If Medical Groups Care About LGBTQ Patients’ Health, They Must Resist Trump’s HHS Pick

Rep. Tom Price scored zero percent on the HRC’s most recent Congressional Scorecard.

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Donald  Trump’s choice of Republican Rep. Tom Price of Georgia to be the next secretary of health and human services has drawn what could charitably be called a mixed reaction. While some medical groups hastily issued statements in support of his nomination, many others have expressed grave concerns about the decisions he would make as head of HHS.

The response from groups dedicated to the health and welfare of LGBTQ people has been one of alarm. Given his terrible record as a member of Congress, should he be confirmed, our community will  need to be vigilant in protecting access to medical care for the full range of our health needs.

Citing Price’s abysmal zero percent approval on the Human Rights Campaign’s Congressional Scorecard and his dedication to the repeal of the Affordable Care Act, the Gay and Lesbian Medical Association didn’t hesitate to oppose his nomination.

“Rep. Price’s record on LGBT health and equality stands in sharp contrast to his two predecessors at HHS who have worked hard over the last 8 years to ensure the department’s policies and programs address the health issues LGBT people experience,” its statement concludes. “GLMA stands prepared to work with our partners to protect this legacy of inclusion and speak out against anyone who opposes and/or seeks to dismantle it.”

The many ways in which Rep. Price has worked against equality for LGBTQ people and fought protection for our families were spelled out by the advocacy group GLAAD. In addition to his support for a constitutional amendment banning same-sex marriage, and his opposition to laws aimed at protecting LGBTQ people from workplace discrimination, Rep. Price was among a small number of House members to attend a “Take Back America” conference that featured a lecture titled “How to Counter the Homosexual Extremist Movement.”

Unfortunately, Rep. Price’s unambiguous antipathy to the wellbeing of LGBTQ people didn’t stop some prominent medical associations from backing his nomination.

Perhaps because of Price’s experience as an orthopedic surgeon before being elected to Congress, the American Medical Association was quick to offer its “strong support” and urged that he be swiftly considered and confirmed. Similarly, the American Association of Medical Colleges expressed confidence “that Rep. Price will bring a thoughtful, measured approach” and said the nation’s institutions of medical education look forward to working with him.

Many physicians did not share these rosy sentiments, however.

More than 700 members wrote an open letter to the AMA, requesting that the organization (of which I am not a member) clarify its stance on a host of subjects on which Price opposes official AMA positions. Issues affecting LGBTQ patients and medical providers were among those areas of disagreement.

Criticism of the AMA’s endorsement also came from the Clinician Action Network, a newly formed progressive medical advocacy organization. More than 5,000 physicians (including the chair of the AMA Advisory Committee on LGBTQ Issues) have signed on to the statement “The AMA Does Not Speak for Us,” which takes the organization to task for failing to consider the myriad ways Price’s nomination will be harmful for patient well-being. (I was happy to add my name.)

As the CAN statement notes, AMA members comprise a small percentage of practicing physicians in the United States. By contrast, every medical school in the country is a member of the AAMC. This led medical historian and author Alice Dreger to explain, via Twitter, why the AAMC’s endorsement is in many ways more troubling, including its apparent indifference to Price’s hostility to LGBTQ people. Education about the specific medical needs of gay, lesbian, and trans patients is already lacking in U.S. medical schools, and policies shaped by an overtly unfriendly administration could only make that deficiency more stark.

To its credit, since endorsing Price, the AAMC has issued an additional statement about its decision. “We have heard your concerns about the nomination of Dr. Tom Price,” it reads, “and want you to know that the AAMC continues to advocate for access, equity, and quality health care. We will work with lawmakers on policy issues and, when needed, oppose positions that would jeopardize the missions of academic medicine and the patients we serve.”

While a newer statement from the AMA’s board chair does seem to acknowledge the criticism the organization received for its endorsement by stipulating “our support for Dr. Price to lead HHS should not be taken as an endorsement of every policy position he has advocated,” it does not directly refer to concerns raised about his record when it comes to LGBTQ people.

It’s not merely Price’s past harms that are cause for alarm, of course, but also what they portend for how he may negatively affect our community in his new position. As secretary of health and human services, he’ll be in a position to do concrete damage to the health of gender and sexual minority patients.

“We have a great diary of what Tom Price has said, and what his thoughts are,” Dr. Raymond Cattaneo, a Kansas City pediatrician, told me. “And even though they are general ideas, I think that we can take those words to really look at how it’s going to affect my [patient] care.”

A gay man himself, Cattaneo has a number of LGBTQ patients. (I was particularly interested in Cattaneo’s thoughts about how Price’s tenure at HHS could affect the care trans people can access—I don’t currently have any trans patients myself.) He worries that Price’s rhetoric may threaten the safety of those patients and the medical care he will be able to deliver to them.

“We were seeing a shift, especially in the insurance industry, to start covering more treatments for our trans patients,” he said.  He described a trend under the current administration toward greater access to care for these patients. He expects that progress to halt.

“I’m going to have to call more people, I’m going to have to have more one-on-one talks with medical directors of insurance companies,” he told me, “I’m going to have to write more letters saying, ‘No, this person is not the gender they were assigned at birth, they’re actually this gender’ so they can get name changes and birth certificate changes. And that’s going to be more difficult.”

Cattaneo also predicts other, subtler erosion of LGBTQ health.

“[Price] has been a huge proponent of Medicaid block grants,” he continued. “With block grants, we know from history, HIV services go down. Money is not there to support every program, and oftentimes HIV services that have been offered go away because there just isn’t money for them. He has had legislation in which he specified block grants, so I think we have a pretty good idea that is one of his goals.”

As HHS secretary, Price wouldn’t be able to accomplish this policy change single-handedly, but given the partisan makeup of Congress and the GOP’s overall opposition to extending Medicaid under the Affordable Care Act, Cattaneo fears block-grant funding and related cuts to HIV services are real possibilities.

While some doctors are sanguine about how Rep. Price might ease regulatory burdens at HHS, those considerations should be secondary to the negative effects his tenure could have on our ability to care for our patients. Though my objections to his nomination aren’t limited to his record on LGBTQ issues, his unmistakable antipathy to our equality and his potential to severely curtail access to medical care for members of our community is reason enough to oppose him. I urge all medical organizations that are silent on his nomination to speak out against it. (I’m looking at you, American Academy of Pediatrics.) And those that have endorsed him should reconsider.