It Could Happen Here - How Trump is Changing Trans Healthcare

Episode Date: February 25, 2025

Two healthcare providers at federally qualified healthcare centers join James and Gare to discuss how providers can organize to take care of their trans patients under the Trump administration.See omnystudio.com/listener for privacy information.

This is John Cameron Mitchell and my new fiction podcast series, Cancellation Island, stars Holly Hunter as Karen, a wellness influencer who launches a rehab for the recently canceled. In the future, we will all be canceled for 15 minutes, but don't worry, we'll take you from broke to woke or your money back. Cancellation Island's revolutionary rehab therapies like Bad Touch Football, Anti-Racism Spin Class, and mandatory Ayahuasca ceremonies are designed to force the cancel to confront their worst impulses. But everything starts to fall apart when people start disappearing. Karen, where have you brought us?

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or wherever you get your podcasts. Hi, everyone, and welcome to It Could Happen Here, a podcast about things falling apart and the people putting them back together. And today, Garrison and I are joined by Hayley and Dan. Both Hayley and Dan are gender affirming care providers in the Northeast and they both work at federally qualified health centers. Welcome to the show, guys. Thank you so much. Thank you.

Okay, so for people who are not familiar, maybe they've been fortunate enough to have really good healthcare their whole life, or fortunate enough to not live in the United States and have this bizarre web of healthcare provision. Can you explain what a federally qualified healthcare center is? Sure. You mind if I take this one, Hailey?

So I would start by saying that our industry, our advocacy arms would riot if they assumed that federally qualified health centers weren't good care, right? So I got to dismiss with that to start. Oh, yeah. I guess good is a relative to... Yeah, I've relied on a federally qualified healthcare center for a while and it was great. They were very nice. Actually, my prescriptions cost a lot less now than they do with my very expensive eye high insurance. Yeah. So around the 1960s, there was the sort of free clinic movement that got started and

what grew out of that became the federally qualified health center system in the United States. So there are roughly 1,600 unique federally qualified health centers all over the country and we as in sort of, you know, confederated set of health centers all across the country are responsible for treating those most in need in the United States. So the Medicaid population, those without insurance, we cannot turn anybody away if you do not have insurance. People in rural areas where health care is very difficult to access and to get undocumented folks,

and really everybody in between. At the health center that I work at, we mostly treat folks on Medicaid, which is pretty typical, although you'll find in states with no Medicaid expansion, it's a lot more uninsured and less Medicaid, but, um, we are the nation's safety net healthcare provider and without us, there are roughly one in 10 Americans would not

get their healthcare. Geez. So like, I guess people who are not in the United States, do you want to go and give us a go one minute speed run of what Medicaid is, Medicare? Sure. So America does not have a nationalized insurance program as we are very frustrated with most of the time. It's mostly commercial insurance that you mostly get through your job.

But if you are not fortunate, this is not the right word. But if you're not fortunate enough to get that, Medicaid is the system that gives health insurance to people who are living at or below the federal poverty line with the Affordable Care Act or the ACA, Obamacare, that level raised a little bit, so you could still get Medicaid if you were at above the federal poverty line, but this is mostly for the working poor. That's who gets Medicaid. Cool. Yeah, it's a great system. Let's talk about how this is funded then. You said the US doesn't have like a single pair healthcare system. So how are these healthcare centers funded right now? Or maybe how were they funded like six weeks ago?

Yeah. Um, so most of the work that we do is fee for service. We're not a lot different than a lot of other places in that regard, right? If you have Medicaid patients, we are a fee for service program. We give provision of care to them on a per visit basis, same as anywhere else in the country and how that works, and we get reimbursed for it. What makes FQs different than everywhere else is two things. One, we get a special rate that is designated

because of our willingness to take on these more expensive, more complicated patients and to ensure that they are healthy enough to keep that expensive systems of care, like emergency rooms and things of that nature. And two is that we have a grant called the Fed 330. And this is a sort of like large sort of use it as you need to grant that depending on the agency is anywhere from five to 25% of your total annual funds and is meant to cover

all of the folks who can't afford care and are uninsured. Part of my funding also, I do a lot of work with HIV and HIV prevention. So a lot of my work is done via Ryan White funding. And there's some other kind of separate funding streams that's applicable specifically to gender affirming care. However, it's all kind of messy and tied up in a lot of those other funding streams that Dan mentioned. And there's some specific limitations because of those funding streams, again, historically, because who knows right now. But there's something called the Hyde Amendment. It means that our

funding would be at jeopardy if we provided abortion care. So there are some kind of limitations. A lot of what we do as an FQHC is providing really comprehensive, expansive care. We're kind of some of the few clinics that do everything that we do under one roof. But there have been some limitations, specifically abortion to that. Yeah, it's more of a health care experience that I'm used to as someone from Europe, like going to one of these centers and like the American one where you get a referral and then get it approved and blah, blah, blah. And like a lot of the ways that I talk to friends who live in other countries,

like, like my role is kind of more similar to like a GP as a nurse practitioner. There isn't necessarily an equivalent, but I feel like a GP is kind of a very similar universal way to understand a lot of what I do. Yeah, that makes sense. So can you explain Ryan White funding? Where does that come from? Why is it called Ryan White? So basically Ryan White funding was initiated in,

