for achievement and participation.
National Association of Social Workers
NASW endorses policies in the public and private sectors that ensure nondiscrimination, that is sensitive to the health and mental health of transgender people, and that promote an understanding of gender expression and identity issue. NASW advocates for the availability of comprehensive psychological and social support services for transgender people and their families that are respectful and sensitive to individual concerns.
World Professional Association for Transgender Health
Gender affirming/confirming treatments and surgical procedures, properly indicated and performed as provided by the Standards of Care, have proven to be beneficial and effective in the treatment of individuals with transsexualism or gender dysphoria.” “The medical procedures attendant to gender-affirming/confirming surgeries are not ‘cosmetic’ or ‘elective’ or for the mere convenience of the patient. These reconstructive procedures are not optional in any meaningful sense but are understood to be medically necessary for the treatment of the diagnosed condition.
As you all know or should know by now, I am transgender and have lived as Mika since 11 October 2009.
Coming out as a transgender woman was the scariest and hardest things I have ever done. It was more frightening than learning about my ultra-rare genetic disease called cystinosis, which will eventually take my life. Being transgender would lead to a lifetime of bullying, harassment, and discrimination. It would mean losing friendships and relationships with my biological family.
Because of the laws in this nation and in Nebraska, I am forced several times a week to come out. I am outed every time I show my ID, every time I go to a doctor’s office, hospital, and pharmacy because my legal sex is still male on my ID and Medicaid file.
One of the first times I experienced significant discrimination because of my gender identity was in 2011 when my kidney failed, and I needed a kidney transplant. Therefore, I went to the Nebraska Medical Center (now known as Nebraska Medicine) to be listed for a transplant and begin hemodialysis. Later, I was denied a kidney transplant (I had a living donor) because of my transgender status.
Unfortunately, I live with severe depression and other mental health concerns because of the animus, discrimination, and physical and sexual assaults that I have survived.
In the past couple of years, my gender dysphoria has been exacerbated, which led to harmful, destructive, and suicidal behaviors. I felt so bad that I frequently did not have the will to continue to fight the near daily battles to have my identity recognized and validated. I was exhausted from the daily struggles to prove my gender and to be treated with respect and dignity.
In January of 2017, I was exhausted from fighting the battles of living with an ultra-rare genetic disease, being transgender in the United States, living in poverty, and being a young adult. These daily struggles broke me. Therefore, I attempted to cope by taking my own life. I wanted to rest. I could not see a future where I did not experience constant daily struggles and where I would be normal.
Because I could not have gender affirming surgery, I continue to struggle to form the most basic human relationships – intimate relationships, which continue to exacerbate my mental health conditions. Thus, I continue to experience immeasurable and indescribable self-hate. I hate that my body does not align with who I am, and sometimes, I would rather destroy my body because of how much it disgusts me than life. These feelings continue to debilitate me, they ruin my life and damage everything from my health, my academic performance, and my attempts to relate to people and form relationships. I even struggle to complete daily tasks.
The hundreds of thousands of transgender, intersex, and nonbinary people across the United States and myself need you to act and fight back against the Trump Administration and the Republicans. Please call, email, write, and confront your local government representatives and demand they protect transgender, intersex, and nonbinary people.
Please go to any of these organizations to join the fight: