How the Religious Freedom Division Threatens LGBT Healthand Science

When Marci Bowers consults with her patients, no subject is off limits. A transgender ob/gyn and gynecologic surgeon in Burlingame, California, she knows how important it is that patients feel comfortable sharing their sexual orientation and gender identity with their doctor, trust and honesty being essential to providing the best medical care. But Bowers knows firsthand that the medical setting can be a challenging place for patients to be candid. That for LGBT people, it can even be dangerous.

"I know from talking with patients that they're often denied services, not just for surgery and hormone therapy, but basic medical care," Bowers says. "I've had patients show up in an emergency room who were denied treatment because they were transgender."

Experiences like these are what make the creation of a new "Conscience and Religious Freedom" division within the US Department of Health and Human Services so troubling. Announced last week by acting secretary of HHS Eric Hargan, the division's stated purpose is to protect health care providers who refuse to provide services that contradict their moral or religious beliefs—services that include, according to the division's new website, "abortion and assisted suicide."

But the division's loose language could leave room for physicians to provide substandard care to LGBT patients—or abstain from treating them altogether. Indeed, in a statement to WIRED, an HHS spokesperson said the department would not interpret prohibitions on sex discrimination in health care to cover gender identity, citing its adherence to a 2016 court order that excluded transgender people from certain anti-discrimination protections.

That's obviously bad for the health and wellbeing of LGBT people, who may feel less comfortable sharing their sexual orientation or gender identity going forward—but it's bad for science, medicine, and policy, as well.

At its core, the new HHS office threatens data and understanding. Collecting facts and figures on sexual orientation and gender identity fills valuable gaps in the medical community's comprehension of LGBT patients and their public health needs, and progress on that front has accelerated in recent years. "Gathering these details has tremendous potential to improve care for LGBT people," says psychologist Ed Callahan, who in 2015 helped orchestrate the addition of fields for sexual orientation and gender identity—aka "SO/GI"—to electronic health records at UC Davis, the first academic system in the country to do so. The more data doctors and policymakers have on LGBT people, the better they can understand the institutional hurdles, social challenges, and public health risks they face as sexual minorities.

The creation of the new HHS division is but the latest development in an ongoing battle over whether and how that data is collected. As of this year, the Office of the National Coordinator of Health Information Technology requires outpatient clinics to use software that collects SO/GI information if they receive federal incentive payments for using government-certified electronic health care records. The Bureau of Primary Health Care requires health centers to report the sexual orientation and gender identity of their patients. And the Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services continue to encourage data collection on SO/GI.

"There’s actually been a lot of good work happening at the Veterans Health Administration," says Sean Cahill, director of health policy research at the Fenway Institute, a Boston-based center for research, training, and policy development on LGBT-related health issues. Since 2012, the VA has encouraged the collection of SO/GI data and issued directives that ensure respectful, equitable, culturally competent care for LGBT veterans. And by the end of Obama's presidency, the number of federal surveys and studies measuring sexual orientation had increased to 12, seven of which also measured gender identity or transgender status. "So the good news is that the shift to gathering these data has been underway for several years, and does continue," Cahill says.

But data collection has slowed under the Trump administration. In the past 13 months, surveys collecting data on participation in Older Americans Act-funded programs and Administration for Community Living-supported disability services have removed questions pertaining to sexual orientation and gender identity. In the same time span, numerous political maneuvers have sown uncertainty and distrust throughout the LGBT community. A July 2017 directive from President Trump attempted to ban transgender people from enlisting in the military, and in December policy analysts were presented with a list of banned words—including "transgender"—not to be used in official CDC budget documents.

In short: Under the Trump administration, the country is simultaneously collecting less data and promoting conditions that leave LGBT patients wary of their healthcare providers. "These patients already face significant obstacles to accessing medical care, and I fear implementation of these measures will only make these obstacles worse," says Stanley Vance, a pediatrician at University of California San Francisco and an expert in the care of gender nonconforming youth. "I also worry that these measures will be an institutionalized form of discrimination against patients who have been identified as a sexual minority or transgender who freely come out to their providers or through information previously entered in electronic medical records."

Even when physicians don’t overtly discriminate against gay and transgender patients, negative health care experiences are routine. Many physicians simply don't think to consider a patient's SO/GI—information they can use to not only respect their patients, but screen them for family rejection, which studies show increases the risk for depression, suicide, and high-risk sexual behaviors. Failing to acknowledge a patient's SO/GI can compound the ill effects of social stigma and inaccessibility to care like hormone therapy or gender affirmation surgery. "Across the board, LGBT patients are the group least likely to come back for further care," Callahan says. "And that often happens because of ways they are dismissed as not existing."

Of course, the reality is that LGBT people do exist, they're entitled to equitable services and care, and they deserve to be counted—sometimes literally. "It really shouldn't be political, you know? It shouldn't be a partisan issue," Cahill says. "It's about science and data and providing quality care to all patients."

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Why Cokes Non-Binary Super Bowl Moment Mattered

There was a controversial four-letter word aired during last nights Super Bowlnot the kind that gets you in trouble with the FCC, but the kind that advances LGBT media representation in a small but still significant way.

The word was them.

In one tiny moment of Coca-Colas The Wonder of Us advertisement, a non-binary personsomeone who doesnt identify as either male or femaleappeared and the ads voiceover used the singular, gender-neutral pronoun them to refer to, well, them. It was a fleeting moment but eagle-eyed watchers noticed both the use of the they pronoun and the rainbow lanyard draped around the non-binary persons neck. The shout-out to LGBT viewers was as crystal clear as it was quick.

