February 25, 2025 • 38 mins
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.
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Episode Transcript
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Speaker 1 (00:01):
Also media, Hi everyone, and welcomed. 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 Haley and Dan. Both Haley and Dan are gender
affirming care providers in the Northeast, and they both work
(00:22):
at federally qualified health centers. Welcome to the show, guys,
thank you so much in care. Okay, So for people
who are not familiar, right, maybe they've been fortunate enough
to have like really good healthcare their whole life, or
fortunate enough to not live in the United States and
have this bizarre like web of healthcare provision. Can you
(00:44):
explain what a federally qualified healthcare center is?
Speaker 2 (00:47):
Sure you mind if I take this with Hailey?
Speaker 3 (00:50):
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.
Speaker 4 (00:59):
Right?
Speaker 2 (00:59):
So ye smiths with that to start.
Speaker 1 (01:01):
Oh, yeah, I get yeah, I guess good is a
relative to Yeah. I've relied on a federally qualified healthcare
center for a while.
Speaker 2 (01:08):
It was great. They were very nice.
Speaker 1 (01:09):
Actually, my prescriptions cost a lot less now than they
do with my very expensive eyeigh insurance.
Speaker 2 (01:14):
Yeah.
Speaker 3 (01:15):
So around the nineteen sixties 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 sixteen hundred unique
federally qualified health centers all over the country and we
as in sort of you know, confederated set of health
(01:36):
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 healthcare
is very difficult to access and to get, undocumented folks,
and really everybody in between. At the health center that
(01:57):
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 we are the nation's safety net healthcare provider, and
without us, there are roughly one in ten Americans would
not get their healthcare.
Speaker 1 (02:13):
Jeez, well, I guess people who are not in the
United States, do you want to go and give us
a go one minute speedrun of what Medicaid is medicare Sure.
Speaker 3 (02:24):
So America does not have a nationalized insurance program, as
we are very frustrated with.
Speaker 2 (02:30):
Most of the time.
Speaker 3 (02:31):
It's mostly commercial insurance that you mostly get through your job.
But if you are not fortunate it's 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 ACABAMBACARE, that level raised
a little bit, so you could still get Medicaid if
you were at above the federal poverty line.
Speaker 2 (02:52):
But this is mostly for the working poor. That's who
gets Medicaid.
Speaker 4 (02:56):
Cool.
Speaker 1 (02:56):
Yeah, it's a great system. Let's talk about how this
is funded them And 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.
Speaker 3 (03:10):
Yeah, 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
(03:33):
our willingness to take on these more expensive, more complicated
patients and to ensure they are healthy enough to keep
out of expensive.
Speaker 2 (03:41):
Systems of care like emergency rooms and things of that nature.
Speaker 4 (03:44):
Yeah.
Speaker 3 (03:44):
And two is that we have a grant called the
FED three thirty 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 twenty
five percent of your total annual funds and is to
cover all of the folks who can afford care and
are uninshort.
Speaker 4 (04:03):
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 firming 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
(04:26):
of those funding streams again historically because who knows right now,
but through something called the High Amendment, it means that
our funding would be at jeoparty if we provided abortion care.
So there are some kind of limitations. A lot of
what we do as an FQT is providing really comprehensive,
expansive care. We're kind of some of the few clinics
(04:49):
that do everything that we do under one roof, but
there have been some limitations specifically abortion to that.
Speaker 1 (04:56):
Yeah, it's more of a healthcare experience. So I'm used
to with someone from Europe like going to one of
these centers and like the American one where you get
referral and then yeah, get it approved and blah blah blah,
and like a lot.
Speaker 4 (05:07):
Of the ways that I talk to friends who live
in other countries, Like, I feel like my role is
kind of more similar to like a GP as a
nurse partitioner. 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.
Speaker 1 (05:23):
Yeah, that makes sense. So can you explain Ryan White funding?
Like where does that come from? Why is it called
Ryan White?
Speaker 4 (05:29):
So basically, Ryan White Funding was initiated in I believe
the early nineties 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. Yeah,
so Ryan White funding right now is a major source
(05:54):
for funding things like PREP, which is medication for prevention
for HAV as well as direct HIV treatment.
