On November 1, the Maryland Carey Law LGBTQ law student organization, OutLaw, the Student Health Law Organization, and the Journal of Health Care Law & Policy hosted a panel on health law in the lesbian, gay, bisexual, trans, and queer (LGBTQ) community. The panel included three lawyers and a pediatric endocrinologist:
The panelists discussed their legal and advocacy efforts on behalf of the LGBTQ community.
Alex Garnick, a 2013 graduate of Maryland Carey Law, talked about his efforts to advocate for LGBTQ students while in law school. Garnick successfully advocated for inclusion of gender identity in the school’s non-discrimination policy as well as insurance coverage for same sex partners of students. While proud of these successes, Garnick also detailed the barriers he faced personally in obtaining insurance coverage for health care. He notes, “There was an explicit exclusion of trans health care in the student health insurance policy. It was applied broadly to deny health care services that were completely unrelated to transition.” Garnick met with the law school administration as well as the entire faculty to advocate for change to the policy. That advocacy did not come without a cost. Garnick notes that he had to compromise his own privacy in the process, including speaking publicly about personal health matters.
Garnick also spoke frankly about the challenges he faced navigating the health system as a transgender person where many physicians lack the knowledge and skills necessary to appropriately address the specific health concerns of transgender individuals. He talked about the isolating nature of these experiences but commended those health care organizations, such as Chase Brexton in Baltimore and Whitman-Walker Health and One Medical in Washington, D.C., that are working to implement best practices and provide services for a community that faces significant barriers to access.
He emphasized the important role attorneys can play as advocates for members of the LGBTQ community, particularly in light of changes in leadership at the federal level and the impact of these changes on the interpretation and implementation of laws such as the Affordable Care Act.
The panel also discussed the barriers trans individuals face in obtaining legal documents, such as driver’s licenses and birth certificates, that reflect their gender identity and the role of the health care system in addressing these barriers.
In Maryland, for example, a trans person can only update these documents if a health care professional certifies that they have undergone gender affirming health procedures, such as hormone therapy and surgery. Many trans people, however, do not want to receive these treatments or cannot afford them and are therefore prevented from obtaining legal documents that accurately reflect their gender identity. The panelists discussed their successful efforts to change these requirements in other jurisdictions. In Washington, DC, for example, trans people can update their driver’s license by self-attesting to their gender identity instead of needing a third party. DC has also created a third gender option on driver’s licenses for those who do not identify as men or women. The panelists emphasized the important role that these legal documents play in protecting trans individuals from harassment and violence.
Allison Dowling, Staff Attorney with Whitman-Walker Health, an integrated health center in Washington, D.C., noted the intersection of numerous areas of the law when working on behalf of the LGBTQ community. She and her colleagues handle a variety of cases, ranging from access to insurance; to immigration to discrimination cases involving health care providers refusing to provide service to trans individuals; as well as housing and employment discrimination. In addition, many clients were born in other parts of the country with varying policies and procedures with regard to changes to birth certificates and other legal documents. Ms. Dowling asserts that the medical-legal partnership model, employed by Whitman-Walker Health, is particularly well suited to meet the often complex needs of LGBTQ clients.
Whitman-Walker Health was one of the first medical-legal partnerships established in the U.S. and provides fully integrated health care, including the provision of legal services on-site. Dowling notes, “The ability to provide coordinated care is really important, particularly for the most vulnerable members of our community. When our Public Benefits and Insurance Navigation team is not able to obtain approval for one of our clients, for example, the legal team can jump in and request a fair hearing much faster than if the client had to handle the matter on their own.”
Attorneys also help to facilitate medical decision making. “We work with clinicians to help clients make informed decisions about medication based on our knowledge of insurance coverage and how best to respond to denials of coverage.” Dowling advocates for broader implementation of medical legal partnerships, “Bringing the different professions together to work on behalf of clients enables our clinic to provide better care and achieve better outcomes across systems of care than if it were just one of us in the room.”