The Terrifying Part of the ACA Repeal That’s Already Affecting Trans and Pregnant People

Continuing his crusade against treating all human beings like human beings, Trump is currently targeting the rights of transgender people and pregnant people. The administration plans to roll back sweeping federal nondiscrimination provisions enacted under the Affordable Care Act (ACA) that protect transgender people and pregnant people.

Everything happening today is overwhelming, but let’s hold one another and try to understand the many layers of what’s going on and what the implications are.

First, let’s set the scene: This morning, Trump signed an executive order on “religious liberty.” Or, as Rachel put it, “not in the sense of actual religious liberty, but in the vein of the Religious Freedom Restoration Acts that empower people and organizations to deny access and services to LGBT people and others.”

Also today, the House is set to vote on a rushed version of the Republicans’ health care bill to replace Obamacare. Not only does Trumpcare 2.0 weaken the definition of pre-existing conditions and raise premiums, the bill will reportedly also defund Planned Parenthood, meaning 400,000 women will lose access to healthcare—in addition to the estimated 24 million that would lose health coverage under the first version of Trumpcare. The bill is so bad, apparently, that Congress has exempted itself from the law’s provisions.

There’s one more thing, though. On Tuesday, the Department of Justice filed a remand and stay regarding “will pause ongoing litigation in a conservative Texas federal district court that had temporarily blocked the Section 1557 regulations and send the regulations back to the U.S. Department of Health and Human Services (HHS) — presumably to gut them. DOJ officials in March decided not to challenge District Court Judge Reed O’Connor’s injunction, which will remain in place while the regulations are remanded back to HHS.”

According to the Health & Human Services website, “Section 1557 makes it unlawful for any health care provider that receives funding from the Federal government to refuse to treat an individual – or to otherwise discriminate against the individual – based on race, color, national origin, sex, age or disability. Section 1557 imposes similar requirements on health insurance issuers that receive federal financial assistance.”

According to Rewire, “that means even religious and religiously affiliated providers that accept money from the federal government can’t deny patients health care or health coverage. If they do, Section 1557 provides a legal vehicle to sue for, say, people seeking sterilization, those seeking abortion care, or transgender patients seeking any health-care services.”

To simplify what this all means:

In a statement, National Center for Transgender Equality Executive Director Mara Keisling said, “The Section 1557 regulation has been literally life-saving for transgender people all across the country, who are routinely turned away from emergency rooms and doctors’ offices and refused coverage for critical medical care. Now, the Trump administration is going after transgender people yet again and trying to take away these basic protections.”

Transgender people face systemic discrimination within the healthcare system, and the impact of condoning outright refusals to provide care perpetuates what is already a minefield of discrimination for transgender people seeking to access care. A community-wide disengagement from the health care system results in dire health outcomes for transgender people, according to TLDEF:

“Rather than enduring abuse and poor treatment, transgender people often simply do without health care. The situation is made worse because in many ways, transgender people have a greater-than-average need to access health care. Transition-related hormone treatments and surgical procedures require partnership with a trustworthy healthcare provider. The alarming rate of HIV infection in parts of the transgender community similarly points to a heightened need for transgender people to access health care without fear of discrimination and poor treatment.”

What’s more is that according to GLAAD, “With transgender people living in poverty at 4 times the national average, a staggering 19% of transgender people report lacking any form of health insurance, including Medicaid.”

As the House debates its repeal of Obamacare, with opponents reading letters of opposition from groups like the American Medical Association and citing statistics of the deplorable impact of this new bill, it’s hard not to crumble under the weight of what might happen to me, my partner, my family, and scores of people I know. But really, Trump’s position in office has already, and will continue to unequivocally impact trans and gender nonconforming people, women, the LGBTQ community, people of color, and the working class.

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Priya Arora is a queer-identified community activist, editor, writer and Netflix enthusiast. Born and raised in California, Priya has found a home in New York City, where she currently works as a Web Editor at Hearst Business Media and the Humanities Editor at Brown Girl Magazine. When she’s not working, Priya enjoys watching old school Bollywood movies, laboring over NYTimes crossword puzzles, reading books she never finishes, and eating way too much of her partner’s homemade Hyderabadi biryani. You can follow her on Facebook and Twitter.

Priya has written 7 articles for us.


  1. Everything that’s happening is heartbreaking. This is why I am immensely frustrated with friends and family that believe that things aren’t so bad, because “Trump hasn’t actually done anything.” This administration hasn’t done anything to the cis privileged classes, but plenty to trans and gender nonconforming people, women, us, people of color, and the working class.

  2. I refuse to live in fear. We need to stay positive, because not only does it make the world a better place, but it is self-survival for transgender people. There are so many things each day that I could let paralyze me:

    In the last 8 months:
    I have been kicked out my home twice
    I moved 5 times
    I have been fired from 4 jobs
    I was homeless
    My sister disowned me
    I lost most of my friends
    Been pushed out of my profession
    Gone into almost inescapable debt
    Been hospitalized after being denied medical care from four different doctors for mere preventive care
    Been sexually assaulted

    Now, after overcoming all of this, why should I let the ACA news scare me? I am a Lion. I am a strong woman with a powerful, supportive network of friends. The world has tried and tried again to beat me down, and I’m still standing. And still smiling.

