QueerCME Vodcast (2022-12-08 10:11 GMT-8) - Transcript
Attendees
Charlotte Persephone Hoffman, Queer Doc (they/them)
Transcript
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Queer Doc (they/them): All right. Hello everyone. Welcome back to the queer. Sammy podcast. I am so excited today to welcome and CP Hoffman from the National Center for Transgender Equality. As CP uses They/them Pronounce CPD. You want to tell us a little bit about who you are and what you do with NCTE.
Charlotte Persephone Hoffman: Sure, thank you so much for having me today. So, cp Hoffman, cp stands for a whole lot of things carrier pigeon, My favorite is correct pronouns. Um, yeah. That's, that's the best one. That's the one everyone loves. Um, Cheese pizzas and other good one. I am a senior policy council at the National Center for Transit Quality in DC,…
Queer Doc (they/them): oh,
Charlotte Persephone Hoffman: where I am doing a lot of work on transgender healthcare, which is always a super exciting portfolio to be on.
Queer Doc (they/them): Yes, right, there's always so much. We were just saying right before we started recording, the bar is really low even in the places where we have great access and and legal protections. There's still So much room for more.
Charlotte Persephone Hoffman: Indeed. Yeah, I I live in Maryland, just outside of DC and we have some very favorable laws here but there's also a lot of work that we still have to do. And fortunately I have some fabulous colleagues that are working in Maryland too work on a lot of that and I'm helping out to the extent. I can though I do have to sort of divide my attention among the other 49 states in the various territories.
Queer Doc (they/them): awesome. Well and cp we do usually try to prioritize folks with lived experience on our podcast. So if you'd be comfortable sharing how you identify, I would love to have that for our listeners to know.
Charlotte Persephone Hoffman: Of course. So I am a trans feminine non-binary person. I am this always surprises people when I tell them because apparently I have good skin but I am in my early 40s and thank you Mother for these wonderful kinetics and I lived most of my life sort of trying to figure out what it was that I was because For those of us who are non-binary folks who aren't in the younger generations, there really wasn't terminology for us and it was really hard to sort of figure out. Why we were sort of why we sort of felt like we were something different. The third thing or you know a 17th thing depending on you know your case. But yeah. So I I
Charlotte Persephone Hoffman: What I'm doing trainings on trans issues and gender identity. I often, you know, get to this question of, you know, Well, how do, how do you describe what gender identity is and sort of the old way that people used to describe? It is like a line where, you know, it's like one point is masculine, and one point is feminine and you fall somewhere on that scale. And you see this on a lot of things like the gender unicorn and, you know, stuff. I I like to think of gender as much more of a like, three or four dimensional thing. so what I'm talking about my own gender,…
Queer Doc (they/them): Yeah.
Charlotte Persephone Hoffman: I ask people to imagine a large field, And somewhere in the middle of the field, there are a couple of boxes that you know, one says Man or has like, you know, that Mars symbol and the other says Woman or has the Venus symbol?
Charlotte Persephone Hoffman: But my gender is not either of those boxes. It's a cat that's roaming around through the field that will sometimes lay down in one of the boxes and get cozy because, you know, like, if it fits it sits, but it doesn't necessarily fit well in the other box. But just…
Queer Doc (they/them): Yeah.
Charlotte Persephone Hoffman: because it's sometimes in the one, doesn't mean that that's where it is all the time when it's like wandering off chasing a squirrel or a bird or whatever. Yeah. Yeah.
00:05:00
Queer Doc (they/them): Right, cats are very adventurous. I love that analogy. Yes, we definitely reference and the
Queer Doc (they/them): Oh my gosh, brain fog.
Charlotte Persephone Hoffman: Gender unicorn.
Queer Doc (they/them): No, and although I, I do share the gender unicorn sometimes when I present, I tend to use the Transling language primer uses the Galaxy model like Universe model.
Charlotte Persephone Hoffman: Oh yeah.
Queer Doc (they/them): You know like What is the thing we live in the universe, right? Which is a multi-dimensional approach and and so that tends to be the one we reference people back to because similar to you. I My gender doesn't fit on a gradient scale. Two-dimensional line. So I I love that reference there.
Charlotte Persephone Hoffman: And I love adding on the part where the cat, the fourth dimension of time where the cat moves, it isn't always in one location.
Queer Doc (they/them): Right. yeah, that's a really fabulous part of the analogy and I just like I don't know, I feel like queer as we love cats.
Queer Doc (they/them): Right, and cats love boxes. So I just think it's a great analogy overall. anyways, and we were getting together today to talk about kind of the state of access to health care and legislation around healthcare for our transgender diverse. Community. And so we were talking before we recorded most of our listeners are healthcare clinicians. So physicians nurse practitioners PAs, who offer, gender for me, care, and their practice, or learning how to, and so, and There has been so much happening in the political climate and with gender affirming care and access. And I was wondering if you could, maybe this is a really big broad question, but could you give us like a general overview of like, where we are as a country with the lake access to care, legislative pieces, that have been happening.
Charlotte Persephone Hoffman: Yeah, and I will say that this is definitely a multi-level question. So I will start at the top level,…
Queer Doc (they/them): Yes.
Charlotte Persephone Hoffman: which is the federal system and then I'll talk about what we are seeing at the States and how that differs. So You're probably your audience is probably fairly familiar with the Affordable Care, Act, aka Obamacare and Section 1557 of that which was the non-discrimination rule that was built into the ACA. So it's it's a really interesting. This is just a side note but it's a really interesting like non-discrimination law because if you look at most non-discrimination laws, they're like these are the protected classes. But the ACA instead is like the protected classes are the ones referenced in these other statutes.
Charlotte Persephone Hoffman: So it's, it's very fun to try to figure out what everything means because you have to like reference, like cross reference cases analyzing other statutes etc. But at the end of the day,…
Queer Doc (they/them): Yeah.
Charlotte Persephone Hoffman: one of the classes protected that comes in through Title 9 of the Educational Amendments Act of, I Want to Say 1972, UM, is sex and we have a variety of
Charlotte Persephone Hoffman: Court decisions including from the Supreme Court that have found that discrimination on the basis of sex includes discrimination on the basis of sexual orientation and on the basis of transgender status or gender identity. So basically that means that we have this wonderful federal law that says, You can't discriminate in the provision of healthcare or health insurance. If you're receiving federal dollars and almost every practitioner or insurance company does receive federal dollars. There's a few out there that don't but between Medicare Medicaid. Various other funding systems, etc. I know your audience. Probably knows all this, but just in case, You.
Queer Doc (they/them): Actually think that distinction is confusing to some several clinicians. I've had this come up with like when they come up against transgender healthcare. Exclusions on policies are like Oh that's not allowed because of the Affordable care act. I'm like well in privately funded plans. It's still is like the Affordable Care Act in the context of the Affordable Care, Act right affordable care and…
Charlotte Persephone Hoffman: Yeah. Hmm.
Queer Doc (they/them): protect the right to access care in those privately fun and plans and where I always see it, come up in my practice is Union plans. And so I work with a lot of folks up in Alaska who are members of different unions and a couple of the unions up there exclude coverage.
00:10:00
Charlotte Persephone Hoffman: Yeah, so, where it gets really confusing here because, you know, the insurance card. You have might say in a blue cross blue shield or you know, whatever your local Blue Cross Blue. Shield's affiliate is, you know, in my case, it's like care first Blue Cross Blue Shield but you know, if you're wherever it might be, You know, I'm blanking on some of the other ones,…
Queer Doc (they/them): Primarily Blue Cross Blue Shield,…
Charlotte Persephone Hoffman: but yeah. Yeah, they all have different names,…
Queer Doc (they/them): they all have to bring up.