I believe the early 90s during the AIDS crisis, and was a large government initiative. It's named after Ryan White, who was a patient who contracted HIV through a blood transfusion. So Ryan White funding right now is a major source for funding things like PrEP, which is medication for prevention for HIV, as well as direct HIV treatment. Yeah. So a number of these things, right, gender affirming care, perhaps care for people with

HIV or preventing people from getting HIV through like pre-exposure prophylaxis, like you said, like these are things that have been like, like at the center of the culture war for the current government, right? Like they're there, like the things that they point to as, you know, whatever their sort of, like in Paxton's, in Paxton's construction of fascism, he talks about moral decline, right? And this is their moral decline,

that this is what they use when they're constructing their kind of, we will save you narrative. What does that mean for funding? And like, what does that mean more importantly for your patients, for people who come to you for these different types of care? I mean, I think it's terrifying. I think I'm more on the patient facing side. So a lot of the conversations I've been having are just about the uncertainty.

I'm a prescriber for a lot of trans youth, adolescents, and young adults. And so moreover, the uncertainty of just being able to get their medication, the stress of being publicly named and targeted in this culture war has just created a climate of fear. As my job, I want to be able to reassure patients that I am going to fight for them and do all that I can. But it's really scary. As Dan mentioned, a lot of our patients don't have financial safety net. They don't have a medical safety net. We're really the one option for them. And if our clinic does not continue to offer this type of care, these are our kids who are going to go without hormones. I prescribe puberty blockers. My work as a gender affirming care provider isn't just blockers and hormones, but those are medications that we know are

life-saving. We know that, that unfortunately kids will suicide if they don't have access to those medications. And so I think, you know, talking about funding, talking about these bigger shifts politically, you know, are things that, unfortunately, a lot of the conversations I'm having are really coming just down to safety and safety planning and figuring out support networks and talking about creative ways to get hormones if we can't prescribe them. Yeah. I think it's worth talking about the fact that there are so many angles of attack on this, right?

There is the one that is just very clearly aimed at trans kids, right? The EO that specifies protecting children, it's nonsense, but that is aimed at ending this care everywhere. Now, are they gonna be able to do it everywhere? I don't know, maybe, but not quickly. But that is aimed at ending this care everywhere. Now, are they going to be able to do it everywhere? I don't know, maybe, but not quickly. But they can end it for FQHCs all across the country by simply making it like the Hyde Amendment.

If we were to perform abortion services at the place that I work, then we would lose our Fed 330 funding and we would lose our FQ designation, which would cut our rate in half. And that would devastate the business and put us out and mean that we could not care for the thousands and thousands and thousands of other people that we care for besides those kids, right? Then there are also the just the dogefuckery

that is going to harm all of this and may create a lot of the same outcomes, right? Which is they turned off grants kind of just across the board. Yes, some of them were targeted on things like gender affirming care, but most of them were just like, it's a grant, we're turning it off. And then there was the TRO, but much of that funding has remained frozen. We have been told that the system is up and running and that they undid what they did and the court stepped in and oh don't we have the courts still here in the United States isn't that a good thing but they just kept the

funding off whether because they're incompetent or because they're actively defying the law doesn't really matter and as a result federally qualified health centers all across the country have laid people off they have closed clinics and have entirely gone underwater in some cases, and then those people are not there to treat the community that needs them so badly. And all of these systems are grounded in their communities. So when you lose, you know, the clinic that's in LA that had to close its doors for the office that's, you know, on one side of town, the people there knew that place, it was part

of their community, part of their existence, it was grounded in that community and its community's needs. And that's just gone. And this puts us in a very difficult position and leadership in a very difficult position of figuring out, well, do I worry about these trans youth and the fact that they might kill themselves? Or do I worry about the impact that standing up on principle and saying, I won't toss them to the wolves,

might have on the rest of the system. And it becomes a very difficult sort of situation for us as providers to navigate, but you know, in fairness to leadership, which I disagree with for them too. Yeah, that's tough. Can you briefly explain like maybe lay out a timeline because we talked about executive orders there, we talked about a TRO. Like there was a large number of executive orders, right? And in the last three weeks, like maybe people miss them.

Can you explain the pertinent executive orders and then what's the tentative restraining order? Yeah. So on Trump's first day in office on the day of his inauguration, so January 20th, he signs the a hundred some odd executive orders. The ones that are particularly of interest to us in healthcare were protecting children against chemical and surgical mutilation is the name of it which is a disgusting and vile name.

