Even with federal health care policies in flux under President Donald Trump’s administration, the Affordable Care Act’s accessible treatment protections remain in place. For doctors, administrators and patients, the challenge lies in how to put those rights into practice inside hospitals.
Anna Kirkland, professor of women’s and gender studies, discussed how civil rights are upheld in health care settings in a lecture Monday evening. The event, hosted in Tisch Hall by the University of Michigan’s Science, Technology, and Society Program, was the first in a series of lectures organized by Joy Rohde, public policy and history professor, and Cara Rock-Singer, assistant professor of Judaic studies.
Kirkland drew from her newly published book, “Health Care Civil Rights: How Discrimination Law Fails Patients.” Kirkland began by situating her research in the broader context of ongoing health inequities, specifically for transgender people.
“We care a lot, supposedly, about the fact that minoritized people have poor health, or what we call health disparities,” Kirkland said. “People report a lot of really unpleasant experiences when they seek health care. My focus in the book is gender identity discrimination and how trans and nonbinary folks experience it.”
Kirkland said many small but significant interactions in a hospital provide opportunities for staff to recognize a patient’s identity. From the way a receptionist greets someone at the front desk to the information recorded in a medical chart, each step presents a chance for either inclusion or erasure. According to Kirkland, these moments add up to shape patients’ experiences of care.
“Think about all the things in a hospital where your gender, gender identity, body and organs need to be … recognized, properly greeted, properly seen, properly treated,” Kirkland said. “When I saw that the ACA was going to tackle this problem, I knew this was going to be complicated.”
Although health care for trans people has been challenged under President Donald Trump’s administration, including gender-affirming care for minors, Kirkland said key protections under the ACA remain in place.
“The Affordable Care Act hasn’t been repealed,” Kirkland said. “Judges can interpret it, and they have. So even though a lot of things are shifting quickly, this law is still okay.”
Much of Kirkland’s talk focused on the logistics of implementing civil rights protections in hospitals. She explained a requirement under former President Barack Obama’s administration to document sexual orientation and gender identity in electronic medical records.
“The organ inventory tells the staff what organs a person has and also what their identity is and how they should be addressed,” Kirkland said. “This is the medical system attempting to fully capture sex, sexual orientation and gender identity, to do civil rights justice to a patient.”
After the lecture, Kirkland opened the floor to questions. One attendee asked what institutional differences made some hospitals more eager to adopt non-discrimination policies than others. Kirkland said larger hospitals tended to be more involved and proactive in creating project teams to work on the policies, while other hospitals might assume the policies aren’t necessary.
“(At one hospital there) could be a dozen people in a room with the project manager working on this for months at a committed place, and then other places (could say), ‘Oh, we’re already doing that already,’ or ‘Oh, it’s not in my binder,’” Kirkland said.
In an interview with The Michigan Daily, Rackham student Amina Abdu, who attended the event, said she was concerned by the potential for the ACA to be distorted.
“Something that really stood out to me was that the level of flexibility in policy leaves a lot up to actors who are not always in the best position to actually protect our civil rights,” Abdu said. “So often the government is abdicating responsibility by leaving things open to interpretation.”
In an interview with The Daily, LSA junior Maggie Christoffersen said the talk highlighted the uneven application of civil rights in health care.
“Health care is definitely changing,” said Christoffersen. “It’s not set up to provide everybody with the rights it should, and those rights are seen differently, like abortion rights or the right for trans patients to receive care, because it’s so subjective.”
Daily Staff Reporter Hayley Weiss can be reached at hayweiss@umich.edu.
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