Charlotte Persephone Hoffman: but You, so your insurance?
Charlotte Persephone Hoffman: So, your insurance card, you know. Looks like your insurance is through Blue Cross Blue Shield, but in a lot of cases, if you're working for a large company or, you know, a large union that has its own insurance plan. The insurance company is actually acting as an administrator rather than the primary insurer. And so in those cases because the company, you know, whether we're talking about, you know, like a Fortune, 500 company like a huge law firm, You know, whatever or the Union itself or whatever, you know, they're not receiving federal funds for health insurance, um, they end up being they end up being not covered by those ACA regulations. Now, most insurance plans that cover like most people in the United States do follow under ACA because, you know if it's a plan that's offered like by like Blue Cross or
Charlotte Persephone Hoffman: Anthem or, you know, whatever, you know,…
Queer Doc (they/them): Yeah.
Charlotte Persephone Hoffman: United Healthcare. You know it's going to be that they're going to receive federal funding somewhere because you know, they have plans on marketplaces or they act as you know, Medicaid administrators or, you know, they have Medicare plus programs or whatever. It's,…
Queer Doc (they/them): Yeah.
Charlotte Persephone Hoffman: there's this weird area where just because their name is on your card. It's they're not necess, it's not necessarily covered because they're the administrator, rather the insurer.
Queer Doc (they/them): Right. Which trips up some of my patients sometimes. Because they'll go, you know, to like the Primera website and pull the primera coverage guidelines, right? Like you actually need to call and verify your specific benefits, right? Because like your plan doesn't necessarily your individual plan is not necessarily the primera overall overarching thing,…
Charlotte Persephone Hoffman: Hmm.
Queer Doc (they/them): right? Like they might just be administrator and so it is The backing heart mass. I wish it wasn't using
Charlotte Persephone Hoffman: Yeah, and And figuring out what your individual plan does or doesn't cover is a freaking nightmare. um, and…
Queer Doc (they/them): It really?
Charlotte Persephone Hoffman: in fact, recently, We had a question about, you know, like well what what private insurance plans, you know, in the state cover or don't cover this thing and I was like that's basically an impossible question to answer because you're looking at like hundreds or thousands of different plans that don't actually have their like they're specific coverage information available in an easily accessible place.
Queer Doc (they/them): Now, right? And this is like we're getting a little in the weeds here, but I'm totally gonna tell a story anyways and right and in part like this is an apical organization. We are, we're talking about healthcare in general, I will always remind everyone to vote and consider voting for single-payer healthcare systems because of this s*** show that we're talking about right now. But You know, like, for example, I was getting and a task recommend in my my gastroenterologist, right? It was like a methane test for like bacteria in my tummy or whatever and I was trying to figure out the cost of the test prior to doing it because like the risk of like the risk of me having the thing we are testing for was very, very low, right? So it was kind of, like, do I really need to do this test and my cutoff point for myself was like, okay, if it's under $400,
Queer Doc (they/them): I'll do it. If it's over $400. I don't think it's worth it. and, I got three different quotes. And right, because like, I had, I'm a KP member, it's an HMO, but that test is an offered through KP, I had to do it through our university system. So I got a quote from my university system, a quote from I got two different quotes from KP and None of the three quotes were the same and none of them were what I actually paid for the test. So, At the end, like the person who was like the most confident in giving me, the quote was like, It's gonna be 379. I was like m***********, it's like right on the edge of my budget that I made for myself, but I was like, Okay, I'll do it. I got a bill like months later for $25 and I was like how
00:15:00
Queer Doc (they/them): Like how are we supposed to plan? Like How are we even supposed to make these decisions when you, You know we can't even understand the costs of care like for the singular test. And I think it's just you…
Charlotte Persephone Hoffman: Yeah.
Queer Doc (they/them): like I said We're getting a little on the weeds, they put in the good faith estimate acts that's like asking healthcare practices to offer estimates. And I feel like what's happening is like people are over inflating estimates in order to protect themselves from later on. People because it, you know, if there's a more than $400 difference, people can come back and say I want my money back, right? And so it's just like,
Charlotte Persephone Hoffman: Oh, it really is.
Queer Doc (they/them): It's a funny s*** show health insurance is really. And I think to get back to our audience and like their primary concern, right? This is what our patients are trans. Patients, have to deal with. Every day. Grants and…
Charlotte Persephone Hoffman: Yeah.
Queer Doc (they/them): generators patients need to access care more frequently than their CIS peers. In order to like get access, not, not every trans patient. Once you know, medical affirmation and not every transmission, wants surgical offer information. There is no one way to be trans. There's no break way to be trans, but so many of us do. And and we have to go through this like trying to become competent and health insurance, and confident in navigating this system, and it's exhausting. And, you know, one of my like partners other partners the other day.
Queer Doc (they/them): Had a potential HIV exposure and was trying to access pet and just ended up like paying $400 for it. Because with by the time, like they found a pharmacy that had the drug that could get it to them in time. Like they were so exhausted from that, like multiple pharmaceutical calls and like just the anxiety around like, Do I need to take pup doing not you know they couldn't on top of that then deal with like accessing some of the patient assistance program. So it was just like too many levels and layers you know?
Charlotte Persephone Hoffman: Yeah.
Queer Doc (they/them): And it's like that cost to all of us, right? and…
Charlotte Persephone Hoffman: yeah, I I have a relatively I had a relatively minor surgery right at the beginning of the pandemic and…
Queer Doc (they/them): not just,
Charlotte Persephone Hoffman: it was like I was literally like Am I going to be able to get in for this swords? My surgery going to be canceled because it was like, right at the beginning of March 2020. But I remember when I,…
Queer Doc (they/them): wow.
Charlotte Persephone Hoffman: I got home afterwards, you know, they gave me like, prescriptions for painkillers and various things and I had so much trouble, getting the painkiller prescription filled that I ended up just never doing it because I went to multiple pharmacies and they were like, Oh we don't have any in stock right now and we can't tell you when it will be available and you can't call to find out. If they have it in stock, you just have to go to various places and I was just like,…
Queer Doc (they/them): After impact surgery and…
Charlotte Persephone Hoffman: Okay, I'll just Yeah,…
Queer Doc (they/them): you're in pain.
Charlotte Persephone Hoffman: and yeah, and I'm like barely like, you know, I'm making my wife drive me around and things. So yeah, I just ended up dealing with like ibuprofen and like, alternating ibuprofen and Tylenol for, you know, like a few days rather than actually having something that was more effective. But that's just the fun of our medical system and…
Queer Doc (they/them): Right, and it's wild.
Charlotte Persephone Hoffman: I know we've gotten way off topic. No.
Queer Doc (they/them): Yeah. Well, thank you back to We were looking at like the federal picture of access to gender care with the ACA we'll get.
Charlotte Persephone Hoffman: Yes.
Charlotte Persephone Hoffman: Yeah, so so we had the ACA passed in 2010 and it has like these sort of generalized principles of non-discrimination in it. So you can't discriminate on the basis of sex or race, or disability, status, etc. But that's a pretty that doesn't provide a lot of guidance.
Charlotte Persephone Hoffman: So in the late Obama years, I believe they released the draft rule in 2015 and it was adopted by the Department of Health and Human Services in 2016 and they adopted some regulations under the ACA that went, they tried to go further and explain what the Department of Health and Human Services understood discrimination to include and that included. A lot of really fabulous language about Uh, healthcare for transgender people. Not denying care to someone based on their the marker, the gender marker on there, you know, insurance card that you would provide to someone else if they had a different marker saying that insurance plans couldn't just per se. Say, we're never covering any gender affirming care. Etc, lots of fabulous regulations.