Yeah. And then protecting women something something something. Defending women. Yeah, defending women which is similarly aimed at transgender individuals And I think will be used after we are under attack for trans youth to come after trans adults in federally qualified health centers as well Those EOs led to later that week on Friday We got emails to every PI which is principal investigator on every federal grant that we had that said because of Those two and there was one about DEI Which is also an executive order you are not allowed to use any of these grant dollars in service of anything in defiance of these three Executive orders so that was the first shot we got and it came only four days later It's threatening but it wasn't specific right? It didn't specifically say we're going to do X, Y, or Z, but it was, here's the threat.

The following Tuesday, Doge is let loose and announces that they are freezing federal grant funding tied to anything that is in opposition to those things. If you actually looked at the Excel file that they released with the actual grants, it froze everything. Like it looked at the excel file that they released with the actual grants it froze Everything like it was not just the stuff that they felt was in opposition to this It was like everything we have a ton of grants that were on that list at the agency that I work at And boy, oh boy. Oh boy. Was there a lot of panic going around? Wednesday rolls around and they get a judge to come in and sort of put a halt on it

And then later that day the press secretary says oh, we're just gonna send the memo We're still gonna freeze everything and then the judge comes back and puts a temporary restraining order so in theory what that should have meant is that all of that grant funding once again flows and It did not importantly to for us given how much Medicaid dollars we take in, Medicaid portals in all 50 states went down, so we could not get any of those dollars in service of what we were doing for 12 hours. But still, it was this very concerning situation, because Medicaid was not on their list of things that they were after,

and yet we couldn't even access it on the state level. A few more weeks go by, and there's news popping about, hey, you said you unfroze stuff, but it's still frozen. Another judge issued an order saying that, like, no, for real, I need it this time, unfreeze everything. I know some of the grants that we had that we couldn't access seem to have come back online,

but I don't know, you know, I think it would be an impossible thing to do an accounting of like every single one that might have been turned off that might might or might not be back on right now. But I am doubtful that at this point, every single grant across the federal agency is is potentially available for folks. Just seems unlikely to me. Yeah, we should pivot to advertisements here. So I'm gonna do that. And then we'll be right back.

Hey y'all, it's your girl, Cheeky's and I'm back with a brand new season of your favorite podcast, Cheeky's and Chill. I'll be sharing even more personal stories with you guys. And I know a lot of people are going to attack me. Why are you going to go visit your dad? Your mom wouldn't be okay with it. I'm going to tell you guys right now, I know my mother and I know a lot of people are gonna attack me. Why are you gonna go visit your dad? Your mom wouldn't be okay with it. I'm gonna tell you guys right now, I know my mother. And I know my mom had a very forgiving heart. That is my story on plastic surgery. This is my truth. I think the last time I cried like that

was when I lost my mom. Like that, like yelling. I was like, no. I was like, oh, and I thought, what did I do wrong? And as always, you'll get my exclusive take on topics like love, personal growth, health, family ties, and more. And don't forget, I'll also be dishing out

my best advice to you on episodes of Dear Cheekies. So my fiance and I have been together for 10 years and the first two years of being together. I find out he is cheating on me, not only with women, but also with men. What should I do? Okay, where do I start? That's not love.

He doesn't love you enough, because if he loved you, he'd be faithful. It's going to be an exciting year, and I hope that you can join me. Listen to Cheeky's and Chill, season four, as part of the My Kultura podcast network, available on the iHeartRadio app, Apple podcasts, or wherever you get your podcasts. Do you remember what you said the first night I came over here?

How goes lower? From Blumhouse TV, iHeart Podcasts, and Ember 20 comes an all-new fictional comedy podcast series. Join the flighty Damien Hirst as he unravels the mystery of his vanished boyfriend. And Santi was gone. I've been spending all my time looking for answers about what happened to Santi. And what's the way to find a missing person? Sleep with everyone he knew, obviously. Pillow talk. The most unwelcome window into the human psyche. Follow our out of his element hero as he engages in a series of ill-conceived investigative hookups. Mama always used to say, God gave me gumption in place of a gag reflex.

And as I was about to learn, no amount of showering can wash your hands of a bad hookup. Now, take a big whiff, my brah. Listen to The Hookup on the iHeartRadio app, Apple podcasts, or wherever you listen to your favorite shows. This is John Cameron Mitchell and my new fiction podcast series, Cancellation Island, stars Holly Hunter as Karen, a wellness influencer who launches a rehab for the recently canceled. In the future, we will all be canceled for 15 minutes. But don't worry, we'll take you from broke to woke or your money back.