Theres a Coke for he and she and her and me and them, the ad declared, as a diverse array of soda slurping faces flashed across the screen. Theres a different Coke for all of us.

To be clear, this advertisement was Cokes marketing department at its finest : Making the experience of drinking their carbonated elixirs seem somehow synonymous with the fact of being human. This non-binary moment comes from a company that has implored us to taste the feeling, as if pure emotion is something that can be ingested. That messaging works, tooand even a hardened cynic like me has a fridge full of Coca-Cola Vanilla Zero that I am convinced can wash away all my sorrow even though I know nothing can.

So, as Matt Kemper wrote for the Atlanta Journal-Constitution in his own analysis of the ad, it is good to remember this is still about a company trying to build brand, win friends, and sell drinks. Capitalism is still capitalism with all of its attendant problems.

Still given the severe underrepresentationindeed, the near invisibility of non-binary people in the media, the importance of 100 million people hearingthem used as a gender-neutral, third-person pronoun cannot be overstated. People from all swaths of society watch the Super Bowl, including an audience that might never have been exposed to a transgender or gender non-conforming person in real life. These are the sort of baby steps that change the media landscape, little by little.

LGBT viewers were quick to notice the them across social media. LGBT media advocacy group GLAAD, in particular, unleashed a stream of heart and crying emojis in response to the ad, which also featured a same-sex couple.

If Coca-Cola itself didnt have LGBT-friendly policies, the ad would seem like a crass attempt to exploit diversity to sell sodaand some particularly critical viewers will say that it already does just that. But its worth noting that the company has a perfect 100 score on the Human Rights Campaigns Corporate Equality Index. The score indicates the company offers transgender-inclusive health insurance coverage and includes gender identity in its equal employment opportunity policy.

But less important than the actual corporate vehicle for the non-binary moment is the moment itself, which comes after years of tedious debate over the use of they as a singular, gender-neutral pronoun. Despite the Associated Press style guide allowing gender-neutral singular pronouns and Merriam-Websters veritable social media rampage of late reminding people that there are centuries of precedent for using they as a singular pronounthere is still widespread resistance to the usage, even in liberal circles.

In fact, last May, a New York Times op-ed misgendered non-binary actor Asia Kate Dillon, who appears in the Showtime series Billions. In a follow-up column, then-public editor for the Times Liz Spayd explained that opinion editors, who generally follow the style and usage guidelines of the newsroom, were under the impression that they could not be used as a singular pronoun. As I wrote at the time, the editors took someone elses identity in[to] their hands and reshaped it to fit the demands of a style guide. One of the first and certainly the most prominent non-binary person to appear on television couldnt even be granted the dignity of the four letters that best describe their identity.

And if The New York Times has this much trouble with they, you can imagine how the far-right media feels about non-binary people adopting the pronoun as their own. Mocking pronoun choices by transgender people is practically a pastime among that crowd.

But non-binary people arent going anywhere. An unweighted 36 percent of the thousands of respondents to the 2015 U.S. Trans Survey identified as non-binary. If thats anything close to indicative of the ratio of binary transgender people to non-binary people, that means there are hundreds of thousands of American adults who dont identify as either male or female. And market research, as Broadly has previously reported, suggests that Generation Z is especially likely to embrace non-binary identification. Fifty six percent of 13-to-20-year-olds told the J. Walter Thompson Innovation Group that they knew someone who used they as their pronoun.

To whatever extent the inclusion of a non-binary person was motivated by an attempt to capture millennial beverage buyers, the net effect is the same: Super Bowl viewers, even the socially conservative ones who might not be keen on transgender rights, heard the use of a pronoun that is only going to grow more common in the coming years.

Judging by the rate at which young people now feel comfortable identifying as LGBT and gender non-conforming, including a non-binary person in a widely-watched TV advertisement will one day be unexceptional, barely worthy of note. At some point, those four letters will be about as normal to overhear as he or she.

But last night, they mattered.

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Trump Administration Protects Your Right to Discriminate Against Women and LGBT People

Suppose my baby daughter gets sick one evening. We bring her to the nearest ER, but the doctors there say they wont treat the child of a same-sex couple because they have moral objections. Thats perfectly legal.

Or suppose a friends teenage daughter is three months pregnant, and suddenly begins bleeding. My friend calls the ambulance, but the ambulance driver says he wont take her, because it looks like she might require an abortion, and the driver doesnt want to assist in an abortion. Also perfectly legal.

Or suppose my friend is transgender. Shes been seeing her doctors for years, but when shes traveling for business and needs emergency care, shes denied treatment because the hospital chain, as a matter of faith, moral conviction, or professional medical judgment, believes that maleness and femaleness are biological realities to be respected and affirmed, not altered or treated as diseases. Thats rightalso perfectly legal.

That quotation comes from a 2016 paper co-written by Roger Severino, then the director of the DeVos Center for Religion and Civil Society, Institute for Family, Community, and Opportunity at the Heritage Foundation. These days, Severino is the director of the Office of Civil Rights of the Department of Health and Human Services.

And today, he announced a new office within his departmentthe Conscience and Religious Freedom Divisionto prosecute precisely these kinds of claims, not on behalf of people denied medical attention, but on behalf of doctors, nurses, drivers, and hospital administrators who seek to deny them.

Like Attorney General Jeff Sessions civil rights division, which has focused on claims of discrimination against white people, Severinos office of civil rights is focused on taking away civil rights. This is the Christian Rights presidency, and their alternative facts prevail.

Of course, thats not how Severinoa long-time conservative activist who has sought to take away my right to marry, my right to adopt children, and my right to be free from employment discriminationputs it. To him, the real victims of discrimination are those ambulance drivers and nurses, who might otherwise be forcedbecause they receive taxpayer moneyto provide medical care they object to on religious or moral grounds.