Speaker 1 (06:02):
Yeah, so a number of these things, right, gender affirming care,
perhaps care for people with HIV or preventing people from
getting HIV through 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 that they're like the things that they point to
(06:25):
is you know whatever they're sort of like Impacton's impacts
in Sunstruction of Fascist and 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
(06:45):
of people who come to you for these different types
of care I mean, I.
Speaker 4 (06:48):
Think it's terrifying. I think I'm more on the fusion
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 tras, youth adolescents and young adults, and
so moreover, the uncertainty of just being able to get
(07:10):
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
(07:30):
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 forming
(07:50):
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 mendications, and so I think you know, talking
about funding, talking about kind of these bigger shifts politically,
you know, are sayings that unfortunately a lot of the
(08:12):
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 if we can't
prescribe them.
Speaker 3 (08:25):
Yeah, I think it's worth talking about the fact that,
like there are 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 like protecting children it's nonsense, but that is aimed
at ending this care everywhere.
Speaker 4 (08:43):
Yeah.
Speaker 3 (08:43):
Now are they going to be able to do it everywhere?
Speaker 2 (08:45):
I don't know. Maybe, but not quickly.
Speaker 3 (08:48):
But they can end it for FQHCs all across the
country by simply making it like the High Amendment. If
we were to perform abortion services at the place that
I work, then we would lose our three thirty funding
and we would lose our a 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
(09:11):
other people that we care for besides those kids. Right,
then there are also the just the doge fuckery 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,
most of them were just like it's a grant, we're
(09:33):
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 courts 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
(09:55):
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
(10:15):
for the office that's 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 the very difficult position, and you know,
leadership in the very difficult position of figuring out, well,
do I worry about these trans youth and the fact
(10:36):
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.
Speaker 2 (10:54):
Yeah, that's tough.
Speaker 1 (10:55):
Can you briefly explain that, maybe lay out a timeline
because we talked about executive order, Say we talked about
a tro like there was a large dumber of executive
orders right in the last three weeks, so like maybe
people miss them. Can you explain the pertinent executive orders?
And then what's a tentative?
Speaker 2 (11:11):
Is training order. Yeah.
Speaker 3 (11:13):
So on Trump's first day in office, on the day
of his inauguration, so January twentieth, he signs one 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
(11:36):
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
(11:56):
got emails to every PI which is principal investor gator
on every federal grant that we had. That said because
of those two, and there was one about DEI which
also in 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
(12:17):
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 a threat. The following Tuesday, dog is
let loose and announces that they are freezing federal grant
funding tied to anything that is in opposition to those things.
Speaker 2 (12:40):
If you actually looked at.
Speaker 3 (12:41):
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
(13:02):
a judge come in and sort of put a halt
on it. And then later that day a press secretary says, oh,
we're just going to send the memo. We're still going
to freeze everything, and then the judge comes back and
puts a temporary straining order. So in theory, what that
should have meant is that all of that grant funding
once again flows. And it did not importantly too for us,
given how much medicaid dollars we take in Medicaid portals,
(13:24):
and all fifty states went down, so we could not
get any of those dollars in service of what we
were doing for twelve 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.
Speaker 2 (13:41):
A few more weeks.
Speaker 3 (13:42):
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 meet
at 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
(14:03):
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
potentially available for folks.
Speaker 2 (14:16):
Just seems unlikely to me.
Speaker 1 (14:17):
Yeah, we should pivot to advertisements here, So I'm going
to do that and then we'll.
Speaker 2 (14:22):
Be right back. Okay, we are back.
Speaker 1 (14:34):
So you talked about like these grants being turned off
or not coming.
Speaker 2 (14:38):
What does that mean?
Speaker 1 (14:40):
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.
Speaker 4 (14:50):
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 into the administration is really
the only way that I I have really been able
to get any updates. So as a healthcare provider, it's
been out or chaos. Basically every day we've gotten different
messaging around whether or not appointments can be scheduled, new patients,
(15:13):
can you know, schedule intakes, whether or not we're able
to prescribe these life saving medications, and no one knows exactly.
Gender firming 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
(15:38):
gender firming care, it literally doesn't make any sense in
terms of you know, 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
(15:58):
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 act
as 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
(16:21):
I believe is best for my patients, which is to
continue to provide them with a care that they need.