Cancellation Island's revolutionary rehab therapies like Bad Touch Football, Anti-Racism Spin Class and Mandatory Ayahuasca Ceremonies are designed to force the cancel to confront their worst impulses. But everything starts to fall apart when people start disappearing. Karen, where have you brought us? Cancellation Island, where a second chance might just be your last. Listen to Cancellation Island on the iHeartRadio app, Apple Podcasts, or wherever you get your last. Listen to Cancellation Island on the iHeartRadio app, Apple podcasts, or wherever you get your podcasts. I'm Mary Kay McBrayer, host of the podcast,

The Greatest True Crime Stories Ever Told. Join me every week as I tell some of the most enthralling true crime stories about women who are not just victims, but heroes, or villains, or often, somewhere in between. Listen to the greatest true crime stories ever told on the iHeartRadio app, Apple podcasts, or wherever you get your podcasts. Okay, we are back. So you talked about like these grants being turned off or not coming. What does that mean? Like, does that mean people don't get care? Does that mean providers don't get paid? Does that mean they can't access their prescriptions? Like, what does

it look like if I'm trying to access care through one of your clinics? So yeah, I'll speak to that a little bit on the prescriber side, because I think, you know, having direct contact with someone who works as the administration is really the only way that I have really been able to get any updates. So as a healthcare provider, it's been utter chaos. Basically every day we've gotten different messaging around whether or not appointments can be scheduled, new patients can schedule intakes, whether or not we're able to prescribe these life-saving medications.

And no one knows exactly. Gender affirming care is basically healthcare. There's nothing that separates it. There's no hard line. There's no clear distinction. It is medically indicated evidence-based care. So saying you can't do gender-affirming care, it literally doesn't make any sense

in terms of what we do as prescribers. And on my end, I've been faced with intimidation. I've been faced with kind of whisper networks of misinformation coming from administration trying to get us to stop prescribing because they do see this type of care as a liability. I'm still prescribing. There is no state law in the state that I am in that prevents my ability to practice to the full extent of my scope.

There are also no medical indications for me to stop prescribing, and I'm ethically bound as a nurse practitioner to do what I believe is best for my patients, which is to continue to provide them with the care that they need. But it's terrifying. I think importantly, Haley and I have the advantage

of working for a more economically stable institution. There's a lot of health clinics out there that have a week's worth of working capital, right? So if all of a sudden they lose access to every grant dollar, they lose access to their Fed330, they were scheduled to draw down on a grant that was going to cover a whole bunch of upcoming expenses, but they haven't done it yet and then they can't, like in very real ways that may mean that the doors are closed and the place goes under and that no one can get care there.

And there is this real challenge of how do we decide what is the best thing to do. But for me, and what started working with, in our agency at least, to organize around this, is that this is an anti-fascist practice. It is the right medical thing to do. It is the right ethical thing to do. But it is also our chance to is an anti-fascist practice that is the right method medical thing to do it is right ethical thing to do but it is also our chance to take an anti-fascist stance against this government because if

we don't stand now for the very first group they're coming for then the next group which is without question trans adults and undocumented people then those groups will fall just as quickly and then at some point we're doing the poem the first they came for the socialist thing. And I just refused to be a part of that. Yeah. Let's talk about what that means then. Like you said, it's difficult to get any response

from administration, right? In terms of what you can do, in terms of what you can't do. How are staff and providers organizing to make sure that they're able to keep providing for their patients? So just to provide also like a little bit of a peek into kind of the broader landscape of this, our clinic is not alone in their confusion on how they've been handling this. Not only FQHC is, but also hospital affiliated clinics,

academic medical clinics have basically clinic by clinic decided on their own plan on how to manage this, which is also incredibly confusing for providers and for patients. But something that was really heartening was that NYU Lingo, and this was in the news recently, they canceled appointments for two kids, literally just two kids, recently, they canceled appointments for two kids, literally just two kids, which is more than enough. And it sparked this enormous outcry and protests. And so I think there's also on my end, a lot of solidarity building with other providers who are doing this work and a lot of inspiration.

There are clinics out there, some who are FQHCs like us, who have stood firm and they've said our doors are going to stay open. We're going to keep providing this care. And so I think there are models out there. And I think that there are networks of healthcare providers who are committed to continue to advocate and just continue to do this, right? Because a lot of what we're facing right now is intimidation. It's not actual legal threats as of yet.

Yeah, I think the organizing side has been challenging but also hugely rewarding, right? It became really obvious really early on that both from the federal government's perspective as well as from our organization's perspective, that the uncertainty was where they wanted us all to live and die. That was the place that served them

and their goals the most. And so how does uncertainty foster? Well, people don't talk to one another, right? Like, this is true kind of in organizational sense, it's across the board, right? If you're in a union, you don't talk about your salary, it doesn't benefit you, it benefits the boss. And so if we're not talking to one another

about where our lines are, who we're gonna treat, whether we're gonna keep doing it or listen to them, what we're being told or not being told, that we're consulting lawyers, all these other kinds of things, then we're all just alone in the dark, kind of trying not to scream and cry about the horrors that are happening around us.