    So please don’t let this news get you down. We have so much power when we indulge in self-care and love. Give yourself that bubble bath. Dance, sing, and laugh more. When others expect us to hide or get angry, the revolution is a smile.

    • I am sorry to hear that. I am currently a graduate student, working 40-50 hours a week and homeless. I’ve moved a lot, lost a lot of family and friends, and generally been in a terrible mood going on 4 months now. Hang in there, sister. I will try to do the same.

      • I truly admire your strength. I can’t imagine what you’re fighting your way through but wish you all the courage to keep going. Hopefully, the time will come soon, when life falls into place for both you and for Saga, above.
        Hugs from the other side of the world, if you want them.

  3. Fuck. I’m just…so tired already. I’m already tired of fighting doctors and my insurance company to get the care I need and to sort out why I’m experiencing some health problems (and I’m not even having to worry about paying for things because my parents are helping me out and can afford to do so and I am incredibly lucky and privileged there). The last thing I need is to lose my insurance coverage or allow companies to raise my prices because I have like 6 “pre-existing conditions” or just deny me care. Or be even more anxious and afraid in ERs that I might be treated even more poorly or just flat-out denied care due to my gender, especially since I have “gender dysphoria” all over my health records (because to get coverage for trans-related care from my insurance company I needed that diagnosis) so I can’t even try to hide it.

    Just…fuck. I just want to be able to live and not worry about putting myself or my family into bankruptcy to do so. I’m scared that that might become even more of a concern.

    • The whole situation is horrible, and it pains me to watch it unfold from where I live (Canada). I really feel for you and hope that you’re able to cope successfully.

  4. How is it legal that congress can exempt themselves? Can we like start a kickstarter and to make commercials(or billboard ads like internet advocates have) in the home district of these assholes? Like have it say the guy who made $400k taking lobbying money(there not suffering) is exempt from this? Make it clear to the constituents that they are voting against the consumer.

  5. “Continuing his crusade against treating all human beings like human beings” is such an accurate and succinct way to phrase what’s happening, which is in itself horrifying.

  6. Can I ask something, as a clueless Canadian? Does this bill “merely” try to take things back to the pre-ACA status quo, or does the list of allowable exemptions actually make the situation worse than it was before? Because one of my friends just posted the full list and it is fucking insane. There are everyday things on there like anxiety, or sleep problems, or heartburn, for fuck’s sake. It is literally a list designed to ensure that no human being is actually eligible for insurance.

    • Well, it’s not that people with pre-existing conditions are ineligible for insurance, it means that the insurance companies can charge anything they want for covering people with pre-existing conditions. This means that many people may be unable to afford insurance, because the insurance company makes it too expensive. So, it’s not likely a person with heartburn will have to pay a lot of extra money, but someone with cancer would be charged so much they couldn’t afford any insurance. When we’re talking just about the extra charging for pre-existing coverage, the situation isn’t really any different than before the passage of Obamacare. But if you look at a bunch of other things in this bill, the situation will be much worse than before Obamacare. A big part is Medicare, a system which provides healthcare coverage primarily to the elderly and disabled. People pay into Medicare throughout their working lives, and this money goes to Medicare recipients. Then, when those people are older and retired, their Medicare is paid for by the younger, working generation. This new healthcare bill cuts Medicare spending by 25%- which is pretty bad considering Medicare isn’t an entitlement program, it’s something people have paid into.

  7. This is all so horrible :( My thoughts are with American trans people and American pregnant people but also with America just in general because your health system is so bad :( You just need an NHS and (like everywhere) fewer prejudiced people.

    • Are you trans? Are you a certified healthcare professional who works with trans patients? If not, what qualifies you to make these statements?
      “…leads to higher risk of disease from intravenous drug use.” Citacian badly needed there, bucko.
      Insurance companies are more likely to cover chiropracty-dangerous quack medicine-than gender affirmation treatment-which multiple studies have shown to benefit the physical and mental health of trans people.

    • Hi Woethe: all medications have potential risks, but using hormones as perscribed is generally very safe. The “higher risk of disease from intravenous drug use” that occurs with street drugs generally comes from sharing needles, which can lead to the spread of blood borne illnesses like HIV, or from dangerous impurities in the substance injected – neither of which is a concern when using medical grade hormones with clean needles (as one would do when receiving proper medical care). Gender confirming Surgeries are also generally safe when performed by a competent practitioner, and can lead people to feel much greater comfort with their bodies.

      As for whether transition related care is “voluntarily done on a healthy body” – hormones and gender confirming surgeries are treatments for gender dysphoria. While the medical commmunity increasingly recognizes that being trans is not itself an illness (see the DSM V), being trans is often accompanied by gender dysphoria, which is the distress a person experiences as a result of the sex and gender they were assigned at birth. This can be very intense and have serious health consequences, up to and including suicide. For some, social transition is enough, but for many physical changes are necessary to ease this pain. In addition, while no one should have to make changes for this reason, the truth is that treatents that allow someone to pass as cis offer some level of protection from the harrassment, assault, and other forms of discrimination and violence often faced by the trans community (which of course have their own health consequences).

      Not all trans people need or want hormones and/or surgery to transition, but for those who do, these are important medical treatments and they should be covered as such.

    • friendos: if you see stuff like this again, you can tag me ( @alarae ) and i will mod/take care of it. i don’t want y’all to have to put out the emotional energy for awful stuff like this <3

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