After the Iowa Legislature passed a ban on gender-affirming care for minors in March, the owners of an LGBTQ+ clinic across the state line in Moline, Illinois, are changing the way they provide that care. decided to start.
The added services will provide care to patients primarily in rural eastern Iowa, including hundreds of patients previously treated at University of Iowa clinics, and to larger cities like Chicago and Minneapolis. This eliminates the need to drive half a day to the clinic.
By June, the project, which calls the Illinois clinic Quad Cities, had hired a provider specializing in transgender health care. So Andy Rowe, the project's director of medical operations, called the clinic's insurance broker and asked if the new provider would be added to the nonprofit's malpractice policy.
“I didn't expect it to be a big deal,” Lowe said. Then, I received a quote from the insurance company. The first explicitly excluded gender-affirming care for minors. The next reply was the same. And what happened after that. By early November, more than a dozen malpractice insurance companies had refused to insure the clinic.
read more: What kind of treatment do transgender youth receive?
Lowe didn't know it at the time, but he wasn't alone in his frustrating quest.
almost half of the state Medications and surgical treatments are prohibited. For transgender youth. Independent clinics and medical practices in states where such care is permitted or protected are relocating to fill the void of patients commuting or relocating across states.but Litigation risks are increasing for clinics, obtaining medical malpractice insurance in the commercial market is a silent barrier to providing care, even in states that have legal protections for medical care for transgender people. In extreme cases, lawmakers have introduced malpractice insurance regulations for gender-affirming care in states where courts have delayed or blocked anti-trans legislation.
Rowe said that five months after he started looking for malpractice insurance, he received a quote for insurance that would allow the project to treat transgender youth. That's when he realized finding a policy was just the first hurdle. He expected the insurance to cost him between $8,000 and $10,000 a year, but he was quoted $50,000.
Lowe said he has never experienced anything like this in his 20 years in health care administration.
Insurance industry advocates say the premium increases are justified because tightening laws surrounding gender-affirming care for minors are putting clinics at greater risk of being sued. There is.
“If state law increases the risk of civil liability for health care professionals, premiums will be adjusted accordingly to reflect the level of financial risk to which the insured is exposed,” the Health Care Professionals Liability Association said. said Mike Stinson, vice president of public policy and legal affairs at . The association, an insurance industry group, said in an emailed statement. If the activity is illegal under state law, insurance won't cover it at all.
read more: Transgender youth 'afraid' of what Louisiana's new medical ban means
Only a few states have passed laws that prohibit malpractice insurance companies from treating gender-affirming care differently than other care. Massachusetts was the first Lawmakers there passed the bill. According to the report, insurance companies cannot raise rates for health care providers who provide services that are illegal in other states.
Since then, five other states have passed laws requiring malpractice insurance companies to treat gender-affirming medicine like any other legally protected medical activity. colorado, vermont statenew york, Oregonand California (A similar bill is pending) Hawaii).
“This was a precautionary measure and was fully accepted by both insureds and insurance companies,” Vermont said. Virginia State Senator “Ginny” Lyons, a Democrat who is a co-sponsor of the state law. He said lawmakers consulted with both doctors and malpractice insurance companies to ensure the wording was accurate. Insurers just want to be able to clearly assess risk, she says.
Lyons said he had never heard of a medical provider in Vermont who had problems with malpractice insurance before this law was enacted, but he said he had never heard of a health care provider in Vermont who had problems with malpractice insurance, but that politics got in the way of doctors' ability to provide care. I was worried that he might. In March 2022, texas tribune A Texas doctor reported that he stopped providing treatment to a minor because his medical malpractice provider stopped covering hormone therapy for a minor.
Lawmakers in some states have gone further and amended medical malpractice rules to limit access to gender-affirming care while bans on providing care to transgender youth have stalled in court. . In 2021, Arkansas became the first state to ban gender-affirming care for transgender children. When the ban was challenged in court last year, the governor passed a new law that would allow anyone who received gender-affirming care as a minor to file a medical malpractice lawsuit up to 15 years after turning 18. signed.
read more: Efforts to restrict medical care for transgender people will continue until 2024, targeting more adults
Similar laws followed tennessee, floridaand missouri Both of these would extend the statute of limitations for medical malpractice claims from 15 to 30 years. (One more thing was introduced, Not allowed in Texas This would extend the statute of limitations to the patient's lifetime. ) Medical malpractice lawsuits are typically It must be submitted Within 1 to 3 years after injury.
The civil liability created by these laws has forced at least one clinic to stop offering some treatments.Transgender Center, University of Washington, Missouri the law said It exposed the clinic to an “unacceptable level of liability.”
Alejandra Caraballo, a civil rights attorney and clinical instructor at Harvard Law School's Cyber Law Clinic, said, “There is a concerted effort on the part of anti-trans activists to use malpractice insurance as a means to exclude care.'' ” was said to have occurred.
She likened the strategy to laws that have long targeted abortion providers by increasing their “legal liability to chill certain types of conduct.”
Anti-trans activists have focused attention on a small number of “detransitioners” who have filed lawsuits against doctors who provided gender-affirming treatment, she said. She believes these lawsuits, filed in states such as California, Nebraska and North Carolina, will be used to lobby for longer statutes of limitations and create a perception of increased liability for providers. ing.
read more: Georgia can resume enforcing ban on hormone replacement therapy for transgender youth, judge says
For independent clinics like the Quad-City projects and smaller medical institutions that purchase malpractice insurance on the commercial market, these tactics limit their ability to provide care. Many providers of gender-affirming care include federally funded health centers covered by the Federal Tort Claims Act, self-insured academic medical centers, and family planning clinics, all of which have low insurance premiums. protected from rising. But prices are soaring at a few independent clinics.
In Albuquerque, New Mexico, where access to gender-affirming care is protected like in Illinois, family medicine physician Anjali Taneja faces similar challenges getting insurance coverage for her clinic. He said he is doing so.
Casa de Salud Hospital, where Taneja is the executive director, had been providing gender-affirming care to adults for years, but when the clinic decided to start offering that care to younger patients, insurance The company did not publish a medical malpractice policy. Taneja said the clinic is estimated to be paying “double what it paid a few years ago” just to cover the gender-affirming care it provides to adults.
Red tape faced by both Casa de Salud and The Project hinders patient care. When Iowa's ban on gender-affirming care went into effect Sept. 1, project officials said they wanted to help transgender people who had previously sought care at the University of Iowa's LGBTQ clinic an hour west. I wanted to serve young people. Instead, Lowe said, patients are being forced to make difficult decisions about whether to live without treatment or commute four hours to Chicago or Minneapolis.
After months of fundraising, the project raised nearly enough money to pay for the $50,000 medical malpractice policy. But Mr Rowe said: “That's a tough swallow.”
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