So we pulled together folks with conversation here, conversation there, folks who before anything was going on internally, you know, made really bold statements about what they would and would not do around this kind of stuff. And now all of a sudden there's an internal network that's looking at, well, okay, so individually, we can keep doing this care,

because it's the right thing to do. But as a group, if they start coming after us, we have a lot more power, there's a lot more that we can do. And I suspect, and you know, Haley's getting at this point, that like, there are probably a network of us across the entire country in these kind of settings that are not talking amongst ourselves at our workplace, but are really not talking about it amongst ourselves

on a national level. And I think we have some power that could be used there to really make a difference in all of this. And I am optimistic that if we talk about this, we get this out there, we make sure everyone's communicating openly about it, that there's a real possibility that we can work together to prevent this from being the first of many dominoes to fall. And one thing that's interesting, I think, is that with trans health care, trans health care is inherently radical. Like trans health care is not something that came from the kind of medical hierarchy. This is by and large a field that was communal. Trans people were doing their own trans health care before it became kind of institutionalized into a lot of these spaces.

So I think we also have a lot of providers who are willing to fuck shit up, right? Like the community and the providers are intertwined. And I do think there is a real kind of radical bent to this type of work, which is why I think a lot of us have been so easily able to collectivize and strategize and kind of come together. It's a pretty small world as well. We sat down on a call and talked about, you know, what are we going to do? And I made mention that like, oh, through my other organizing work, I've got a DIY connection

for estradiol. So that's a huge thing that will help us if we can't prescribe this anymore, if Medicaid stops covering it, yada yada yada. I was like, but I don't have a DIY solution for tea, if anyone knows of anybody, that'd be great. And immediately someone's like, oh yeah, absolutely, I do, it's tested, it's 99.9% pure, we're ready to go. So now, I wouldn't have done that, there was no way for us to know that that was the kind of radical work that people were doing, if not for coming together on this kind of stuff.

Yeah. Maybe we should explain like the inherent risks like legally, and then the distinction between those two hormones legally, right? Like if people are unaware. Yeah. So, you know, as a medical provider, again, I have to be a little bit careful here, but basically because testosterone has been used by mostly the cis male community as an anabolic steroid and used, you know, in somewhat would call

like anabolic steroid misuse or steroid use disorder, it is a controlled substance. Estradiol is not. They're both bioidentical hormones. Every human on this planet, their body makes estrogen and testosterone, ENT, estradiol and testosterone. However, in the United States, testosterone is considered a controlled substance, which makes it a little more tricky for folks to access without a prescription and also can put them at legal risk if they do so.

Right. Like there's a built in legal consequence for people who are trying to manufacture that or who are trying to obtain it like outside of the sort of prescription system. Not that there aren't other probably legal threats coming down the pipeline, I guess. Also testosterone is a, yes, it is a controlled substance. It does, it does flow in the bodybuilding community. Yeah, it's a controlled substance. It does flow in the bodybuilding community. Yeah, it's not well controlled.

Yes, and that is also worth stating because, yes, if you go to your average gym... Oh, yeah, you can walk across the border to Tijuana and see like, you know how gas stations have the prices unleaded, premium? Yeah, you can get testosterone prices displayed in the same fashion. I mean, I'm sure you're huge fans of Joe Rogan. So many of my other patients who are not trans have been influenced to purchase testosterone because of our good friend Joe Rogan. Yeah. Yeah.

Fascinating stuff. Yeah. Which is also gender affirming care for whatever that's worth. Like six people get gender affirming care too. Yes, yeah, fascinating stuff. Yeah. Which is also gender affirming care for whatever that's worth. Like six people get gender affirming care too. Yes, they do. It's a little easier for them right now. Hey y'all, it's your girl, Cheeky's,

and I'm back with a brand new season of your favorite podcast, Cheeky's and Chill. I'll be sharing even more personal stories with you guys. And I know a lot of people are going to attack me. Why are you going to go visit your dad? Your mom wouldn't be okay with it. I'm going to tell you guys right now, I know my mother and I know my mom had a very forgiving heart.

That is my story on plastic surgery. This is my truth. I think the last time I cried like that was when I lost my mom. Like that, like yelling. I was like, no. I was like, oh, and I thought, what did I do wrong? And as always, you'll get my exclusive take on topics like love, personal growth, health, family ties, and more.

And don't forget, I'll also be dishing out my best advice to you on episodes of Dear Cheekies. So my fiance and I have been together for 10 years. In the first two years of being together, I find out he is cheating on me not only with women, but also with men. What should I do? Okay, where do I start? That's not love. He doesn't love you enough. Because if he loved you, he'd be faithful.