No one should be forced to choose between helping sick people and living by ones deepest moral or religious convictions, Severino said today, and the new division will help guarantee that victims of unlawful discrimination find justice. For too long, governments big and small have treated conscience claims with hostility instead of protection, but change is coming and it begins here and now.

To reiterate, these religious exemptions are already on the books. They began as far back as 1970, but gained steam particularly after Roe v. Wade legalized abortion nationwide. Immediately, Christian Right organizations sought religious exemptions to the new laws, just as they had sought them to the civil rights laws of the 1960s.

Except that in the case of abortion, they won. At first, these conscience clauses only exempted doctors and nurses from having to perform abortions. But quickly, they spread to exempt entire hospitals and hospital chains, and covered not just abortion but contraception and family planning counseling as well. Within a decade, almost anyone was exempted from almost anything related to womens health.

Immediately, Christian Right organizations sought religious exemptions to the new laws, just as they had sought them to the civil rights laws of the 1960s.

That same playbook has been used against LGBT people in the last ten years. With every advance in LGBT equality, the Christian Right has sought religious exemptions to the new legal protections. Now, not only can churches and religious leaders refuse to perform a same-sex marriage (which has always been the case), but any religiously affiliated organization can refuse to have anything to do with one, private corporations can refuse to respect them, and, depending on what the Supreme Court says this year, private individuals can turn same-sex couples away from their businesses.

Moreover, the Sessions Justice Department has said that they will not enforce any civil rights laws at all when the offender has a religious justification for breaking it.

That is also why todays announcement is so significant. State and federal governments all have limited resources, and are always performing triage, allocating time and money to some priorities over others. A new office devoted exclusively to these conscience claimsnot, for example, unequal access to vital healthcare services, anti-trans discrimination, or any number of other issuesmeans more conscience claims will be processed and prosecuted.

According to Severino, this shift has already taken place. From 2008 until the 2016 election, he said at the ceremony celebrating the opening of the new division, there were 10 complaints of conscience violations. Since then, we have received 34.

Those are tiny numbers, of course, but they reflect what Severino called a culture change at HHS and throughout the government. We are not going to allow people of faith to be bullied and targeted anymore, he said.

Of course, one could argue that its the people of faith bullying and targeting women and LGBT people, not the other way around.

But that inversion of victim and oppressor is typical of the religious exemptions movement, which has had unprecedented success in 2017 and 2018. At the ceremony, Severino cited religious exemptions for Quakers from having to serve in the militarybut the Quakers werent singling out others for discrimination. Severino also cited Dr. Martin Luther King, Jr.,s Letter from a Birmingham Jailbut Dr. King wasnt asking that African Americans be allowed to discriminate against other people and deny them services.

Most egregiously, Severino cited an alleged Nazi practice of forcing Jews to write sacred Hebrew texts in the soles of their shoes, thus forcing them to transgress Jewish law with every step they took. But the parallel to a doctor wishing not to counsel a transgender person in hormone therapy is inapt. The Jewish victim is not harming anyone else; the doctor is.

And even when theres another doctor or nurse or ambulance or hospital or pharmacist available, the dignitary harm of being told no trans folk allowed or contraception is morally evil remains. Thats the point of the Masterpiece Cakeshop case currently before the Supreme Court: its not about one wedding cake, its about bakeries being able to hang a no gays allowed sign on the door.

With the opening of the new office, HHS has taken a standthe same one Severino has been pushing for many yearson the side of the religious pharmacist, against the woman seeking birth control; on the side of the pediatrician who wont see my daughter.

Everyone is entitled to an equal seat in American civic life, Severino said at the ceremony today. But some seats are more equal than others.

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The Fight for LGBT Equality in 2018 Will Be Fierce

Jay Michaelson: So, here we are at the end of a strange year for LGBTQ Americans. On the one hand, mainstream acceptance of gay people continues to spread; gays are now officially boring. On the other hand, trans people are being singled out for government persecution on the one hand and continued street violence on the other.

Meanwhile, as all three of us have written, the Trump-Pence administration is inflicting the "death of a thousand blows" against LGBTQ civil rights, severely limiting employment rights, marital rights, access to healthcare, access to safe facilities in schools, and so onwhile literally erasing LGBTQ people from government forms, proclamations, and observances.

For that reason, it's even harder than usual to look toward 2018 with any sense of certainty. What are we most hoping for in the year to come? And what do we fear?

Samantha Allen: I have written the word bathroom hundreds of times over the past two years of covering the various state-level attempts to restrict transgender peoples restroom use. I wish I never had to type it again; I didnt sign up to be a reporter to write about the human excretory system every week.

But in 2018, I am hoping to talk about bathrooms a lot less frequentlyand I have reason to believe that will be the case.

One of the most important victories for transgender people this year came in the form of something we avoided: a bathroom bill in Texas that would have effectively made birth certificates into tickets of entry for restrooms in public schools and government buildings. But that was scuttled at the last second by the business community, local law enforcement, and a sympathetic speaker of the House who said he [didnt] want the suicide of a single Texan on [his] hands.

Im confident that well see somebut fewerred-state legislatures really push for bathroom bills. Theyre political losers and money drainersand everyone in elected office knows that by now

I was in the state this summer when this thing almost got passed and I witnessed firsthand the gloriously outsized Texas rage against a bill that could have cost them billions (Tim wrote about the Texas bathroom battle at the time for the Daily Beast).

Between that and North Carolina being forced to repeal the most controversial aspects of HB 2 under pressure from the NCAA, Im confident that well see somebut fewerred-state legislatures really push for bathroom bills. Theyre political losers and money drainersand everyone in elected office knows that by now.