00:20:00
Charlotte Persephone Hoffman: the problem was first, they we immediately saw the regulations challenged in a like, Basically selectively picked court in Texas, where opponents were like Which, which court can we go to? Where we're most likely to find a judge? She's most likely to say This is, You know, this goes too far and I'm going to strike it down across the whole country. So they found that judge in Texas and he said, basically Everything in this about gender identity. I'm striking down and then that wouldn't have necessarily been a problem. If say the 2016 election had gone differently but because we ended up with the Trump administration, they decided not to appeal
Charlotte Persephone Hoffman: and they also didn't want to fix the rules to you know comply with any technical flaws. I would say there weren't technical flaws but you know, I would have I would have gone through the appeal process and said No, this is wrong. But you know, I mean, There's a number of options that we're available but because of the administration and it's hostility to trans folks, that's not what happens. And in fact instead in late 2019, the Trump administration issued new rules or draft new rules that completely cut out all of the protections for gender identity. And those went the final version of those rules. After they get a huge public comment period, those were released. I want to say, like,
Charlotte Persephone Hoffman: Within three days or something like that of the Supreme, Court's decision in Bow stock, which was the employment. Nondiscrimination case that said that the Civil Rights Act when it's said, You know, you can't discriminate on the basis of sex that includes sexual orientation and gender identity. So, Immediately courts struck down the trump-era rules and I know this is getting into the weeds, but I think it's helpful to sort of understand this broad text.
Queer Doc (they/them): They're good weeds. Yeah, it's a good overview.
Charlotte Persephone Hoffman: Yeah. Yeah. So um They? So immediately the courts were like, well, clearly you have to consider this Supreme Court decision that says that this is discrimination. So those were struck down and…
Queer Doc (they/them): Yeah.
Charlotte Persephone Hoffman: then after the 2020 election, we had the Biden administration come in. And they had this situation where The 2016 rules had basically been struck down at least in part the 2019 the 2020 rule had been struck down. And so there's this question of what are the rules and what's going on here and what really constitutes discrimination? So earlier this year,…
Queer Doc (they/them): Yeah.
Charlotte Persephone Hoffman: the Biden administration, released new draft rules that pick up a lot of what was in those, those Obama era regulations but add some additional things that are really fabulous. So, for instance, one of the huge additions that Just really stellar as it includes protections for intersex individuals. which,
Charlotte Persephone Hoffman: Has really been like needed for decades. So the current status of that is that the public comment period for the for those rules closed on October 3rd and currently the Department of Health and Human Services is reviewing. All of the comments of which there were something like 50,000. And they have to read through all of them and respond to them in some way before they can issue the final rule. Now, the way the response often works is they're like We got a lot of comments that said X. Here's our response to all 30,000. That's that acts So they don't have to like you know do 50,000 people yeah…
Queer Doc (they/them): Individualized responses? Yeah.
Charlotte Persephone Hoffman: but so our hope is that sometime in 2023. We'll see final rules from the Department of Health and Human Services that put back into place and expand on those protections that had we should have really been having since 2016.
Queer Doc (they/them): Right. And to be clear, the ACA, the original ACA all of the protection that came with, that still stands,…
Charlotte Persephone Hoffman: Absolutely. Yeah.
Queer Doc (they/them): right? So, Just for all of our listeners what CPA is saying, all the kind of rulemaking helps clarify and extend the protections but none of it has changed the original productions.
Charlotte Persephone Hoffman: Yeah. So for instance you know you can still bring a claim under the ACA under 1557 of the ACA saying You know I've been discriminated against by this healthcare provider or this insurance company because they've done X. But then you would have to demonstrate in court that you know, the thing that they've done, the constitutes discrimination, these regulations would include rules that say, you know, like denying care in these specific can situations or denying coverage in. These specific situations is always discriminatory so it eliminates that need to prove that something is discriminatory and you can just say Well This has been done ergo you violated the regulations and…
00:25:00
Queer Doc (they/them): Perfect.
Charlotte Persephone Hoffman: the number of steps and it makes it a lot easier to challenge things and for those challenges to move along speedily
Queer Doc (they/them): Right? Which will also make challenges more affordable for our community as a whole, right? And so oftentimes when these things are challenged and right, I was working in Alaska when the suit was brought against Alaska State Medicaid. And, and…
Charlotte Persephone Hoffman: Yeah.
Queer Doc (they/them): for excluding gender, affirming care coverage, and right, and none of our patients and folks, that participating, like, we're paying the attorneys, right? Like that was all funded through ACLU grant, funding things like that, but that's all money. We could spend advocating somewhere else for other protections…
Charlotte Persephone Hoffman: Absolutely.
Queer Doc (they/them): because like CP and all the other people involved in and these lawsuits, in these advocacy processes, obviously need to be compensated for their time. And so, and yes, That very exciting to see what happens with these new rules.
Charlotte Persephone Hoffman: Yeah. yeah, so the sort of addendum to this is also that because we've been waiting on these regulations The Department of Health and Human Services has not been particularly active in enforcements in part because of the way that the decision on the 2016 rules was written. So we really have been waiting for these new rules to go into effect, to give the Department of Health, and Human Services teeth to start going after, you know, providers insurance companies and states that are putting restrictions on the ability of trans people to access healthcare.
Queer Doc (they/them): Yeah. Okay.
Charlotte Persephone Hoffman: And there is actually a fabulous provision and the draft rules. We'll see if it survives for the final rule but I loved it. Which says, basically like a inconsistent state law, that said, This is not verbatim, This is, you know, from my memory, but an inconsistent state law that, you know, says that as a policy, the state doesn't believe that gender affirming care is ever necessary. Isn't an excuse for denying care to someone. so, that would go really far in, you know, being able to Challenge. A lot of things that we're seeing at the state level.
Queer Doc (they/them): Space, right? And then, let's Let's go to the state level…
Charlotte Persephone Hoffman: Of course.
Queer Doc (they/them): then now, right? Like that was a good actually set yourself up for that perfectly.
Charlotte Persephone Hoffman: Perfect segue. Yeah, exactly. So there are 50 states plus a number of territories and so, you know, it's really important to know that What's the case in one state might not be the case elsewhere. And so we have some states that are truly fabulous on access to health, care for trans folk and there are states that are truly awful. And so, you know, we have been pushing the good states to be better and the, you know, kind of in between states to adopt the practices, the good states have. And we've been in the not so great states, trying to combat some of the worst tendencies that we see going on. So to provide an example,
Charlotte Persephone Hoffman: There's been on these sort of bad side and I'll talk about some of the good stuff in a minute, but on the bad side you know, we're seeing a number of states in the past few years have been seeking to ban, gender reforming care, especially for minors. So we've seen these bands pass in a few states. Arkansas was the first one, Arizona recently passed one and and I know there's at least one more that I'm blanking on you can.
Queer Doc (they/them): You see, Alabama.
Charlotte Persephone Hoffman: Alabama. There we go. Yeah, I know. I knew I was.
Queer Doc (they/them): all the A states are like,…
Charlotte Persephone Hoffman: Yeah. Yeah,…
Queer Doc (they/them): really Not doing great.
Charlotte Persephone Hoffman: really it. There's like, all the A states have just gone for, you know, banning the gender of human care. And then there's other states that, you know, are kind of like, Well we're gonna do this just as soon as we have our, you know, legislature back in session or, you know, there's other states that have considered things but they haven't passed. But they have passed a number of states and it's very terrifying, you know, for people who live in those states to suddenly be like Oh wait am I going to be able to continue to access care myself or to provide you know care for my kids? You know depending on what the case is fortunately thus far.