But it's terrifying.
Speaker 3 (16:27):
I think importantly, Haley and I have the eventage 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, it lose access
to their three thirty. They were scheduled to draw down
on a grant that was going to cover a whole
(16:48):
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 you know, how
do we decide what is the best thing to do.
But for me and what sort of started working with
in our agency at least to organize around this is
(17:09):
that like, this is an anti fascist practice. That is
the right medical thing to do, It is the 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
(17:31):
doing the poem the first they came for, the socialist thing,
and I just refused to be a part of that.
Speaker 1 (17:37):
Yeah, let's talk about what that means then, Like, like
you said, it's difficult to get any response from administration
right in terms of what you can do, in terms
what you can't do. How are staff and providers organizing
to make sure that they're able to keep providing for
their patients?
Speaker 4 (17:57):
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 FQHCs, but also hospital
affiliated clinics, academic medical clinics have basically clinic by clinic
decided on their own plan on how to manage this,
(18:19):
which is also incredibly confusing for providers and for patients.
But something that was really heartening was that NYU laying gone.
This was in the news 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
(18:40):
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 they're there are models out there, and I think
(19:03):
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.
Speaker 2 (19:18):
As of yet.
Speaker 3 (19:19):
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.
(19:40):
And so how does uncertainty sort of foster Well, people
don't talk to one another, right, Like this is true,
kind of an organizational census across the board. Right, if
you're in the union, you don't talk about your salary
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 going to treat, whether we're going to keep
doing it, or listen to them what we're being told,
we're not being told that we're consulting lawyers all these
(20:02):
other kind of things, then we're all just alone in
the dark kind of you know, 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
(20:22):
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, Hayley'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
(20:46):
amongst ourselves at our workplace, but are really not talking
about it amongst.
Speaker 2 (20:50):
Ourselves on a national level.
Speaker 3 (20:52):
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 to 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.
Speaker 4 (21:09):
And one thing that's interesting, I think is that with transhealthcare,
transhelscare is inherently radical, Like transhalscare 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 healthcare before it became kind of
(21:30):
institutionalized into a lot of these spaces. So I think
we also have a lot of providers who are willing
to function 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
(21:52):
so easily able to collectivize and strategize and kind of
come together. It's a pretty small.
Speaker 2 (21:59):
World as well.
Speaker 3 (22:00):
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 us to dial. So that's a
huge thing that will help us if we can't prescribe
this anymore, if Medicaid stops covering it, yah, YadA, YadA.
Speaker 2 (22:15):
I was like, but I don't have a you know,
a DIY solution for TEA.
Speaker 3 (22:18):
If anyone knows of anybody, that'd be great, And immediately
someone's like, oh, yeah, absolutely, I do.
Speaker 2 (22:23):
It's tested.
Speaker 3 (22:23):
It's a ninety nine point nine percent pure we're ready
to go.
Speaker 2 (22:26):
So now, like I wouldn't have done that.
Speaker 3 (22:28):
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.
Speaker 1 (22:34):
Yeah, maybe we should explain like the inherent risks, like
legally and then then distinction between those two hormones legally, right,
like if people are unaware.
Speaker 4 (22:44):
Yeah, so you know, as a medical provider again, I
have to be a little bit careful here. But basically
because the stone has been used by mostly the cistmail
community as an anabolic steroid and used you know somewhat
would call it like animalic steroid misuse or steried use disorder.
(23:04):
It is a controlled substance. Estradial is not. They're both
bioidentical hormones. Every human on this planet, their body makes
estrogen and testosterone E and T estradyle and testosterone. However,
in the United States, testosterone is considered a controlled substance,
which makes it a little more tricky for folks to
(23:27):
access without a prescription and also can put them at
legal risk if they do so.
Speaker 1 (23:33):
Right, Like, there's a built in legal consequence for people
who are trying to manufacture there 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.
Speaker 5 (23:46):
Also, testosterone is yes, it is a controlled substance. It
does flow in the bodybuilding community.
Speaker 1 (23:54):
Yeah, it's not well controlled.
Speaker 5 (23:56):
Yeah, that is also like worth stating because yeah, so
if you go to your average gym.