It's going to be an exciting year, and I hope that you can join me. Listen to Cheeky's and Chill, season four, as part of the My Kultura podcast network, available on the iHeartRadio app, Apple podcasts, or wherever you get your podcasts. Do you remember what you said the first night I came over here?

Ow, goes lower. From Blumhouse TV, iHeart Podcasts, and Ember 20 comes an all-new fictional comedy podcast series. Join the flighty Damien Hirst as he unravels the mystery of his vanished boyfriend. And Santi was gone. I've been spending all my time looking for answers about what happened to Santi. And what's the way to find a missing person? Sleep with everyone he knew, obviously. Pillow talk. The most unwelcome window into the human psyche. Follow our out-of-his-element hero as he engages in a series of ill-conceived investigative hookups. Mama always used to say, God gave me gumption in place of a gag reflex.

And, as I was about to learn, no amount of showering can wash your hands of a bad hookup. Now, take a big whiff, my brah. Listen to The Hookup on the iHeart Radio app, Apple podcasts, or wherever you listen to your favorite shows. This is John Cameron Mitchell, and my new fiction podcast series, Cancellation Island, stars Holly Hunter as Karen, a wellness influencer who launches a rehab for the recently canceled. In the future we will all be canceled for 15

minutes, but don't worry we'll take you from broke to woke or your money back. Cancellation Island's revolutionary rehab therapies like Bad Touch Football, Anti-Racism Spin Class, and mandatory Ayahuasca ceremonies are designed to force the cancel to confront their worst impulses. But everything starts to fall apart when people start disappearing. Karen, where have you brought us?

Cancellation Island, where a second chance might just be your last Listen to Cancellation Island on the iHeartRadio app, Apple podcasts or wherever you get your podcasts I'm Mary Kay McBrayer, host of the podcast the greatest true crime stories ever told Mary Kay McBrayer, host of the podcast, the greatest true crime stories ever told. Join me every week as I tell some of the most enthralling true crime stories about women who are not just victims, but heroes or villains or often somewhere in between. Listen to the greatest true crime stories ever told

on the iHeartRadio app, Apple podcasts, or wherever you get your podcasts. So let's talk about like what this organizing looks like on the ground, right? Like, A, if someone's working, maybe they're not in a FQHC, right? Maybe they're working in academic health center. Maybe they're working in academic health center. Maybe they're, they're working, you know, in one of the many other places where you can access gender affirming care in this country and they are feeling like alone or they're scared and they're not receiving any affirmation or help from their management and they don't know who they can talk to among their colleagues.

Like, how are people connecting? to among their colleagues? Like, how are people connecting? Like, what are people talking about? And like, how can people who are because, you know, the healthcare system is vast in this country, because it duplicates itself, because the nature of American privatized healthcare, like, how can people who want to continue providing care for patients do that? How do they organize their colleagues? How do they contact people who are already organizing? Like, let's talk through their nuts and bolts of it. I mean, I think there's a lot of national orgs out there that are really doing the work. So if you're a medical provider, I would highly recommend to join Glamour, which is a gay and lesbian medical association, because they have some lawsuits. And as a member of Glamla,

that could possibly give you some additional protection following other orgs like Lambda Legal, Sage, which is an organization for an elder, gay, lesbian, and queer trans folks. Trans people have existed and have built organizations. A lot of those organizations are fighting this on a national level and some of those are more geared toward kind of healthcare professionals like Glamah. I would say there's two conversations that we all need to be having. Like those external

organizations are huge and necessary for direction. Within your own space, you have to talk to your colleagues in a way that's honest and talk to them about risk taking, talk to them about where you will and will not budge on some of these kinds of things, talk to them about the value of the work that you all do because there's more of you doing it. Talk to your trans colleagues, they exist, they're out there,

like they have very strong opinions on this, I am sure. And then talk to a lawyer, talk to an employment lawyer, because your corporate attorneys have very different goals than you do. Their goal is simply to protect the company and its bottom line. And both they and the federal government and the DOJ are spewing absolute bullshit. So don't let them flood the zone with nonsense. Get a lawyer who can tell you what's nonsense and stand firmly in that because it is.

And then when you start thinking about as an organization, as a group, as a set of employees, communicating with leadership about these kind of things, know that the law is actually not on their side, it's on yours. And let them know that they are exposing themselves to vulnerability for malpractice and for civil rights violations

and any number of other things that they probably don't wanna be on the hook for. This is the leverage that we've got right now. It seems to have slowed things down a little bit internally for us that they've had to confront a very well-pointed out legal opinion that said that they were exposing their providers to civil lawsuits if they didn't do this

and that the FDCA, the Federal Tort Claims Act, didn't protect people under these guides. That has been really beneficial to us. The other thing I would say is there's a real union feel to a lot of this and as we started coming together A bunch of us realized well, we all kind of had union Conversations somewhere along the way but corporate unions and like SEIU Represents a lot of like individual sort of arms of companies like the ones that we work at