00:30:00
Charlotte Persephone Hoffman: We've seen courts granting injunctions against the enforcement of any of these laws. So none of them have gone into effects, but whether that's going to be what we see going forward is an open question, especially given how conservative the Supreme Court is. So, you know, it's possible to, you know, get lower courts just say, Oh no this is, you know, This clearly violates the Constitution etc. But once we get it up to the Supreme Court, once it's appealed up, it's not quite clear. What they'll do at that point. Now I, I would say based on existing precedent that we've seen both from Supreme Court and elsewhere that the answer is clear that these that these sorts of laws are unconstitutional, but again, the Court has become so radicalized that
Charlotte Persephone Hoffman: Existing precedent is no longer, something you can rely on as we saw earlier this year with the Dobbs decision. Overturning Roe v Wade. Us. So it's it's very worrisome in that regard.
Queer Doc (they/them): Yeah.
Charlotte Persephone Hoffman: But I wanted to give you a little bit of an example of what we're sort of seeing in, you know, some some states. So I'm gonna talk about Florida and Texas because they're too interesting examples of states that We've not seen legislative bans, but we are seeing a lot of other really scary actions by the States.
Queer Doc (they/them): Right? And I'm in a positive for a second just to point out. So, the seats that did pass legislative bands, and I just want to point out that CP did mention that court place in junctions, on all the bands that have been placed. So, for healthcare clinicians, you are still allowed to provide gender firming care to adolescents in those states. It's not like you're not you're not legally prohibited from providing care. You are not risking your license and to do so. And then, yeah, the CPS transitioning into talking about Florida and Texas because they're not leisure of actions. They are outside of the legislation Florida. Actually, I don't know about Texas. Specifically Florida is my where I grew up. So I follow a little more closely and Florida actually had a piece of legislation introduced to van health care for for minors and it failed like legislation did not find it into place and now they're medical board. You know, is actually taking action. So cp tell us more
Charlotte Persephone Hoffman: Yeah. So there are a lot of these bills have been raised in a lot of states and there are a few that have passed and there are a lot that haven't and Florida. As you say, it's one of the states where, you know, There was a bill introduced and it didn't go anywhere but that was
Charlotte Persephone Hoffman: Not like the fact that, you know, the bill was introduced wasn't enough for you know, certain conservatives in the state. And so instead of you know, sort of waiting to see what the legislature would do in 2023 when they come back into session, we saw a number of executive agencies within Florida, start, taking action themselves without legislative authorization. So earlier this year the the agency that runs the Florida Medicaid program, I'm blanking on what it's specific name is but they they issued the study that was basically like
Charlotte Persephone Hoffman: Is gender affirming care like something that is within like, you know, good medical practice or is it something weird and experimental and they reached this decision that gender affirming care was experimental and so it should not be covered by the State Medicaid program. Now this was completely in opposition to all medical science. The opinions of, you know, medical associations that have looked at the issue, all of the testimonies submitted. But, you know, they cherry picked the experts that they wanted to look at. And they found people who are like, Oh no, this is, this is totally experimental and bad. And so you know, as of earlier this year, the like I believe it was August, the Florida Medicaid program stopped paying for any sort of gender affirming care.
Charlotte Persephone Hoffman: Um, more recently, and this has been truly terrifying. You mentioned this just a second ago, the Florida Board of Medicine and the Florida Board of Osteopathic Medicine, have opened investigations and proposed rulemaking to prohibit physicians and osteopathic. Physicians licensed in Florida. From providing gender, affirming care to minors and these rules. They proposed them after a meeting in which basically, they only heard from opponents of trans health care. And all of the like Trans youth trans advocates, people who had like driven to Orlando from across the state, you know, to be able to tell their stories. They were all told.
00:35:00
Charlotte Persephone Hoffman: We don't have time for you today. You should just go home and you could submit a submit something through the, You know, online form. So they had a public comment period open for 21 days which is a very short amount of time for people to be able to find out that it exists and to you know pull together their reasoning and that closed on Monday. So You know, I will say that NCTE works with a number of other organizations in the end, we had 119 organizations that signed on to our comment with us in which we
Charlotte Persephone Hoffman: Basically told the boards of medicine and osteopathic medicine that they're proposed, rules were in opposition to establish medical science. They were in defiance of recommendations issued by every major medical society. That's looked at the issue, including the AMA, the American Academy of Pediatrics, the Endocrine Society, the the Pediatric Endocrine Society, my favorite was the Pediatric nurse practitioners group, which is called napnap. Which I was just like, I could really go for a nap nap right now, but yeah. but, you know, like
Charlotte Persephone Hoffman: statements from every organization that's looked at this and they're like, no, like gender affirming care is important. And so, we talked about that we talked about, you know, how it's discriminatory in general. And we talked about the implication it's going to have for, you know, physicians who are licensed in Florida, thinking about getting licensed in Florida, or who are licensed in multiple states and how, you know, there's going to be a lot of weird issues for, you know, someone who's licensed in New York and Florida who's providing care and like New York, you know, it's Florida suddenly going to start like actions against them.
Charlotte Persephone Hoffman: And also what impact will have on like Florida Board of Medicine investigations in other areas when they, you know, try to report those to other state boards. So, we hit on some things that I think a lot of other organizations were unlikely to head on,…
Queer Doc (they/them): Yeah.
Charlotte Persephone Hoffman: but that are all relevant and…
Queer Doc (they/them): Yeah. That integrated view from like a national level.
Charlotte Persephone Hoffman: medical practitioners.
Queer Doc (they/them): I think it's really important piece, brought to the table, the I think, you know, the The review document that stops Florida. Medicaid, it came from the Department of Health and And it was like a document done by. I want to say like
Queer Doc (they/them): Actually, under review, for tweeting transphobic comics, and by the Oxford University.
Charlotte Persephone Hoffman: I am shocked.
Queer Doc (they/them): So, great news there and then the experts and support Dr. McNamara from Ciel is where she is. And And then University of Florida how to representative from their gender clinic.
Queer Doc (they/them): I can't remember the other person, but all three work. Actually work with trans youth and right. And so I think,
00:40:00
Queer Doc (they/them): From the Get like, Right the Florida Board of Medicine states that they are in apolitical body, but they are actually appointed by the governor. So they there is like really no way. They can be. Able to position is appointed by. A politician. And so I think, That statement. You know, it's just a load of worship, frankly. And And, you know, if I think
Queer Doc (they/them): Nctes response about like the bigger implications of what this means, for clinicians licensed in. Multiple states is really important. I think it's important for Florida clinicians. Know the commentary did and the rule is not an effect as of yet. So currently you can still provide your affirming care to minors in state of Florida. There are no restrictions on a cable pay for it, but other than that, it's still legal to provide that care. and, although we've already seen several people stop and just when the proposed rule came up on the table, a few months ago, and then and,
Charlotte Persephone Hoffman: Yeah.
Queer Doc (they/them): The proposed rule does state like care for miners that have already initiated care? Can continue it's like starting care for someone that cannot happen and so you do not have to discharge your patients already receiving care, you don't have to stop their care. That's a really important thing for clinicians to hear here.
Charlotte Persephone Hoffman: That is a critical point that yeah,…
Charlotte Persephone Hoffman: I should have had one.
Queer Doc (they/them): yeah, and…
Queer Doc (they/them): yeah, and we did the same, I wrote like a 12-page response and my response was less about like this like national political, like all of this interconnectedness that you view as large organization and more about like, These are all the problems with your arguments and…
Charlotte Persephone Hoffman: Hmm.