Tim Teeman: Id like to share your optimism, but Roy Moore supplies a harsh correctivefor me anyway. In the celebrations that followed his defeat at the hands of Doug Jones in the Alabama Senate race, some difficult questions were left hanging.

Moore was a candidate whose rampant homophobiahis actual desire to see discrimination enacted against millions of LGBT Americans, his desire to see prejudice and discrimination enshrined in lawwent mostly unchallenged and unquestioned. Only on the last day of the race did Jake Tapper of CNN ask his spokesman whether Moore believed homosexuality should be illegal (the answer: Probably).

This was a shameful and telling omission by the media. The depressing footnote to Moores loss is that extreme homophobia itself is not a disqualification for a political candidate in 2017. Active homophobia was seen as a valid mandate to hold by the modern Republican Party.

Moore was only too happy to hold it close even in defeat, as he showed by posting (on Facebook) Carson Jones, Doug Jones gay sons, post-election interview with The Advocate. It was a sly attempt to stir up anti-gay poison. Politicians like Moore are thankfully fewer and fewer in number, but homophobia and transphobia are still a major currency in this White Houseand that Trump and other of Moores high-profile Republican supporters dont see it as a disqualifying characteristic tells us something very sad and alarming indeed.

Since ordinary gays are now not so novel, Hollywood's search for novelty is causing them to explore stories of people of color, rural folks, genderqueer folks, and other people who aren't Will or Grace

Jay Michaelson: I am putting most of my hopes outside the machinery of the state. Hollywood told some beautiful queer stories in 2017; I hope this expands and continues in 2018. A decade ago, when I was a professional activist, we had it drilled into us that the number one factor in someone "evolving" on any particular LGBTQ issue was knowing someone who was L, G, B, T, or Q. And if they didn't have firsthand knowledge, media figures counted too.

So, while the Republican party caters to its Christian Right base, I hope that continued media visibility makes them pay for doing so. There's a nice irony too: since ordinary gays are now not so novel, Hollywood's search for novelty is causing them to explore stories of people of color, rural folks, genderqueer folks, and other people who aren't Will or Grace. That might not be for the best motive, but the consequences could be profound.

Tim Teeman: Then we have the 'wedding cake' case at SCOTUS, which you have written about Jay. That seems currently going in favor of the baker refusing to bake a wedding cake for a gay couple. This isn't just about a wedding cake, of course, but providing a signal that discrimination based on "beliefs" is OK, which can be used against LGBT people in so many contexts.

Samantha Allen: Im afraid the Trump administrations attacks on the LGBT community will continue to be so persistent and so piecemeal that they will continue to get shuffled to the side. This past month, we were stunned when the Washington Post reported that the CDC had been discouraged from using the term transgender in preparing their annual budget, but if people had been paying closer attention to Trumps appointments in the Department of Health and Human Services and other federal agencies, this wouldnt have been a surprise.

We cant afford to pretend anymore like these are stunningly cruel attacks that come out of nowhere: leaders of anti-LGBT groups regularly walk the White House halls, they wield tremendous influence right now, and the administration is quietly giving them what they want.

Im worried that, with so many other scandals dominating the headlines, the systematic erosion of LGBT rights will continue to fly under the radar

Trumps tweets on transgender military service created a media shockwave, but that moment aside, the administrations attacks on LGBT people in 2017 have been considerably less flashy: amicus briefs filed to the Supreme Court, tinkering with executive orders, adjusting the Department of Justices approach to transgender students. All of these perniciously subtle attacks have taken place against a cultural backdrop of continuing bigotry and violence: In the last year, for example, at least 28 trans people have been killed, most of them transgender women of color.

Tim Teeman: I think one of the things the U.S. would do well to figure out (he said vainly) is the separation of Church and State. The Religious Right has such a grip on the levers of power here, in certain states and in certain administrations like President Trumps which is greatly relying on the bedrock of its support. LGBT people, activists and groups are facing a traumatic 2018, as the far right of the Republican support seeks to shore up support around Trump, and trans people especially are especially vulnerable in such an atmosphere.

Jay makes a good point: at a time when the Right seeks a ratcheting up of the LGBT culture war, LGBT people and their straight allies working in the culture at large should work to put a wide diversity of LGBT lives and characters into that culture, whether it be TV, film, literature, art, or whatever. Actual LGBT presence will be vital in 2018.

If this global backlash isn't stopped, queer people will be murdered, arrested, targeted, stigmatized, and forced to leave their countries (and then denied refugee status) in numbers we have never seen before

Samantha Allen: The death of a thousand blows of LGBT rights under Trump is only going to continue in 2018, and Im worried that, with so many other scandals dominating the headlines, the systematic erosion of LGBT rightsa phenomenon thats directly affecting at least 4 percent of the U.S. population and 7 percent of millennialswill continue to fly under the radar.

Thatd be like the Trump administration deciding one day that everyone in the state of Pennsylvania didnt deserve human rightsand it somehow not being front-page news every single day until it got fixed.

Jay Michaelson: My greatest fear for 2018 is on a somewhat macro-scale. The rise of nationalism, nativism, and right-wing populism around the world is terrifying. On one level, it's an understandable backlash against globalization, multiculturalism, and technology: people unable or unwilling to change are clinging to old identities and myths. But it's also profoundly dangerous, and queers are just one population endangered by it. It's not to be taken lightly.

Already we've seen the United States retreat from the whole concept of human rights, giving carte blanche to murderous anti-LGBTQ elements in Russia, Egypt, Chechnya, Indonesia, and elsewhere.