They aren't interested in the politics of the work you do. They're interested in your benefits, they're interested in you as a worker, but they're not interested in your relationship to the work. And so we're approaching this not necessarily as a union, but from the perspective that if we need to strike on behalf of patients and their access to care, that's a tool in our toolbox. And we don't have to do anything more

than declare it a strike to be protected under the NLRB and some of these various different things and we can do it for political reasons instead of for pay reasons, which means we can do it as a diverse group instead of as all the nurses, all the advanced practice providers, all of the psychologists and therapists and LCSWs where they break us apart by discipline instead of by, you know, what sort of managerial status you are. Yeah, yeah, I think that's a very good point. I read a book recently about how the longshoremen in San Francisco stopped weapons going to

Chile or El Salvador by striking and refusing to load weapons onto ships. And like, that's a union energy we could use right now. Yeah, I think people would be well advised to like, I will say that they'd be well-advised to check with federal and local law because like some state legal landscapes can be very different, right? I want to end with like, people are probably afraid of accessing care, right? Like, people are probably afraid of going to see their providers, like understandably, like you said before, like especially kids or people under 18 are

like right in the center. The president of the United States called out a friend of mine personally by name recently. She's a trans athlete and like they're really coming after people. I understand that people are afraid. Like what should they know if they're concerned about their hormone supply or they're on puberty blockers right now? Like if people are listening, what would you, maybe they don't know where their provider stands, you know? Yeah. I mean, I tell my patients this, but I'm in awe of them. They're incredible. And

a lot of them are nerdy feeder kids who love cats, and they want to just exist. And some of them are also incredible, outspoken activists. They are just amazing. And I will fight with everything that I've got for them. And I really hope they know that. I think one of the mantras I've been given to fellow colleagues, as well as to our leadership to like get their heads on straight, And I really hope they know that. I think one of the mantras I've been given to fellow colleagues as well as to our leadership

to get their heads on straight is that fascism is messy, right? It's a scary, messy, there are a lot of throwing stuff at the wall and seeing what sticks. But the things that in theory are still in place, like when and if they fall, we have different problems than the ones we're facing now, right?

So we still have, in this country, protections for your healthcare information. So if what you worry about in going to the doctor is that someone will find out that you're trans and put you on a list, like I can't tell you that's never going to happen. But I can tell you that if it happens through your healthcare clinic, like we have significantly changed the threat model that we're all living in because HIPAA doesn't matter anymore and doesn't exist. Your providers are spending enormous amounts of time thinking carefully about how they document,

where they document, how much of a deal they want to make it, whether or not they can change the thing they're prescribing for you and what diagnosis is for. We are finding ways to sort of throw as much cover and shade and camouflage over this as we can. is for we are finding ways to sort of throw as much cover and shade and you know camouflage over this as we can but you shouldn't not come get care your life matters you being in the body that you were meant to have matters come talk to us come ask for help we're here to do it and we're not gonna stop until they

make us and right now they can't make us and so we're gonna keep doing it and I think the mantra of trans people have always existed. Trans people exist. And personally, I'm going to do my best to make sure that for every single one of my patients that they continue to get what they need, however that looks like. That is good to hear. I know a lot of trans people have essentially trauma with aspects of the medical community establishment, whatever. Yeah.

And like, you know, not all practitioners, maybe as much in our camp as maybe you are. And I would encourage people if they are still looking for care through like these sorts of channels, you should try to find out where other trans people in your city are already going. There's certainly like clinics will have stuff on their website that indicate that they either specialize in this or they offer this. I suppose, you know, maybe just a general practitioner who may not be, you know, the greatest in this vein. And like this still happens. I've talked to a lot of friends recently who've spoken about having increasingly uncomfortable experiences with nurses or doctors when they're trying out like different clinics or different providers, university providers. So it is definitely worth doing some research beforehand.

So you know, the place you're going is going to be like with you, which is just an unfortunate reality of being trans. But that has been the case for a long time and it only continues to be a factor when considering care. Absolutely. It's really important to ask your friends, that's really solid advice, in part because, whether I like it or not, a lot of organizations are taking the stuff that says,

hey, we treat trans people down off their website, off their marketing materials We are not trying to draw that attention It doesn't mean we don't do it doesn't mean we're not skilled and trained and educated and smart and passionate about it It just means we don't really want to totally fly a trans flag on the roof right now Because it's just gonna cause everybody harm. So talk to your friends talk to people in your community. They know us We know them I have a lot of activism experience outside of my work

and it's amazing how many of those people end up being the same people that are in this conversation because of the way that this all works. Yeah. Yeah, I was just gonna say, I think, unfortunately, it is the norm. And evidence shows that, like large evidence of studies show that trans people are treated pretty horribly by the healthcare system.