Queer Doc (they/them): your expert witnesses and and like, you know, here's and like the body of and I I just called them out as
Queer Doc (they/them): You know, making motivate personally, motivated decisions, and choices that are going to kill people. And so, it didn't really meant words there and right and and called them to task for violating their oats as clinicians, right? Because we take notes to do no harm and and no matter how much you want to say about the research in our field being and it's infancy and like the data being not as high quality as any of us want it to be like these comments can definitely be seen as
Queer Doc (they/them): As true to some degree, like depending on your perspective and how you're looking at this and one, they're ton of other fields of medicine that are exactly the same and we don't legislate away the right to care to and the data we do have, um, right The the data we do have that is decent quality shows that we have improved mental, health outcomes, less depression, less thoughts of suicide less attempted suicides, right? And that suicidal ideation goes down over the whole lifetime, not just like a year or six months from like we have like a good study with thousands of participants that shows lifetime reduction and so,
Queer Doc (they/them): Those board members of that, Florida, Medical board, like our in violation of their oath to do new harm because they are increasing the likelihood of death by suicide for these trans youth. And so I think hands down like their right to practice medicine should be absolutely examined and their licensure should be called into question. Of course they're the board that would be doing that. Examination and questioning so I doubt that that's going to go anywhere, but that's my personal. Thoughts on the Subject.
Charlotte Persephone Hoffman: I yeah, it's the point you're making about like the quality of research and the amount of research actually reminds me of the situation with medical research on marijuana. Where we've had statutes in place that limit research, that can be done, that limit funding for things that expressly make it impossible to, you know. Demonstrate that, you know, marijuana or cannabis, derived, things are have a medical value and it's not quite that awful with like trans health care, but we have lived with decades, you know, I mean, at this point effectively a century of
Charlotte Persephone Hoffman: Governments, and funders saying, Well, if you want to do this, you can do it on your own with your own money. And we're not going to fund it and we're probably not going to publish it because we think that, you know, you're weird freaks and you know, when Like I don't I It's really hard to ignore the fact that the best evidence that we had about like gender affirming care in the 20th century with all burned by Nazis. like the destructive of the Hearstfeld clinic,…
00:45:00
Queer Doc (they/them): Yeah.
Charlotte Persephone Hoffman: and it's like archives, destroyed decades of research and like,
Queer Doc (they/them): Right. Right.
Queer Doc (they/them): That would give us this longer history to that would go further towards making this case. And I want to be very very clear like when I say like the research in our field is limited and it's kind of in its infancy, that doesn't mean that we don't have some high quality research like there's you know, 16 Great studies and one of the ones published last year had over 10,000 participants. So we're starting to get sample sizes that are much more. Of value. And right. And so, and, and also rate some of the
Queer Doc (they/them): Like, oppositional points on the researchers like that. We don't have rtcs, there's no way to do an RTC and gender affirming care. It cannot be done physically. Um, also we like if you wanted like rtc's on some of the things, like we use like statins for, like they're they're many many drugs. We use that we would never do an RTC on and, and part and, you know, in part because and like a review board whenever approve it because like the existent literature that we do, have says there's benefit and so to like find it and placebo, someone would actually be causing harm and you can never get Approval, just for that project. And so I think, Want to be very clear.
Queer Doc (they/them): that the evidence we do have and has Some quality and value. And that it's not necessarily very different than what we see in some of the other fields that again are not legislative. At all.
Charlotte Persephone Hoffman: It absolutely. Yeah.
Queer Doc (they/them): And so Florida is doing some weird chat right now. You can still practice in the state of Florida and we're assuming I talk to One of the physicians at the University of Florida Adolescent Clinic. We're assuming when they do announce the rule that a lawsuit is going to be brought
Charlotte Persephone Hoffman: Absolutely, that won't be us at NCTE because we don't have a like litigation arm. But I absolutely guarantee that one of the or multiple of the, you know, litigation houses that focus on the sort of work. Whether it's, you know, the ACLU or Lambda Liga land and legal or you know one of the other national or state-based orgs, you know will be challenging this because It's really, I think I looked through the regulations that the Florida Board of Medicine and the Florida Board of Osteopathic Medicine. Have released in the past, like regulating the practice of medicine and they're all things like when you prescribe, You know this, when you prescribe opioids, you have to do it in this way. It's not. You cannot do this.
Charlotte Persephone Hoffman: And so this is really going you know of like several steps beyond what they've done in the past. You know, in the past they've tried to ensure that where care is being provided, it's being done and you know sort of following best practices and here they're saying you just can't provide this care at all. And that's a dramatic change from their own precedent.
Queer Doc (they/them): Yeah.
Queer Doc (they/them): Right from their own previous regulations. I agree. I looked through some of them as well before I wrote my response and brought up a similar point as well. And yeah, I think so. I think Southern Legal and You are probably going to be involved in this one. And so yeah, the public commentary closed on Monday and we haven't heard any updates from them as of yet.
Charlotte Persephone Hoffman: Not yet. I suspect that we probably won't see a final rule until sometime next year. Hopefully we will it won't be much before or possibly after the final rule from the Department of Health and Human Services on the Affordable Care Act. And so you know if that if that does include that provision I mentioned earlier about, you know, inconsistent state law or policy, then we'll see, you know, a federal regulation saying Doctors, we don't care what the Board of Medicine says. This is discriminatory And because that's federal law.
Queer Doc (they/them): and then,
Charlotte Persephone Hoffman: It preempts the state action.
Queer Doc (they/them): And that's going to be really, I think.
Queer Doc (they/them): a really uncomfortable place for us as clinicians to be because just…
Charlotte Persephone Hoffman: Absolutely.
Queer Doc (they/them): because there is a federal law saying that like, You have like the state law is inconsistent and like, federally, you saw the right to practice your licensed by the state and the state can still pursue action against you, right? And some of these seats have are trying to criminalize care, not just like make it. Like right with the Florida Board of Medicine, it's just you would go before the Board of Medicine, your license to be investigated, you might lose your license to practice which is devastating in and of itself, right? But
00:50:00
Queer Doc (they/them): Arizona. Was it Arizona that criminalized? I can't remember…
Charlotte Persephone Hoffman: I think it's Alabama.
Queer Doc (they/them): which one try to actually like Alabama, try to criminalize it. And so like You could be a breast that you could go to jail, you could potentially face present time rate. And so how do you as the clinician?
Queer Doc (they/them): Know what to do. Obviously, right? we know in our heart, like, providing care is like Definitely the right things to do. It's the thing that's an importance of do you know harm and if we're put in jail we can't take care of anyone. So like how do you how do we balance these things right? And particularly when we're licensed in multiple states and…
Charlotte Persephone Hoffman: Yeah.
Queer Doc (they/them): so I'm licensed in Florida, I take care of you in Florida.
Queer Doc (they/them): If I'm right if I'm facing charges in Florida and what happens to my you know 400 Other patients in other states that rely on me for their care. And how do we do that math? How do we how do we make those decisions? It's so complex.
Charlotte Persephone Hoffman: So the good news is that state boards of medicine, and I, I actually I I very briefly a number of years ago, worked for the Indiana Attorney General's office in their unit that basically in their Life, Medical Licensing. Union unit that did investigations for like the State Board of Medicine and the State Dental Board, and all of that. So,
Charlotte Persephone Hoffman: I have a little bit of insight here that I think is actually helpful for folks and…
Queer Doc (they/them): US.
Charlotte Persephone Hoffman: what the policy of at least all the Indiana boards was was, you know, you had to notify them. If you had been like censured or you know, whatever in another state and if the action that you were penalized for was something that violated Indiana regulations, then they would open up an investigation but if it was something that was not illegal in Indiana, then they wouldn't have jurisdiction to open up in action. So We're we're likely to see situations where, you know, someone who's licensed in Florida if these if these rules ever go into effect and
Charlotte Persephone Hoffman: I'm a little doubtful that we'll see them actually in effect. But, you know, if, if the Florida Board of Medicine, or the Board of Osteopathic Medicine, does bring action against someone and says, we're stripping your license because you provide a gender affirming care to someone. And then they report that to the other state your licensed in. That other state is likely to just ignore it as long as they don't have a similar rule. So, you know, you don't necessarily have to worry about, you know, the New York Board of Medicine on the Georgia Board of Medicine, or, you know, wherever unless we start seeing other boards of medicine, adopt these the same sort of things.