In 2018, the US will practically zero out its aid to vulnerable LGBT populations around the world. At the UN as elsewhere, America is now allied with Putin's Russia, in this case withdrawing protection from LGBT people and instead defending the oppression of us.

But this is just the beginning. If this global backlash isn't stopped, queer people will be murdered, arrested, targeted, stigmatized, and forced to leave their countries (and then denied refugee status) in numbers we have never seen before.

Figure out some way to help those who dont have as much, or who are especially politically and culturally vulnerable, and who could do with support. Give money, volunteer, whateverdo what you can

Tim Teeman: On that basis, LGBT people and their allies with any time, money, commitment and energy might think about involving themselves with activism and campaigning for organizations like The Trevor Project, HRC, Anti-Violence Project, National Center For Transgender Equality, GLSEN, PFLAG, OutRight Action International, and groups in their local area. If they don't want to do something overtly political, then maybe figure out a way to help those who dont have as much, or who are especially vulnerable, and who could do with supportwhether that be financial and pastoral.

If you need inspiration, look to Nathan Mathis who wasn't going to let Roy Moore winor lose at it turned outin Alabama without shaming him over his homophobia; and without remembering, in the most moving way possible, his dead lesbian daughter, Patti Sue.

Listen to, and be inspired by, the stirring stories of those from times when things were not just bleak but political progress and cultural evolution seemed alien and utterly distant. Eric Marcus has distilled, and continues to distill, amazing interviews with the likes of Sylvia Rivera and Frank Kameny, conducted for his landmark book Making Gay History: The Half-Century Fight For Lesbian and Gay Equal Rights, into a must-listen podcast.

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If States Got LGBT-Friendlier, They Could Earn Billions

If Texas lawmakers piled up hundreds of millions of taxpayer dollars in the middle of an empty field and set it on fire, there would be massive public outrage.

But according to data from the Williams Institute at the UCLA School of Law, that is effectively what Texas and other states are already doing by not creating a more supportive atmosphere for their LGBT citizens.

As the state-level Williams Institute numbers start to add up nationwide, its becoming clear that legislators dont just cost their states big money by passing attention-grabbingand boycott-inducinglaws like North Carolinas HB 2; they are also losing out on potentially billions of dollars by failing to pass laws that protect LGBT people.

Those invisible costs of inaction are hard to estimateand even harder to convey to the public.

The boycotts and stuff make headlines because they often involve big companies or famous people and that link is very clear, Williams Institute State and Local Policy Director Christy Mallory told The Daily Beast. But were trying to illuminate this other link.

Mallory has co-authored several analyses showing the economic impact of allowing statewide discrimination against LGBT people to continueand thereby incurring the sort of public health costs associated with minority stress, a psychological term for the stress that often accompanies social marginalization.

A Williams Institute report released last year, for example, estimates that if Texas could reduce the disparity in depression rates between LGBT and non-LGBT citizensone of the many public health outcomes linked to minority stressby just 25 percent, the state could save nearly $290 million dollars in costs associated with lost productivity, health care, and suicide (PDF).

Add another $118 million for reducing the LGBT binge drinking disparity by a quarterand another $1.6 million in estimated shelter and Medicaid expenses that could be reduced by banning discrimination against transgender peopleand the report proves that Texas is missing out on a load of cash by being one of the nearly 30 states that has yet to prohibit discrimination based on sexual orientation and gender identity. Or, as the Dallas Voice recently summarized it, "discrimination in Texas is expensive."

Were not saying that the disparity is going to totally go away or that a certain law would completely close that gap, but we do say that these health outcomes that have been linked to minority stress do have a cause, Mallory told The Daily Beast. So we try to look at [the effects of] even narrowing that gap.

The Williams Institute also compiled similar reports on Georgia and Florida last year with similarly striking findings: Florida could cut $224 million in annual costs by reducing the disparity in LGBT and non-LGBT smoking rates by 25 percent, for example, and Georgia could save $80 million every year by doing the same.

Mallory told The Daily Beast that a similar report on Arizona will be forthcoming in March, with two more scheduled to follow by the end of the year.

And considering that a majority of states still do not have full statewide protections for LGBT people, its easy to imagine the total tally of wasted cash nationwide reaching into the billions as more states come under the microscopeespecially because the Williams Institute is only able to estimate some of the many economic variables at stake.

For instance, Mallory said, there are economic costs associated with the number of LGBT children who enter foster careor the number of youth under state care who could otherwise be adopted out to a same-sex couple in states where religious organizations are allowed to discriminate on the basis of sexual orientationbut its harder to put a price tag on these phenomena.

Were continually looking for new data and information that we can use to measure costs, Mallory told The Daily Beast, adding with a look forward to 2018: Were hoping to look at some new and different angles this year, but it will all depend on the data we can get.

LGBT advocates are quick to point out that if lawmakers cant understand these costseven as they get spelled out for them over the course of 2018then businesses already do, and theyre taking action as a result.

I think in some ways this is the untold story of the non-discrimination fight right now, Kasey Suffredini, president of strategy for the organization Freedom for All Americans, told The Daily Beast. Because even though a lot of the discussion and coverage nationally over the last 18 to 24 months or so has been about these high-profile defensive fights like North Carolina there have been places with proactive legislative fights underway where businesses really have come forward.

In 2016, for example, Massachusetts passed a bill protecting transgender rights with overwhelming support from the business community, as The Boston Globe and other outlets reported. Some of that business support is motivated by bottom-line concerns, Suffredini says, like maintaining a competitive edge in recruiting, but they are also, he adds, simply listening to their LGBT employees.

