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Sexual Orientation Policy Tally

The term “sexual orientation” is loosely defined as a person’s pattern of romantic or sexual attraction to people of the opposite sex or gender, the same sex or gender, or more than one sex or gender. Laws that explicitly mention sexual orientation primarily protect or harm lesbian, gay, and bisexual people. That said, transgender people who are lesbian, gay or bisexual can be affected by laws that explicitly mention sexual orientation.

Gender Identity Policy Tally

“Gender identity” is a person’s deeply-felt inner sense of being male, female, or something else or in-between. “Gender expression” refers to a person’s characteristics and behaviors such as appearance, dress, mannerisms and speech patterns that can be described as masculine, feminine, or something else. Gender identity and expression are independent of sexual orientation, and transgender people may identify as heterosexual, lesbian, gay or bisexual. Laws that explicitly mention “gender identity” or “gender identity and expression” primarily protect or harm transgender people. These laws also can apply to people who are not transgender, but whose sense of gender or manner of dress does not adhere to gender stereotypes.

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Health Care Religious Refusals Endanger Millions

New report highlights the coordinated efforts to insert exemptions into health care

Washington, DC, March 26, 2018—In the wake of the Trump Administration’s announcement of a new Conscience and Religious Freedom Division within the Department of Health and Human Services, and proposed rules that seek to radically expand the ability of health care providers to deny patients care based on religious or moral beliefs, the Movement Advancement Project (MAP) and the National Center for Transgender Equality (NCTE) are releasing a new report, Religious Refusals in Health Care: A Prescription for Disaster. The report examines the coordinated efforts to allow medical providers to legally discriminate and deny needed care—from the recent actions at the federal level to the lack of nondiscrimination protections at the state level.

Tomorrow, Tuesday, March 27, a public comment period closes on the proposed rules from the Department of Health and Human Services that would allow healthcare providers to refuse care based on religious or moral beliefs. At the state level, virtually every state has healthcare-specific religious refusal laws allowing medical providers to refuse to perform certain procedures or to prescribe or dispense medications, and more states are considering these types of health care-specific religious refusal laws.

The growing number of religious exemptions in health care could encourage doctors, hospitals, paramedics, and other medical providers to pick and choose which patients they will treat, and who receives medically-necessary treatment. The risks are particularly high in low-income or rural areas, where fewer healthcare providers exist in the first place: if one doctor refuses treatment, there may be no alternative source of care available.

“These religious exemption laws are undermining the foundation of our medical system, which should be to put patients first and to do no harm,” said Ineke Mushovic, executive director of MAP. “When doctors can pick and choose who to serve and what care to provide based on their personal beliefs rather than medical best practices and patients’ need, it puts everyone at risk. For women and other communities, such as LGBT people, people of color, low-income people, or individuals with disabilities, finding competent and qualified healthcare providers is already difficult enough, and healthcare refusals mean they don’t get the health care they need.”

Religious Refusals in Health Care: A Prescription for Disaster outlines the key types of health care which will be at risk if providers are able to refuse treatment and choose which patients they wish to serve, resulting in broad and dangerous harms, including:

  • Creating a health care system where patients' health comes second to health care providers' personal beliefs.
  • Restricting access to a wide range of reproductive health care, including emergency care.
  • Allowing healthcare providers to limit information shared with patients.
  • Refusing health care for patients because of who they are, including women, transgender people, LGBT people, and children of LGBT parents.
  • Permitting refusals of care for sexual health, including sexually-transmitted infection and HIV-related health care.

“Many transgender people already live in fear of harassment, discrimination, and violence when seeking health care,” said Mara Keisling, executive director of the National Center for Transgender Equality (NCTE). “Religious refusal laws and policies are doubly harmful: they worsen this already prevalent problem, and they misrepresent what religious freedom really is. Twisting the language of civil rights to promote discrimination does a disservice to this important value.”

Thirty-one states lack explicit legal protections against discrimination in health care and public accommodations. Even in states with nondiscrimination laws, some business owners and service providers are suing for the right to refuse service based on their religious beliefs.

This report builds off of the findings and recommendations of a November 2017 MAP report, Tipping the Scales: The Coordinated Attack on LGBT People, Women, Parents, Children, and Health Care, which detailed how religious exemption laws are being pushed forward, and their impact millions of people including 10 million LGBT people and their children, 11.6 million single parents and children, 14.1 million unmarried couples, 62.4 million women who are eligible for birth control under the Affordable Care Act, and 1.6 million unmarried pregnant women.

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MAP's mission is to provide independent and rigorous research, insight and communications that help speed equality and opportunity for all. MAP works to ensure that all people have a fair chance to pursue health and happiness, earn a living, take care of the ones they love, be safe in their communities, and participate in civic life.

The National Center for Transgender Equalityis the nation’s leading social justice advocacy organization winning lifesaving change for transgender people.


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