Speaker 1 (24:02):
Oh yeah, you can walk across the borders to Tijuana
and see like gas stations have the prices like unleaded premium. Yeah,
you can get testosterone prices like displayed in the same fashion.
Speaker 4 (24:13):
I mean, I'm sure you're you're huge fans of Joe Rogan.
So many many of my other patients who are not
trans have been influenced to purchase disasterone because of our
good friends.
Speaker 1 (24:30):
Yeah, yeah, fascinating.
Speaker 3 (24:32):
Which is also gender affirming care for whatever that's worth,
like gender firm in care too.
Speaker 1 (24:37):
Yes they do. It's a little easier for them. Right now,
So let's talk about like what this organizing looks like
on the ground, right, Like if someone's working, maybe they're
(24:59):
not in an f QHC, right, maybe they're working in
academic health center. Maybe 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
(25:22):
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's 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 contac
(25:43):
people who are already organizing, Like, let's talk through that
nuts and bolts of it.
Speaker 4 (25:46):
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 gain lesbian medical association, because they have
some lawsuits and as a member of GLAMMA.
Speaker 2 (26:04):
That could possibly give you some additional protection.
Speaker 4 (26:07):
Following other orgs like Lambda Legal Stage, which is an
organization for an elder gay lesbian and queer folks. Trans
people have existed and have built organizations. A lot of
those organizations are fighting this on a national level, and
(26:28):
some of those are more geared toward healthcare professionals like Glamma.
Speaker 3 (26:32):
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 kind of things. Talk to them about the value
(26:53):
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
(27:17):
and the federal government and the sort of 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 you know, leadership
(27:40):
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 want to be on
the hook for. This is the leverage that we've got
right now. It seems to have slid things down a
little a little bit internally for us that they've had to
(28:02):
confront like a very well pointed out legal opinion that
said that like 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 like there's a real union sort
of feel to a lot of this, And as we
(28:24):
started coming together, a bunch of us realize, 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 are interested in your benefits,
they are interested in you as a worker, but they're
(28:46):
not interested in like your relationship to the work. And
so we are 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 toolblocks, and we don't have to
do anything more than declare it to strike to be
protected under the NLRB and some of these various different things.
(29:07):
And we can do it for political reasons instead of
for pay reasons, which means we could 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.
Speaker 2 (29:22):
You know what sort of managerial status you are.
Speaker 1 (29:26):
Yeah, yeah, I think that's a very good point. I
read a book recently about how the long shoremen in
San Francisco stopped weapons going to the gil by striking
and refusing to load weapons onto ships and like that's
a union energy we could use right now. Yeah, yeah,
I think people be well advised to, Like I will
say that they'd be well advised to check with federal
(29:47):
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
eighteen are like right in the center. The President of
(30:10):
the United States called out a friend of mine personally
by name recently. She's a trans athlete, and like they're
really coming up to people. I understand that people are afraid,
Like what should they know if they're concerned about their
hormone supply or they're own puberty blockers? Right now, like
people are listening, what would you Maybe they don't know
where their provider stands, you know, Yeah.
Speaker 4 (30:33):
I mean I tell my patients, says, But I'm in
awe of them. They're incredible. And a lot of them
are nerdy theater 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
(30:55):
with everything that I've got for them, and I really
hope they know that.
Speaker 3 (31:01):
I think one of the mantras I've been given to
fellow colleagues as well as to our leadershift to like
get their heads on straight, is that like pascism is messy, right,
Like it's a scary messy. There are a lot of
throwing stuff with the law on sea and what sticks,
but the things that in theory are still in place,
like when and if they fall, we have different problems
(31:23):
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 your trends 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
(31:44):
in because HIPPA 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 you know, camouflage
(32:05):
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 going to stop until they make us. And
right now they can't make us, and so we're going to.
Speaker 2 (32:21):
Keep doing it.
Speaker 4 (32:22):
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.