Queer Doc (they/them): Right? And one of the interesting. and,
Queer Doc (they/them): Things that California has done right is past a lot to be sanctuary state for I think and…
Charlotte Persephone Hoffman: Mm-hmm.
Queer Doc (they/them): I think you know better than me. I think it covers families and clinicians right? Offering gender affirming care And so that's kind of an interesting approach as well.
Charlotte Persephone Hoffman: Yeah, and there's a number of states that have been considering things along these lines. I know New York has something that they've been considering and it's been raised with their legislature. I'm trying to remember whether The Connecticut bill cover gender affirming care. If it was focused on abortion, Because that was one of the first ones that we saw Post-dods. But
Charlotte Persephone Hoffman: Yeah. So this is something that a number of states are taking up. There's also chatter about something along these lines in Maryland and it's probably going to be, you know, something that we see a lot of, you know what we can, what we think of as blue states taking up in the next legislative session or, you know, in the next couple of years, especially as we see more and more hostile action by conservative state legislatures.
Queer Doc (they/them): Right. And I know and in Washington, I'm part of like a coalition that as involved in pediatric, gender care and we've been trying to get in front of our legislators to like Um, get something short sanctuary state status as well. And
Charlotte Persephone Hoffman: Yeah. And, and part of what those laws do is, I mean, they're all going to be a little bit different based on state. But, you know, part of what they do is they say that, you know, they won't provide, they won't respond to subpoenas, you know, for certain types of things that aren't illegal in the state. So you can't. um, you know, you can't subpoena California for medical records, about you know, someone's abortion, or gender affirming care that they received in California in order to, you know, bring an action in Arizona against like them for, you know, having received care or having, you know, facilitated their children, receiving care
00:55:00
Queer Doc (they/them): Yeah, right. And that was, I think, Arkansas is like that was one of the weird thing in Arkansas that they can't take kids out of the state, right? For care.
Charlotte Persephone Hoffman: and, that's,
Queer Doc (they/them): Like, Which is like you can't f****** like that's not like That's you can't legislate that that's like so and it's interesting to me that they even put that in because like the likelihood of that getting struck down by a judge. Seems much higher to me than if they had that part out, right? It's like I think you can easily find a judge who's like Yeah you shouldn't do transcare on kids.
Charlotte Persephone Hoffman: Yeah.
Queer Doc (they/them): I think it's much harder to find a judge. She says Parents can't take their kids out of state. Um
Charlotte Persephone Hoffman: Yeah because like one of the basic fundamental rights under the Constitution that like everyone in the judiciary agrees on is like the ability to travel within the United States. And that's a like blatant restriction on the ability to you…
Queer Doc (they/them): Right.
Charlotte Persephone Hoffman: travel to another state.
Queer Doc (they/them): So weird. And what's happening?
Charlotte Persephone Hoffman: Yeah.
Queer Doc (they/them): Tell us about what's happening in Texas.
Charlotte Persephone Hoffman: So Texas.
Charlotte Persephone Hoffman: The situation there has been complicated by the fact that the Texas legislature does not meet every year they meet every other year. So they're going to be coming back into session in 2023. But 2022. They didn't have a session, but basically, the Texas government in the meantime was, like, we really want to do something to show that we're being tough against like trans kids and so early in 2022. The Texas Attorney General and Governor. Well, the Texas Attorney general issued a memo saying basically that providing gender affirming care to minors is child abuse and should be investigated by the Department of Child, Safety and Welfare, or whatever specifically called in Texas.
Queer Doc (they/them): Yeah.
Charlotte Persephone Hoffman: And then the like very shortly after this, memo was issued the Texas Governor Abbott is An order to the department to investigate. Parents of trans kids who were facilitating their kids? Receiving gender affirming care. with the intention of, you know, potentially taking their kids away from them. And putting them into the foster care system or whatever. So this was absolutely horrifying because it leapfrogged over everything else. To We're gonna take your kids away from you if you affirm their gender. and if you do anything to help, provide them with care, so, unsurprisingly immediately there was litigation to challenge this and it's been frustrating.
Charlotte Persephone Hoffman: because, The side of Texas parents. Keeps winning but in ways that are irritatingly restricted each time. So initially. A judge like a trial judge in Texas. Is she an injunction against this thing? Oh, yeah, you've you've demonstrate that. This is, you know, discriminatory, you know, all it's a violation of constitutional rights etc, etc. And then the Texas Court of Appeals immediately was like, oh well, Those plaintiffs demonstrated that so you can have an order as to them. But anyone else in the state has to bring their own lawsuit? Yeah. And so you…
Queer Doc (they/them): Oh God.
Charlotte Persephone Hoffman: this was challenged at various levels it up to the Texas Supreme Court and they basically Had a very wishy-washy decision, that was like. well, you can't charge these specific parents. You can potentially charge other people, or you can open investigations against other people, but you don't have to they they said basically, well, the governor's order was illegal But investigating the families wouldn't be illegal as long as they don't have the specific, you know, order covering them specifically. which is just some real b******* because it's basically like trying The court was basically trying to have their cake and eat it too of saying Well you've clearly overreached but we're not actually going to do much to stop like if the department just decides to keep doing this,
01:00:00
Charlotte Persephone Hoffman: So the latest is that a broader injunction has been issued for. I want to say the Families, that are members of Texas PFLAG. They were able to sort of file as a group.
Charlotte Persephone Hoffman: And but there's this amorphous situation for other parents of trans kids in Texas. And as a result, we've seen a lot of families like trying to look into moving out of state, but that's a horrific solution for people who, you know, they lived their whole lives in the state, all their family are there they have. That's where their job is, you know, like to suddenly have to move like across the country to, you know, hopefully be safe and hopefully not have your kids stripped away from you because you're just doing your best as a parent to give them the care. They need. It's just horrific. Um, so Texas is definitely high on the list of states that we expect to see. an attempt to ban, gender reaffirming care through the legislature in 2023, and
Charlotte Persephone Hoffman: You know, we're going to combat it definitely, but it's
Queer Doc (they/them): You'll expect to see less legislation in 2023 because I know part of 2022. It was midterms, right? So I know we, in the circles I move and we talked about the fact that like, These legislative actions are very often to like Garner like that conservative religious, right? Vote voting block and are we thinking like the numbers are gonna keep going up in 2023? Are we hopeful that absent in terms? They will be slightly less horrifying.
Charlotte Persephone Hoffman: so, I expect we'll see more bills filed.
Charlotte Persephone Hoffman: Now, whether they pass is a different question, there's certainly a number that have already been pre-filed or…
Queer Doc (they/them): Don't.
Charlotte Persephone Hoffman: that legislators have already said we are going to file this in a number of states. So for instance there was a situation in Oklahoma a couple of months ago, where the state legislature stripped the Oklahoma University Medical Center of funding under the like Covid Relief Act,…
Queer Doc (they/them): Down.
Charlotte Persephone Hoffman: unless they stopped, providing gender affirming care,…
Queer Doc (they/them): that's,
Charlotte Persephone Hoffman: miners and we're hearing that, you know, the legislators are planning to bring a full band on gender, affirming care for minors in 2023. Again, That's something that we and,…
Queer Doc (they/them): Right.
Charlotte Persephone Hoffman: you know, other national and state organizations, shout out to Freedom, Oklahoma for the great work they have been doing, you know, we're going to oppose because it's, you know, It's not right to deny healthcare to trans kids. It's awful. It's discriminatory. It hurts, everyone.