As Justin Nelson and Chance Mitchell, cofounders of the National LGBT Chamber of Commerce, put it in an Advocate op-ed this week, now, more than ever, the private sector is listening to the collective voice of the LGBT community.

That proactive corporate support for LGBT people may be quiet but it is powerful nonetheless.

Indeed, so much of 2017 was spent guessing how much North Carolina or Texas would lose by passing an anti-transgender bathroom billpotentially $3.76 billion according to an AP estimate for North Carolina and $3.3 billion in Texas tourism dollars, according to another studythat the recurring long-term costs highlighted by the Williams Institute have not become widely known to the public, even as corporate decision-makers took them into consideration.

For instance, as Amazon searches for its second headquarters, there is widespread speculation in outlets as wide-ranging as Bloomberg and the Washington Blade that the retail giant may be less likely to select a city in a state with a recent history of anti-LGBT legislationor a threat of anti-LGBT laws to come in the near future.

In 2018, a record 609 companies achieved a perfect score on the Human Rights Campaigns Corporate Equality Index.

Suffredini says that companies are increasingly realizing that their own policies arent enough when it comes to LGBT issues; they also want state and local governments to reinforce the internal protections they offer. Minority stress, after all, cant be fully alleviated by a company handbook if the environment outside of work is a hostile one.

Employees want more, Suffredini told The Daily Beast. Employees dont just live in the four walls of that company. Employees get on the bus to go home. They go across the street to eat lunch. They rent an apartment, they buy a home.

So if 2017 was the year when the public watched corporations stand up to anti-LGBT legislation in North Carolina, Texas, and Mississippi, Suffredini predicts that 2018 will be the year when we see them pushing for the proactive protections.

It may also be the year when we are able to move beyond a simplistic approach to the cost of anti-LGBT discriminationnamely, the idea that bad laws cost states moneyto a more holistic and interconnected understanding of discriminations costs.

As Suffredini put it, Nobody does well socially or culturally when they live in an environment where they have poor health outcomes just because of who they areand that also takes an economic toll on the state.

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How Trump Made 2017 a Horrific Year for LGBT Rightsand Worse Is to Come

2017 wasnt just a bad year for LGBT equality in the United States. It was a pivotally bad year; an epochally horrific one, in sometimes subtle but almost always sinister ways.

The events of the last 12 months will have ramifications that could last for the next 12 years. And so, what better way to highlight the monumental terribleness of 2017 than to imagine the year it could have been, had a different candidate won the election, or had Donald Trumps image as an LGBT-friendly Republican not been sloughed off like snakeskin the moment he stepped foot in the Oval Office.

It seems like an eternity ago but it was only in January that the White House said that President Trump is respectful and supportive of LGBTQ rights. If that were true, LGBT Americans would have had not just a very different 2017, but a different 2030 as well.

This fantasy 2017 begins in February when, instead of rescinding Department of Education and Department of Justice guidance protecting transgender students restroom rights, that guidance is left solidly in place.

That decision doesnt just help the reported 59 percent of transgender students who have been denied access to a restroom matching their gender, it has potential ripple effects for generations:

As my Daily Beast colleague Jay Michaelson noted, the Supreme Court remanded the case of transgender teenager Gavin Grimm in part because the federal government had rescinded the guidance.

Lets say that the guidance remains in place and so the justices take up the case, ruling in favor of Grimm, who had been denied access to the boys restroom at his Virginia high school. Then, instead of the transgender restroom issue swirling around at the circuit court level for years to come, there would be federal-level clarity.

Transgender youth would be able to stop cutting their food and water intake to avoid uncomfortable restroom experiencesas many currently report doingand their mental health would undoubtedly improve, as peer-reviewed literature suggests.

Things only get better in March when we learn that the 2020 Census will indeed ask questions about sexual orientation and gender identityinstead of apparently scrapping a proposal to do so. Then, instead of having to rely on an elaborate statistical guessing game to estimate the size of the LGBT population, we would have harder numbers in three years.

As The Daily Beast has repeatedly pointed out, that number is not trivial: Census and federal survey data informs public policy and allows government agencies decide what to do with their resources. We would know exponentially more about the LGBT community, in areas ranging from economic well-being to racial diversity to the average date our housing units were built. And after the 2030 Census, wed be able to track the LGBT communitys progress over time with two comprehensive and reliable data setsinstead of having to wait until 2040 to gather all that information.

The wins keep piling up in April when, in our alternate universe, Neil Gorsuch doesnt get confirmed as a Supreme Court justice and a judge more likely to protect LGBT rights from the anti-LGBT religious freedom crowd takes his chair.

Then, LGBT Americans have to worry less about landmark civil rights cases reaching the Supreme Court over the course of the next few decadesespecially cases that deal with transgender rights and non-discrimination legislation.

And the consequences would be more immediate than that, too: The Masterpiece Cakeshop case, which could potentially decide whether some business owners can refuse service to LGBT people based on religious belief, would be an opportunity for same-sex couples to cement marriage equality even more firmly in place, instead of a source of anxiety. (As it stands, SCOTUS watchers are speculating after this months oral arguments that the case is headed toward a narrow victory for Christian baker Jack Phillips, who refused to make a wedding cake for a same-sex couple, with Gorsuch possibly being one of the Courts most reliable votes in favor of Phillips, as Patrick Hornbeck noted for Religion Dispatches.)

After the spring, LGBT equality wouldnt go on summer break. Transgender recruits would begin enlisting in the military as scheduled, joining the estimated 4,000 transgender troops who are already serving. Instead of anxiously watching the various legal challenges to a transgender troop ban, those service members would continue to serve with distinction, as District Judge Colleen Kollar-Kotelly wrote in her preliminary injunction against that ban.