Speaker 5 (32:38):
Then it is good to hear. I know a lot
of trans people have essentially trauma with aspects of the
medical community, establishment, whatever, and like you know, not not
all practitioners, maybe as much in our camp as maybe
you are. And I would encourage people as they are
if they're still looking for care through like these these
(32:59):
sorts of channels, you should you should try to find
out where other trans people in your city are already going. Yes,
there's certainly like clinics will have stuff on the website
that indicate that they either specialize in this or they
offer this as opposed to you know, maybe just a
general general practitioner who may not be you know, the
greatest in this vein, and like this, this still happens.
(33:20):
I've I've talked to a lot of friends recently who've
spoken about having increasingly uncomfortable experiences with nurses or doctors
where they're trying out like different clinics or different 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
(33:42):
an unfortunate reality of being trands. But that is that
has been the case for for a long time and
it only continues to be a factor when when considering care.
Speaker 3 (33:50):
Absolutely it's really important to ask ask your friends that
that's 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.
Speaker 2 (34:04):
We are not trying to draw that attention.
Speaker 3 (34:06):
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.
Speaker 2 (34:11):
It just means we.
Speaker 3 (34:12):
Don't really want to totally fly a trans flag on
the roof right now because it's just going to 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.
Speaker 2 (34:33):
Yeah.
Speaker 4 (34:34):
Yeah, I was just going to 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
(34:54):
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.
Speaker 1 (35:07):
Yeah, yeah, I think that's really good.
Speaker 2 (35:09):
I think that was really great.
Speaker 4 (35:10):
Guy.
Speaker 1 (35:10):
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, there's an organization you
could direct them to, or maybe like the way people
coming shout out to you, or I know a lot
of people. There are people in my family who are
healthcare providers who have substantially changed their outlook on the
(35:32):
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.
Speaker 4 (35:51):
The gender liberation movement is incredible. They're doing a lot
of work, kind of public feasing to really get 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
(36:12):
you're on the healthcare side, and you know 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.
Speaker 3 (36:30):
I think if you're looking as a SIS 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.
Speaker 2 (36:51):
So force them on the record. Ask them.
Speaker 3 (36:53):
If they don't tell you, send them an email. If
they don't know, respond to the email, send a follow
up email, Like make people we'll 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.
(37:14):
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 because we just like are figuring
this as we go to But you can email us
at Community Health Resistance at proton dot 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
an Amazon or a Starbucks like diy union project where
(37:36):
we're all working on this together for the politics rather
than the pay as the primary sort of reason for it.
Speaker 2 (37:41):
Let's let's let's be a red union and get something going.
I don't know that we can.
Speaker 3 (37:46):
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.
Speaker 1 (37:51):
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. You'll be able to keep taking care
of people.
Speaker 2 (38:05):
We hope so too.
Speaker 5 (38:09):
It Could Happen Here is a production of cool Zone Media.
Speaker 4 (38:12):
For more podcasts from cool Zone Media, visit our website
coolzonmedia dot com, or check us out on the iHeartRadio 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,
Also media, Hi everyone, and welcomed. 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 Haley and Dan. Both Haley and Dan are gender
affirming care providers in the Northeast, and they both work
(00:22):
at federally qualified health centers. Welcome to the show, guys,
thank you so much in care. Okay, So for people
who are not familiar, right, maybe they've been fortunate enough
to have like really good healthcare their whole life, or
fortunate enough to not live in the United States and
have this bizarre like web of healthcare provision. Can you
(00:44):
explain what a federally qualified healthcare center is?
Speaker 2 (00:47):
Sure you mind if I take this with Hailey?
Speaker 3 (00:50):
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.
Speaker 4 (00:59):
Right?
Speaker 2 (00:59):
So ye smiths with that to start.
Speaker 1 (01:01):
Oh, yeah, I get yeah, I guess good is a
relative to Yeah. I've relied on a federally qualified healthcare
center for a while.
Speaker 2 (01:08):
It was great. They were very nice.
Speaker 1 (01:09):
Actually, my prescriptions cost a lot less now than they
do with my very expensive eyeigh insurance.
Speaker 2 (01:14):
Yeah.
Speaker 3 (01:15):
So around the nineteen sixties 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 sixteen hundred unique
federally qualified health centers all over the country and we
as in sort of you know, confederated set of health
(01:36):
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 healthcare
is very difficult to access and to get, undocumented folks,
and really everybody in between. At the health center that
(01:57):
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 we are the nation's safety net healthcare provider, and
without us, there are roughly one in ten Americans would
not get their healthcare.