Queer Doc (they/them): And and just right and to give people an idea of what what CP and I are talking about in 2015. Right, There were 19 bills introduced that were like Antia. Um, and, Trans. Folks, right, youth sports bills, bathroom bills, things like that and then you know by 2020 there were 66 I think in 2020 we've had over 200 this year right in 2022. And so, that's when I was asking later, Are we gonna see more or less? I'm for our listeners and for our listeners. CP, What, um, what, what are actions, that they can take as clinicians to kind of help, like, in this vein of advocacy and maintaining access to care for the the kids in their states.
Charlotte Persephone Hoffman: so, if you are in a state where these sorts of bands or rules or, you know, legislation are being considered, First off, definitely speak out, you know, in a lot of these cases, you have an opportunity to either, you know, testify to submit a written statement, You know, to make some sort of statement in support of your patients. Now, you don't necessarily have to do that as an individual. And in fact, sometimes it can be stronger. When it's, you know, a group of physicians coming together or, you know, you petition, your state, medical association to take a stance on the bill. There's a lot of, like, conservative states that You know, they are thinking about things like this but if they're like the State Medical Association came out in force and said You can't do this.
Charlotte Persephone Hoffman: That would be a real. Unexpected block to them, You know, that's, that would be, you know, an audience that, you know, has real sway in a lot of states, but doesn't necessarily hasn't necessarily gotten involved in these sorts of fights in the past. And so, you know, if you can get your like, you know, state and local medical associations to really take this up, that would be hugely helpful. In a lot of places. It's not going to be decisive everywhere because there's some places where Legislators are going to do what they're going to do. And there's some states like Oklahoma where There isn't an opportunity to provide testimony to the legislature. They just don't have that built into their system in most states like you can go and testify you know on purpose.
01:05:00
Queer Doc (they/them): You can't call your representatives in those states. So, so right.
Charlotte Persephone Hoffman: You can absolutely.
Queer Doc (they/them): Yeah, you can particularly, if you are a member of that seat, if you live in that state, you get to call, you know, your representatives and talk to them and well you don't get to talk directly to them.
Charlotte Persephone Hoffman: it's not for a nice staffer, who will take your message and…
Queer Doc (they/them): You talked.
Charlotte Persephone Hoffman: type it into a computer system and yeah,
Queer Doc (they/them): Yeah. And we actually and that the APA actually has agree template for like how to make a statement to one of your legislation or legislators. And so, on our queer product blog, we kind of using their template helped shift that towards talking about access to gender farming care. So that Sarah for clinicians that they can use and just have A templated thing to say you still need to put some stuff of your own words and experience. That's what makes it a meaningful statement…
Charlotte Persephone Hoffman: Yeah.
Queer Doc (they/them): but that can help. So definitely like speaking to your legislators. Um you mentioned too you have so many people sign on to the letter y'all wrote and on the public comment to the Florida. So often times being on the mailing list of like NCTE um at your local ACLU and
Charlotte Persephone Hoffman: Yeah.
Charlotte Persephone Hoffman: Most most states have a state level,…
Queer Doc (they/them): Any other organization?
Charlotte Persephone Hoffman: queer organization. If you want to find out what you're like, state level, queer organization is, You can go to the Equality Federation website. I think they're quality, federation.org, They have a list of all, their affiliate organizations. Not not everywhere does in the list that, like, the list of states that doesn't is kind of entertaining because it's like, either, extremely conservative states or extremely liberal states. And then there's a few that don't that it's like interesting,…
Queer Doc (they/them): Like we don't need it there.
Charlotte Persephone Hoffman: like there's not a state level, organ Pennsylvania. But Pennsylvania has the weird thing where it's like Philadelphia and Pittsburgh and then like all the space in between and so like there's Philadelphia Orgs and there's Pittsburgh Orgs but there's not necessarily a statewide org. But most it's do have one and…
Queer Doc (they/them): Look, hey. So good.
Charlotte Persephone Hoffman: you know get on those lists because they will keep you you know, much more prized of what's going on with your state legislature than the national works. Well,
Queer Doc (they/them): Right. And you can also, um, I'm at the clinician, you can ask one of your like clinical support, team members or staff members to do this. Depending, you know, I have a private practice. So, like, how my staff helps support me is very individualized to our needs. And so, when it comes to like anti-trans stuff, I'm actually very on top of that. But like we're also involved in some advocacy for over-the-counter birth control, and for access to controlled substances without required first in-person visits, right? Which is primarily focused on treating on people with substance use disorders, but actually, it's very applicable and transcare because of testosterone and right in my like, kind of one of my teammates, one of my assistants does all that tracking for me, right? They stay on top of that. They submit our, like, they sign us on to all of the things that get sent out to be signed on, to, in support of things that these other organizations have written. So like you can definitely, you know,
Queer Doc (they/them): Have someone help you do this and then just show you where to sign right to help save some of your time and you can also do some more of this yourself. And and easiest option is usually signing on to something. Another organization has written for you. But also asked, if you mentioned writing your own comment, can be really powerful and then advocating within any organization you are a member of and so CPU specifically brought up state medical associations but also if you You know, are a member of your
Queer Doc (they/them): A board of whatever medicine you're in, or you're, you know, um, local medical society or whatever, kind of organizations you are in. If you can, again, get a group of people together to make a statement that's signed on, by all the individuals and endorsed by the organization, that's gonna have a larger impact. And so that's an advocacy option as well. Other ideas for involvement advocacy clinicians, helping maintain access.
Charlotte Persephone Hoffman: I think that's most of the things.
01:10:00
Charlotte Persephone Hoffman: Listen to your patience and they come in and, you know, tell you that they have needs or that, you know, something is happening. That's scaring them because they'll often be more aware of what's happening, then you will and sometimes more aware than, like what the, you know, state or local queer orgs are depending on, You know, what, all they're having to deal with. I will say that, you know, I used to work at Maryland's State Level, Queer Organization, Free State Justice. And, you know, my time there are staff wavered between like three people and eight people. And, you know, we were dealing with just so many different things and like we tried to keep, you know, our finger on the pulse of everything going on in the state. But there it was hard. And, you know, there was a lot of relying on other organizations that were specialized in particular, geographic, areas or subject matter areas to, you know let them take the lead on things to or
Charlotte Persephone Hoffman: give them to support when they took the lead on things, so that You know, someone was on top of everything.
Queer Doc (they/them): Right? And I think that's such an important point, right? Like we as individual clinicians don't have to reinvent the wheel, right? Like we can again by like getting on these mailing lists by getting um following these organizations on social. Like you can just amplify the advocacy that they are already doing which actually is less time and energy for you. And right you can like repost and social media shoutouts like so when exactly what CP said that Florida Medical Board Public Commentary period was 21 days and so trying to get that amplified. So people new to go and make comments right? Like and reposting other like a quality Florida. Did some great social around making comments and things like that is is really important. So and I think like right when we saw this, when the Supreme Court moved the protection for Roe v Wade. A lot of people were on Facebook like You can come camping at my house and it's like, Hey they're already a lot of organizations that are doing advocacy.
Queer Doc (they/them): Success for Abortion Care. Why don't you just give them your time and energy instead of trying to like create a system that you don't need to create because it already exists and your creation of it is probably going to actually be Really bad because you don't know what you're doing and you have no experience. So, um,
Charlotte Persephone Hoffman: And you're creating a horrific paper trail of like evidence.
Queer Doc (they/them): Yeah. Also you're posting on social media like Come…
Charlotte Persephone Hoffman: Yeah. Yeah.
