Nashville Pride Fest 2018
In late May, the Trump administration proposed two rule changes that would allow homeless shelters and health care providers to deny access to transgender people. The proposals, which come from the Department of Housing and Urban Development and the Department of Health and Human Services, would undo Obama-era protections that prevented discrimination based on gender identity.
Marisa Richmond, a longtime activist in the Nashville LGBT community and professor of women’s and gender studies at Middle Tennessee State University, says the rule changes would exacerbate existing problems and undermine recent gains.
“It’s a major issue in the trans community, homelessness,” says Richmond. “Young people are kicked out of their homes by families, many are evicted by landlords, people lose their jobs because of job discrimination, and obviously if you don’t have a job you can't pay your rent, can’t pay your mortgage.” Richmond currently sits on the Metro Human Relations Commission and is the first transgender city board member in Nashville history.
Richmond says that besides limiting access to gender-affirming treatments like hormone therapy, the rules could allow doctors to bar trans patients from even routine care. “Transgender people have other ailments,” she says. “We sprain ankles and break wrists just like everybody else. We have diabetes and hypertension.”
The suggesteded rule from HUD would allow federally funded shelters to “consider a range of factors” including “the individual’s sex as reflected in official government documents, as well as the gender which a person identifies with.” The HHS rule would roll back Section 1557 of the Affordable Care Act, which in 2016 extended protections to transgender patients.
Barbara DiPietro is the senior policy director of the National Health Care for the Homeless Council. She says the Obama administration's Equal Access Rule, which prevents anti-trans discrimination at all shelters receiving federal funding, makes conditions much safer for transgender clients who needed shelter.
“It no doubt prevents many people from being assaulted or victims of violence," says DiPietro of the Equal Access Rule. With the existing protections, “They’re not afraid to seek shelter because of their gender identity, or they are now able to be residing in areas of gender-specific service that more represent their gender identity.” For example, trans women aren’t placed into men’s shelters, a potentially unsafe arrangement.
On the local level, says DiPietro, this means that access to services will depend on where clients live.
“Individuals who live in smaller communities will disproportionately be locked out,” she says. DiPietro explains that clients in bigger cities may be able to find a welcoming provider should one turn them away, but “that’s definitely not an option in many communities — you generally only have one shelter provider or two.”
According to a spokesperson, the Metropolitan Development and Housing Agency distributed $148,000 in federal funding across six Nashville shelters for operations and essential services in 2018. Outside the city, the Tennessee Housing Development Agency plans to allocate $850,000 of HUD funding to 23 shelters across the state in 2019. This doesn’t include Nashville-Davidson County, Chattanooga and Memphis, which receive direct HUD funding.
Brian Haile, the CEO of local health care providers Neighborhood Health, emphasizes that inclusive providers will need to affirm their commitment to serving the most vulnerable.
“It’s important that individuals who feel displaced ... because of federal policy changes know that there are plenty of other organizations in Nashville that really do value them and see their humanity and want to serve them in a way that’s really affirming and provides them with dignity,” Haile says.
Neighborhood Health oversees 13 sites across Nashville and offers hormonal therapy to transgender patients. In December, before the rule proposals went public, Neighborhood Health’s board adopted a broad “welcoming and inclusion” statement that laid out its acceptance of all clients.
Richmond is hopeful that doctors and providers in bigger cities like Nashville will remain welcoming, and pointed to Vanderbilt University’s new transgender health clinic as a recent gain for the community. Not far out of sight, however, is a package of legislation from Tennessee state House Republicans that Richmond and other activists have dubbed the “Slate of Hate.” While most bills stalled earlier this year, including one that sought to ban gay marriage, a watered-down “bathroom bill” survived both chambers and received the governor’s signature — though it was amended to the point that it is ultimately ineffective.
Despite that, Richmond notes that nationwide support for trans rights is growing, and companies have even thrown their weight behind the cause: Wall Street firm AllianceBernstein, which is moving its headquarters to Nashville, warned the legislature that anti-LGBT bills were “anti-growth” and “anti-jobs.” “So many people, including businesses, said we’re not going to tolerate this, we’re not going to be a part of that,” says Richmond. “So, we’re having successes in those areas, and that’s putting more and more pressure on the politicians not to pass those bills.”
Both rule changes are subject to a 60-day public comments period, during which representatives from NHCHC and Neighborhood Health will likely contribute statements. DiPietro also predicts some advocates will challenge the changes in court should they come to pass.
Adding to the controversy, HUD secretary Ben Carson denied any plans to change LGBT protections just one day before the proposal went public (this happened in the same hearing in which he confused REOs with Oreos). Democrats blasted Carson and accused him of lying. A quartet of House Democrats sent Carson a letter seeking answers about his testimony and the proposed rule change.
A national 2015 survey of nearly 30,000 respondents found one-third of transgender people experienced homelessness at some point in their lives. Among Tennessee respondents, one-third experienced housing discrimination, 36 percent experienced homelessness, and more than half of the respondents reported police misconduct. About 1 percent said they had been physcially attacked because they were transgender.
