The study says that discrimination in accessing health care can lead to postponement of needed care two to three times above normal.
“Anti-transgender discrimination in public accommodations has effects on the physical and emotional wellbeing of transgender people, and therefor it’s really a public health issue,” Sean Cahill, director of policy research at the Fenway Institute told WGBH News.
“Discrimination in health care settings creates a unique health risk for gender minority people. The passage and enforcement of transgender rights laws that include protections against discrimination in public accommodations—inclusive of health care—are a public health policy approach critically needed to address transgender health inequities,” the study, written by the Fenway Institute’s Sari Reisner, concludes.
The study found that 65 percent of respondents reported discrimination when accessing public accommodations. The five most prevalent areas where the respondents ran into discrimination were in transportation settings, retail establishment, restaurants, public gatherings and health care.
“Discrimination in public accommodations is common and is associated with adverse health outcomes among transgender and gender-nonconforming adults in Massachusetts,” the study reads.
In 2013, researchers surveyed 452 individuals from the transgender community and assessed “demographics, health, health care utilization, and discrimination in public accommodations venues in the prior 12 months.
“We also asked people, particularly those who have experienced discrimination in a health care setting, if that affected their desire to return for health care or to seek health care in the future. And we found that of those experiencing discrimination in health care settings, 25 percent were less likely to seek routine care and 19 percent were less likely to seek emergent care,” Cahill said.
Researchers from the Harvard and Yale schools public health, the Heller School for Social Policy and Management, Brandeis University, Wagner School of Public Service, New York University, Fenway Health and the advocacy group Massachusetts Transgender Political Coalition published the investigation “Legal Protections in Public Accommodations Settings: A Critical Public Health Issue for Transgender and Gender-Nonconforming People” in the Milbank Quarterly this month. Some of the study’s data had previously been released in 2014.
Massachusetts added non-discrimination language for gender identity to its laws in 2011. The state became the 16th in the country to carve out protections for transgender people in employment, housing, public education and credit access. The hate crimes laws were also updated to include gender identity among the list of protected classes.
The 2011 anti-discrimination law defines gender identity as “a person’s gender-related identity, appearance or behavior ... sincerely held as part of a person’s core identity; provided, however, that gender-related identity shall not be asserted for any improper purpose.”
The Massachusetts Transgender Political Coalition defines gender identity as “appearance or behavior, whether or not that gender-related identity, appearance or behavior is different from that traditionally associated with the person’s physiology or assigned sex at birth.”
Left out of the 2011 law was a provision to allow transgender people access to public accommodations, things like transportation settings, medical facilities - and yes, public bathrooms and locker rooms - that are traditionally segregated by gender.
Before the bill’s scheduled hearing Oct. 6 in the Judiciary Committee, LGBT advocacy group Freedom Massachusetts Coalition will host a lobby day Sept. 17 to introduce members of the transgender community to lawmakers who may not have yet met any.
House lawmakers met behind closed doors in July for what Speaker Robert DeLeo’s office called a “conversation” on the issue. Massachusetts Transgender Political Coalition executive director Mason Dunn, Attorney General Maura Healey and Joyce Linehan, Boston Mayor Marty Walsh’s top policy advisor, briefed lawmakers at the meeting.
One obstacle for the bill could be a business lobby wary of government mandates or new rules that could open them up to lawsuits. Retailers Association of Massachusetts President Jon Hurst said that the bill needs to be clearer about what new accommodations will be necessary and what it allows regulatory boards to do beyond the initial scope of the legislation.
“With a lot of small businesses operating out of very old building in MA, there is always the concern—real or exaggerated—that expensive upgrades may be required. Making it clear removes all doubts,” Hurst told WGBH News in an email.
Freedom Massachusetts co-chair Kasey Suffredini maintains that the new law would cost businesses nothing.
“Nothing in this legislation would require businesses to make alterations to their physical premises, nor is the coalition supporting the bill — which includes both large and small businesses — seeking such changes,” Suffredini told WGBH News.
House Democrats could also be wary of taking a culturally controversial vote. The issue of accommodations was dropped from the 2011 bill after opponents raised questions about public safety resulting from allowing transgender people to use the accommodations they prefer. That open opposition has cooled in the Legislature to the point where both Senate President Stanley Rosenberg and House Speaker Robert DeLeo want to revisit transgender rights.
Some business heavyweights like Google, Eastern Bank and Harvard Pilgrim Health Care are backing accommodations access. Gov. Charlie Baker, who for years ran Harvard Pilgrim himself, has said the current protections for transgender people go far enough.
Stonehill College political science professor Peter Ubertaccio told WGBH that Democrats who may be inclined to support transgender rights might be weighing the political consequences.
“Conservative Democrats that represent districts that could become Republican, because they’re more red than other districts in the state, are probably thinking of the specter of Richard Moore and losing their seat to a well funded Republican candidate,” Ubertaccio said.
The specter in question refers to Democratic former Uxbridge Sen. Richard Moore, who in the shocker of the 2014 election, lost his seat of almost 20 years to conservative Republican challenger Ryan Fattman.
Ubertaccio said the issue on it’s own may not be enough to sink a contested Democrat running in a reddening district in 2016, but it could add fuel to a challenge. Misinformation and misunderstanding about transgender people and the legislation itself could cause some incumbent headaches.
“It’s easy to demagogue on an issue such as this,” Ubertaccio said.
But the timing might work out in the LGBT lobby’s favor. With Speaker Robert DeLeo now on board, getting the bill passed in 2015 could be a reality. That quick time frame, and the Speaker’s support, could create enough of a buffer to protect on-the-fense Democrats from repercussions at the polls in 2016.