And most of my patients have experienced that in some way or another, but like I was talking about before, a lot of trans healthcare kind of comes from a DIY community and there's a lot of really good community information about, you know, kind of who to trust and who you can go to in terms of finding an allied provider. Yeah, yeah. I think that's really good.

I think that was really great guys. Thank you so much for your time and for your words for people. Is there anything else you want to share or perhaps if people want to support your efforts somehow or support people's access to care that's an organization you could direct them to or maybe like a way people can reach out to you. I know a lot of people, there are people in my family who are healthcare providers who have substantially changed their outlook on the world and politics by how terribly their trans patients have been treated.

So like, if you know, like some of us have been organizing for a minute, some of us have been organizing for like literally a minute and like how do those people access these networks? Like how can people who are not in healthcare support you and what you're doing and reach out? The gender liberation movement is incredible. They're doing a lot of work kind of public facing to really get the point across on why this is so essential and also why everybody should have the right to their own bodily and gender autonomy. I think I mentioned earlier, but LAMA, if you're on the healthcare side, and there are also kind of, if you're in an academic setting,

looking to WPASS, the World Professional Association for Transgender Health, kind of going to the experts in this field and really following and mirroring what they're doing. I think if you're looking as a cis person who gets your care somewhere that might get federal funding, but this is the thing that you care about, would encourage you to sort of make people get on record about this kind of stuff, right? It's been the most distasteful piece of all of this is the kind of like weasel

hiding in all of this. So force them on the record, ask them if they don't tell you, send them an email. If they don't, you know, respond to the email, send a follow up email, like make people get on the record about this so that we know where their values are. And if their values don't align with yours, take your business elsewhere. Because at the end of the day, healthcare is a business because the United States sucks and so we have to use those dollars in the ways that we can. And it matters in a lot of ways.

I don't know that anyone will care to, and I certainly don't want to present us as the people with all the answers here. Cause we just like are figuring this out as we go too. But you can email us at communityhealthresistance at proton.me and maybe let's have a conversation. Maybe there's like a ton of people in the FQ world who want to do like a Amazon or a Starbucks, like DIY union project where we're all working on this together for the politics rather than the pay

as the primary sort of reason for it. Let's be a red Union and get something going. I don't know that we can, I don't know that it's the right call, but I imagine there's more of us out there feeling this way than not, so. Yeah, and like whatever it is, we're stronger together than we are apart,

so like talking is how we fix this. Thank you so much, guys. I really appreciate you being so open about this, and yeah, I hope that you succeed and are able to keep taking care of people. Thank you. We hope so too. It Could Happen Here is a production of Cool Zone Media.

For more podcasts from Cool Zone Media, visit our website, coolzonedmedia.com, or check us out on the iHeart Radio app, Apple Podcasts, or wherever you listen to podcasts. You can now find sources for It Could Happen here listed directly in episode descriptions. Thanks for listening. This is John Cameron Mitchell and my new fiction podcast series, Cancellation Island, stars Holly Hunter as Karen, a wellness influencer who launches a rehab for the recently canceled. In the future, we will all be canceled for 15 minutes. But don't worry, we'll take you from broke to woke or your money back.

Cancellation Island's revolutionary rehab therapies like Bad Touch Football, Anti-Racism Spin Class, and mandatory ayahuasca ceremonies are designed to force the canceled to confront their worst impulses But everything starts to fall apart when people start disappearing Here in wherever you brought us Cancellation Island where a second chance might just be your last Listen to cancellation island on the I heart radio Apple podcasts, or wherever you get your podcasts. Do you remember what you said the first night I came over here?

How goes lower? From Blumhouse TV, iHeart Podcasts, and Ember 20 comes an all-new fictional comedy podcast series. Join the flighty Damien Hirst as he unravels the mystery of his vanished boyfriend. I've been spending all my time looking for answers about what happened to Santi. And what's the way to find a missing person? Sleep with everyone he knew, obviously. Listen to The Hook Up on the iHeartRadio app, Apple podcasts, or wherever you listen to your favorite shows.

I'm Mary Kay McBrayer, host of the podcast, The Greatest True Crime Stories Ever Told. This season explores women from the 19th century to now. Women who were murderers and scammers, but also women who were photojournalists, lawyers, writers and more. This podcast tells more than just the brutal, gory details of horrific acts. I delve into the good, the bad, the difficult, and all the nuance I can find. Because these are the stories that we need to know to understand the intersection of society, justice, and the fascinating workings of the human psyche.

Join me every week as I tell some of the most enthralling true crime stories about women who are not just victims, but heroes or villains, or often somewhere in between. Listen to the greatest true crime stories ever told on the iHeartRadio app, Apple podcasts, or wherever you get your podcasts. I'm Mark Seale. And I'm Nathan King. This is Leave the Gun, Take the Cannoli.

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