Queer Doc (they/them): Let's we know it's having so so don't reinvent the wheel. Like Give your voice these organizations that already have it or if you are part of an organization, that is an advocating and you have the time and energy Start working within your work. I think those are great options and As well. See what other we've been. I feel like I've kept you forever CP. I think we could talk, like for another two hours. I'm trying to think of their other. Things, we should. Bring up.
Charlotte Persephone Hoffman: So I one thing I did want to hit on is that, you know, I've been talking a lot about, you know, things that are horrible going on in states. But there's a There's a lot of room for good things and,…
Queer Doc (they/them): Oh yeah.
Charlotte Persephone Hoffman: you know, there's like you mentioned, you know, the the laws that states are passing to create like refuge. I'm sorry, I completely blanked on the term.
Queer Doc (they/them): We, I think it's sanctuary states,…
Charlotte Persephone Hoffman: Sanctuary states.
Queer Doc (they/them): is what?
Charlotte Persephone Hoffman: There we go. Yeah, sorry I had covid a few months ago and my residual brain fog. Periodically makes me forget like a word that I'm like it's just in my brain somewhere locked away. Yeah so uh you know we're seeing sanctuary state bills. One thing that we're going to be seeing you know in the in the next few weeks in Maryland, for instance and again Maryland's where I live, It's a great example here because it's A state that is the votes very heavily Democratic but still has a lot of room for improvement in a lot of ways, you know? So,
Charlotte Persephone Hoffman: We've had, you know, Medicaid coverage of gender affirming care. Since 2015, you know, there's state laws protecting, you know, prohibiting discrimination on the basis of gender identity, or social or sexual orientation. Yes, this is magic Cat. She's wondering past And so, you know, so there's a lot of good stuff in place, but The 2015 policy that says, Yes, Medicaid will pay for gender, affirming care include the list of 31 things, that they're not going to pay for. And you know it's like well we're gonna pay for these certain things that we see as like necessary, but all this other stuff we're considering cosmetic or…
Queer Doc (they/them): Yeah.
Charlotte Persephone Hoffman: not medically necessary.
Queer Doc (they/them): Right. Yeah, we had that in Washington, right? Our ACA had a list of non-covered services and one of our with the last piece of update to it, like one of the biggest things we asked them to do is remove the list of non-covered surfaces and Exactly the same.
01:15:00
Charlotte Persephone Hoffman: Yeah, so we've been working for a few years to try to get that list. Struck down in one way or another. And right now, we have a great situation where the newly elected or the, the governor who's going to be coming into office in the beginning of January who's been recently elected West Moore has said that he, you know, we'll sign this bill if it's past that will you know, remove these particular Yeah,…
Queer Doc (they/them): Some.
Charlotte Persephone Hoffman: so that's fabulous. You know there's some questions as to what the bill will look like whether it's going to just eliminate those You know, carve outs or whether it will say will affirmatively pay for things. you…
Queer Doc (they/them): Right.
Charlotte Persephone Hoffman: and there's gonna there's questions that you know, We're expecting to get from, you know, the bean counters and the legislature…
Queer Doc (they/them): Right.
Charlotte Persephone Hoffman: who are very concerned about the cost of everything.
Queer Doc (they/them): And then also, what is the process for approval? Right? Because I think in Washington, we had like It was a case-by-case basis. And so like, We could never figure out why things were actually getting denied, right. Like and it really That was really, really tough. And because it's like,
Charlotte Persephone Hoffman: And that's like huge problem with our current insurance system in general. We're even where things are required to be covered insurance. Companies have an incentive to initially deny coverage and then, There's a decent chance you'll appeal and ask for it to be covered and then they'll be like, Oh yeah, I guess we have to cover this but they know that a certain number of people aren't going to appeal.
Queer Doc (they/them): Okay. Yeah, right. It's that Yeah, capitalism and healthcare don't work. Um, fyi news new splash everyone. Um, But yeah,…
Charlotte Persephone Hoffman: It was capitalism all along.
Queer Doc (they/them): I think and there are definitely seats that are taking action to help protect and trans youth trans families and clinicians and I think CPS desire to like take a moment to focus on that trans joy. It's really, really important. And right. I love that.
Charlotte Persephone Hoffman: the other thing that we haven't seen, Specific movement on yet for many states but where there's, you know, huge potential and that we might start seeing you know this year. Next year, you know, soon are affirmative protections of gender affirming care for minors. So, you know, we're seeing conservative states, ban, gender affirming care, but we haven't yet seen, you know, progressive states past legislation. That say that says This is affirmatively protected and…
Queer Doc (they/them): Yeah.
Charlotte Persephone Hoffman: This cannot be used, you know, as a justification for, you know, child for child custody hearings or…
Queer Doc (they/them): Child Protective Services. Yeah.
Charlotte Persephone Hoffman: Yeah, social service is It can't be, you know, you can't be penalized for doing this and we haven't seen that yet, but there's the hope that will start seeing that and the, you know, coming years
Queer Doc (they/them): Right? And some of those actions I think would be so important which we didn't get into this topic and we probably won't really get into it a time because I already kept you for so long. But You know. This legislative action is harmful to the mental health and also probably like long-term chronic health of trans and gender diverse people. Right? This is, this is minority stress in action and we know that affects long-term health outcomes. And so, definitely like I had one of my 17 year old patients. Like talk about how loud she felt all of this noise was and how she felt like everyone was just calling her like a pervert, and right? And in like she is a child and these are adults who are like causing her this harm and I think and
Queer Doc (they/them): And that affirmative legislative action, that, that voice of like safety and acceptance and love, right is like can help counteract some of this, like negative noise. And so, I think that is another really important part of of advocating for these affirmative pieces of action and and to help combat like just the mental health effects of all this negative legislative Kerfuffle.
Charlotte Persephone Hoffman: Yeah. Absolutely.
Queer Doc (they/them): Yeah. Yeah any other closing word cp for our clinicians doing dinner grooming care. In this crazy political climate.
Charlotte Persephone Hoffman: Yeah, I just want to thank all of you for Doing the work that you're doing, this is absolutely critical life-saving work. That has been unfairly stigmatized by a lot of people and so thank you for doing it. Thank you for sticking it out and dealing with, you know, all of this like ridiculous, like groomer rhetoric. And, you know, people talking about mutilating kids and all sorts of stuff that's just patently false, but can be so hard to You know, deal with on a day and day out basis, so thank you all.
01:20:00
Queer Doc (they/them): Yeah, and see, I feel like CPS thinks is like, in some ways that breaks my heart that this is something, we say, thank you for because, like, it should just be like an everyday part of healthcare and an everyday part of life, and it's not. So I totally understand where CP is coming from and particularly like, Like you know layered against all the legislative action that's been happening. We've had all of the attacks on children's hospitals from extreme right knee groups. Right now and you know including death threats and some multiple of our physicians who are larger face in the public. Space. And so, our podcast episode from November, the one before, this one was actually around like digital security and protection. And it's been interesting to talk to some of my, like, SIS colleagues who have like, actually Some of them have taken a little bit of a step back, you know, and and I am in no way dismissing your thing.
Queer Doc (they/them): Someone shouldn't do the thing, that feels right and safe for them and their family by any means as an individual. And please don't take my comments. Me, not It's interesting though to think about like where like right, see CPA and I like, as part of this community, like there's not a choice here for us like there's right? This is and me, this is my partner. This is my family that people are trying to like legislate away and and so there is no stepping away from this. There is no backing down, there is definitely like trying to do it as safely and as legally as possible to maintain again that access to like my multi-state practice but and,
Queer Doc (they/them): This is who we are is not just the work we do. So, thank you so much,…
Charlotte Persephone Hoffman: Yeah.
Queer Doc (they/them): cp for coming on and sharing about that.
Charlotte Persephone Hoffman: Thank you for having me.
