On Monday, June 15, 2020, the Supreme Court issued a landmark ruling expanding employment discrimination protections guaranteed by the Civil Rights Act of 1964 to LGBTQ employees. This should be cause for celebration, except that it was juxtaposed with a policy change to the Affordable Care Act made by the Department of Health and Human Services three days earlier allowing providers to refuse care to patients who identify as gay, lesbian, bisexual, transgender, non-binary or queer. This has made for a confusing time for the LGBTQ community during a month usually reserved for celebrating Pride.

There is still reason for some hope, says Robbie Goldstein, MD, PhD, medical director of the Massachusetts General Hospital Transgender Health Program.

“It is not legislation. It is not judicial action. And it does not take effect for 60 days from the date that it is finally published," he says. “So nothing will change for anyone across this country over the next 60 days. The hope is that judicial action will actually push back on this ruling.”

The Impact on Transgender Health

The Transgender Health Program at Mass General has always been committed to providing gender-affirming care to all patients.

“Gender-affirming care is lifesaving care,” says Dr. Goldstein. “It is the best tool we have to prevent suicide, violence and trauma against the transgender community.”

But despite the inclusive nature of care at Mass General, the impact of the policy change could be far-reaching. Massachusetts already has laws in place protecting people based on gender identity and sexual orientation in health care. So patients who live in Massachusetts or have Massachusetts-based insurance will likely not be affected. But the challenges in obtaining coverage for gender-affirming care could come for those patients who travel for care at Mass General.

“It becomes our responsibility to advocate and fight for those people who may not be able to get care," says Dr. Goldstein. “Local and national advocacy are going to be really important to build up the laws in each state to protect folks no matter where they live, and to try to bring down the federal regulations that are denying care.”

Groups like Lambda Legal, GLAD and the Human Rights Campaign have already been fighting these laws in court and are waiting to see how the Supreme Court decision affects health care rulings.

The Current Climate

And of course, these changes have come during the COVID-19 pandemic and the Black Lives Matter protests around the country, which both have a tremendous impact on transgender health care.

During COVID-19, the transgender community has not been able to visit support groups or affirming spaces, has struggled to receive medications that require injections in a health care setting and has had surgeries delayed, which have not yet been rescheduled.

At Mass General, clinicians worked quickly to maintain their connections with patients and the community, Dr. Goldstein says.

“We very quickly turned to virtual visits and figured out ways that we could get people in for injections. We have obviously had roadblocks, but we have tried to be very present for our patients.”

The Transgender Health Program has always been built on a racial justice mission. They see more patients of color on average than the hospital as a whole and work hard to make sure the spaces are gender-affirming, racially affirming and ethnically affirming.

“There’s no other group in the U.S. that experiences violence at the rate of trans women of color,” Dr. Goldstein says. And as such, he has seen the transgender community come out strong during the Black Lives Matter protests and national conversation.

“The trans community has really come out to say: ‘We are here. We are part of this conversation and we are not just black women. We are not just trans women. We are a group that has all this intersectionality and it is important for us to be there and to be a part of the conversation.’”

The Transgender Health Program is committed to meet patients where they are and affirming who they are, and have been active in the community partnering with organizations like the Trans Club of New England, the AIDS Action Committee, the Boston Living Center – Victory Programs and BAGLY to further support the community amid troubling and confusing times.

Celebrating Pride

In 2020, Pride celebrations were cancelled due to the COVID-19 pandemic. However, virtual celebrations occurred around the world. But Dr. Goldstein sees Pride Month as a time to reflect on his work with the LGBTQ community throughout the year.

“Pride Month is not the only time of the year when this hospital or the Transgender Health Program or any of us does the work of caring for LGBTQ patients,” he says. “We are committed to the broader LGBTQ community year-round. But in June we get to stop for a second and recognize the work that is being done, the community that is stronger because of that work and all the people here at Mass General who do the work every single day to make this place better for LGBTQ folks.”