But remember, in this alternate 2017, that ban doesnt exist because Trump was respectful and supportive of LGBTQ rights instead of waking up one morning and tweeting, without evidence, that transgender inclusion in the military would mean tremendous medical costs and disruption. And in this fantasy 2017, young transgender people who are hoping to join the military would be able to look forward to doing so, rather than wait years for the various court cases to resolve.

Pride Month would be marked not by dead silence, but by an official statementor even the White House being lit up in the rainbow colors of the same flag that a smiling Trump once hoisted on the campaign trail (albeit upside down).

Election night in the dream version of November 2017 would, hopefully, unfold similarly to its real-world counterpart, with dozens of openly LGBT candidatesincluding the mayor of Seattle, incoming Virginia Delegate Danica Roem, and several other transgender candidateswinning their contests. But these victories wouldnt be framed as responses to anti-LGBT actions on a federal level, so much as electoral confirmations of the increasing acceptance in this country.

And finally in December, the White House would include mention of LGBT people and people of color in its World AIDS Day statement, because those often intersecting groups are disproportionately likely to be affected by HIV/AIDS. An intact Presidential Advisory Council on HIV/AIDS would remain intactinstead of one that lost six membersand be able to work with full effectiveness to combat the devastating rates of new infections that persist for gay and bisexual men especially.

Oh, and the Centers for Disease Control and Prevention would submit a budget that repeatedly used the not-at-all-banned word transgender in discussing HIV prevention programs for transgender people.

In sum, we would be looking back at year when same-sex marriage was seen as a done deal, not the grounds to start the next chapter of a culture war. Federal transgender protections, which were already precarious and often effected through executive action, could potentially have become rock solid in some areas, with the hope of more progress to come.

Same-sex marriage rights would be further embedded into this countrys legal fabric. And LGBT people would have continued to feel seen, heard, and valued after eight years of slow but meaningful progress.

LGBT advocates warned that the 2016 election would have consequences for the community, long before it was believed that Trump even had a chance of winning. Human Rights Campaign President Chad Griffin said back in January of last yearbefore the Republican primaries had even started that all the progress we have made as a nation on LGBT equalityand all the progress we have yet to makeis at stake in November.

As we enter January 2018, it is painfully clear that these warnings were not exaggerations. This year could have gone very differently, but it didntand LGBT people will pay the price.

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Pentagon approves first gender-confirmation surgery for transgender service member

Four months after President Donald Trump first tweeted he would block transgender people from serving in the military, and two weeks after a federal judge temporarily blocked that ban, one transgender military member has undergone gender-confirmation surgery. Hers is the first procedure approved and funded by the Pentagon.

According to the New York Times, an active-duty military member received the surgery on Tuesday afternoon. According to NBC News, the service member who underwent the surgery is a female infantry soldier who got her Combat Infantry Badge in Operation Anaconda in Afghanistan in 2003.

In a statement from Chief Spokesperson Dana W. White, the Pentagon stated that a waiver for funding the service member’s procedure was approved by the director of the Defense Health Agency because she had already began a gender-confirmation course of treatment, and her doctor deemed the procedure medically necessary.

Since military hospitals don’t have the surgical expertise for gender-confirmation surgery, the service member received the procedure in a private hospital. The Supplemental Health Care Program is covering the cost of surgery, as dictated by the Defense Secretary Jim Mattis’ interim guidance on transgender service members.

According to a 2016 study from the RAND Corporation, allowing transgender military members to serve openly would have “minimal impact” on readiness and heathcare costs, contradicting Trump’s initial assertion of the costliness of trans service members when he first issued the ban via Twitter.

“Regardless of Trump’s attempts at enshrining discrimination in policy, we must ensure that transgender troops are treated the same as everyone else. That includes equal access to medically-necessary care,” Human Rights Campaign National Press Secretary Sarah McBride told the Daily Dot in a statement.

A representative Lambda Legal did not return the Daily Dot’s request for comment.

H/T Jon Passantino/Twitter

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The NAACP just issued a travel advisory against visiting Missouri

The Missouri chapter of the NAACP hasissued a statewide advisory against visiting the state if you’re a woman, person of color, person with disabilities, or LGBTQ citizen because you “may not be safe,” theAtlanta Black Star reports.

The warning comes as Senate Bill 43 was signed into law, which amends theMissouri Human Rights Act tomake housing and workplace discrimination cases significantly more difficult to prove in court. The law is slated to go into effect Aug. 28.

NAACP delegates are also concerned with“racial” and “ethnic disparities in education, health, economic empowerment and criminal justice,” as well as a recent report that shows black drivers are 75 percent more likely to be pulled over in Missouri than white drivers.

The NAACP also pointed to a history of “violent and dehumanizing” racial discrimination in the state, racist incidents at the University of Missouri in Columbia, and homophobic comments made by a representative in the Missouri House, who claimedthat there is a “distinction between homosexuality and just being a human being.” Missouri is also home to Ferguson, where in 2014, black teenager Michael Brown was shot and killed by a white police officer, and sparked national debate about excessive police force.

“Our ongoing issues of racial profiling, discrimination, harassment, and excess violence towards people of color have been further exacerbated by the passage, and signing of 43,” Springfield NAACP President Cheryl Clay told the Springfield News-Leader. “Not all the communities have the desire of the will to do the right thing for people in their community. Thus, this is why Missouri has earned the travel advisory for the whole state.”

Associated Press reports that national delegates have moved to adopt the advisoryand that the travel advisory may be officially ratified by the NAACP’s national board in October.

H/T Atlanta Black Star

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This transgender man just gave birth to a healthy newborn son

Transgender man Trystan Reese and his husband Biff Chaplow live in Portland, Oregon. They have three children, including a newborn sonwho Reesecarried to term.

Though Reese,34, began hormone replacement therapy about 10 years ago, the couple decided to try for a baby last year. He became pregnant but unfortunately miscarried at six weeks.

The coupleplanned to wait another year to try again.But Reese learned that there might be complications with restarting and stopping testosterone,so the couple decided to take another shot at having a child sooner rather than later.

Six months after the couple began trying for a baby again, Reesefound out he was pregnant with Leo.

“The moment he was born was just like a pure moment of bliss, like the happiest moment of my life,” Chaplow told Fox 19. “Just to see the very beginning of Leo, of his life, was just amazing.”

WE ARE HEADING HOME!!! Leo has received a clean bill of health (and so has Trystan) so we are happily heading back home to settle into our new life with our newest little addition. 😍😍😍

Posted by Biff and I on Sunday, July 16, 2017

Reese has since spoken out about his story as a transgender father, and how the outside world views his body.Reese was nervous going for his six-week ultrasound at an OB/GYN, for instance, but foundthat the office’s fellow patients “wouldn’t even bat an eye that there was a dude with a beard claiming to be pregnant who is here to get bloodwork done.” He says that “doesn’t come magically,” and that he hasn’t faced “an ounce of transphobia” throughout his journey.

“I think my body is awesome. I feel like it’s a gift to have been born with the body that I did, and I made the necessary changes so that I could keep living in it, both through hormones and through other body modifications,” Reese wrote in a Facebook post, according to the Daily Mail.

Going forward, Reese wonders ifthe stigma against transgender pregnancies will lessen as society begins to accept trans people’s gender identity. He hopesother trans men who want to become pregnant will build a healthy relationship with their body thatallows them to become fathers.

“Most trans men dont have the relationships with their body that would allow them to engage in something that still feels so rooted in femininity. It’s something that their mothers did, their sisters did,” Reese said, according to the Daily Mail.“I hope that some of that is social, that it isn’t an inherent part of being transgender. I hope more people will get to the place that I’ve gotten to from the support of the people around me.”

H/T Daily Mail

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How tech companies are recognizing Pride Month

In the month of June, tech companies celebrated Pride in the best way they know how: small, quirky product updates.

With San Francisco and New Yorks annual Pride event hitting this weekend, its a good time to reflect on just how far LGBTQ visibility in the tech community has come in a few short years. While theres still plenty of work to be done, were happy to celebrate some of the fun ways that companies are showing their solidarity with the queer community while also holding them to task on the stuff that really matters.


Apple may often lead the charge in Silicon Valleys LGBTQ advocacy efforts, but its Pride Edition Apple Watch($49) band proves it can make superficial yet delightful shows of queer solidarity too. TechCrunch hardware editor and official pride angel Brian Heater sent me one and either my cute new haircut or the rainbow watch band has been turning heads all pride month, but im pretty sure its the band.

The best part of this particular pride indulgence is that some of the proceeds go to groups like GLSEN and the Trevor Project.


Facebook added a well-received Pride reaction this year, though reports suggest the opt-in featureisnt available globally. In spite of ongoing tensions between the platform and the LGBTQ community, Facebooks queer users are already pretty attached to the little rainbow reaction so hopefully it sticks around.


Instagram added a special LGBTQ sticker set for Pride 2017 and launched a global Pride-inspired photo project. The stickers are cute and include a trans flag-inspired design.


In 35 cities, Pride parade routes will show up on Google Maps for iOS and Android. According to Google, a special Pride icon will display additional events in those cities, which include Seattle, New York and San Francisco.


Ubers local markets seem to be all kind of doing their own thing for Pride, but they apparently will deliver on-demand drag shows in Seattle for the second year running. Unfortunately, wed expect that a delivery drag queen performance is even harder to score than a delivery kitten.


Putting its money where its cute UI features are, Lyft announced that it would donate $100,000 over the next 12 months to LGBTQ causes. It kicked that pledge off with a Human Rights Campaign partnership called Round Up and Donate which invites riders to opt in from the Settings menu in order to round their fares up to the nearest dollar for a good cause. Anecdotally, I can confirm that Lyft cars along Pride parade routes show up in rainbow colors which was a nice touch.

For the month of June, Twitter introduced a nice little hashtag icon that manages to combine a rainbow pride flag with the pink and blue transgender flag, which is a lot of colors in not a lot of pixels. To summon the new icon, try the hashtags #Pride2017, #PrideMonth and #LoveisLove.


Shout out to Salesforce for the gayest looking lobby weve ever seen.


Skype introduced some rainbowy stickers and a colorful gradient text background, for getting very gay points across.


Not settling for rainbows alone, Spotify curated acollection of music so robust that might actually last for the whole month. Or at least one really, really sleep-deprived Pride weekend.


For 2017, Snapchat launched a rainbow emoji brush, a new sticker set, Pride-themed geofilters and Pride-specific stories so users can get a glimpse of celebrations around the world, including in Paris, Toronto and Mexico City this upcoming weekend. Props to Snapchat for its inclusion of the trans flag.

While its nice to see these kind of fun Pride-themed product tweaks during the month of June, using its power and platform for good old-fashioned advocacy remains the best way that Silicon Valley can express its solidarity with the LGBTQ community.

That means signing onto legal briefs for queer issues that affect the tech community, contributing to organizations that have been quietly doing the hard work for years, crafting policies that include and enrich members of the queer community and making sure that LGBTQ employees are extended workplace protections and health insurance benefits that can help them not just live, but thrive.

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