Speaker 1 (02:13):
Jeez, well, I guess people who are not in the
United States, do you want to go and give us
a go one minute speedrun of what Medicaid is medicare Sure.
Speaker 3 (02:24):
So America does not have a nationalized insurance program, as
we are very frustrated with.
Speaker 2 (02:30):
Most of the time.
Speaker 3 (02:31):
It's mostly commercial insurance that you mostly get through your job.
But if you are not fortunate it's 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 ACABAMBACARE, that level raised
a little bit, so you could still get Medicaid if
you were at above the federal poverty line.
Speaker 2 (02:52):
But this is mostly for the working poor. That's who
gets Medicaid.
Speaker 4 (02:56):
Cool.
Speaker 1 (02:56):
Yeah, it's a great system. Let's talk about how this
is funded them And 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.
Speaker 3 (03:10):
Yeah, 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
(03:33):
our willingness to take on these more expensive, more complicated
patients and to ensure they are healthy enough to keep
out of expensive.
Speaker 2 (03:41):
Systems of care like emergency rooms and things of that nature.
Speaker 4 (03:44):
Yeah.
Speaker 3 (03:44):
And two is that we have a grant called the
FED three thirty 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 twenty
five percent of your total annual funds and is to
cover all of the folks who can afford care and
are uninshort.
Speaker 4 (04:03):
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 firming 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
(04:26):
of those funding streams again historically because who knows right now,
but through something called the High Amendment, it means that
our funding would be at jeoparty if we provided abortion care.
So there are some kind of limitations. A lot of
what we do as an FQT is providing really comprehensive,
expansive care. We're kind of some of the few clinics
(04:49):
that do everything that we do under one roof, but
there have been some limitations specifically abortion to that.
Speaker 1 (04:56):
Yeah, it's more of a healthcare experience. So I'm used
to with someone from Europe like going to one of
these centers and like the American one where you get
referral and then yeah, get it approved and blah blah blah,
and like a lot.
Speaker 4 (05:07):
Of the ways that I talk to friends who live
in other countries, Like, I feel like my role is
kind of more similar to like a GP as a
nurse partitioner. 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.
Speaker 1 (05:23):
Yeah, that makes sense. So can you explain Ryan White funding?
Like where does that come from? Why is it called
Ryan White?
Speaker 4 (05:29):
So basically, Ryan White Funding was initiated in I believe
the early nineties 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. Yeah,
so Ryan White funding right now is a major source
(05:54):
for funding things like PREP, which is medication for prevention
for HAV as well as direct HIV treatment.
Speaker 1 (06:02):
Yeah, so a number of these things, right, gender affirming care,
perhaps care for people with HIV or preventing people from
getting HIV through 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 that they're like the things that they point to
(06:25):
is you know whatever they're sort of like Impacton's impacts
in Sunstruction of Fascist and 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
(06:45):
of people who come to you for these different types
of care I mean, I.
Speaker 4 (06:48):
Think it's terrifying. I think I'm more on the fusion
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 tras, youth adolescents and young adults, and
so moreover, the uncertainty of just being able to get
(07:10):
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
(07:30):
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 forming
(07:50):
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 mendications, and so I think you know, talking
about funding, talking about kind of these bigger shifts politically,
you know, are sayings that unfortunately a lot of the
(08:12):
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 if we can't
prescribe them.
Speaker 3 (08:25):
Yeah, I think it's worth talking about the fact that,
like there are 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 like protecting children it's nonsense, but that is aimed
at ending this care everywhere.
Speaker 4 (08:43):
Yeah.
Speaker 3 (08:43):
Now are they going to be able to do it everywhere?
Speaker 2 (08:45):
I don't know. Maybe, but not quickly.
Speaker 3 (08:48):
But they can end it for FQHCs all across the
country by simply making it like the High Amendment. If
we were to perform abortion services at the place that
I work, then we would lose our three thirty funding
and we would lose our a 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
(09:11):
other people that we care for besides those kids. Right,
then there are also the just the doge fuckery 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,
most of them were just like it's a grant, we're
(09:33):
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 courts 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
(09:55):
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
(10:15):
for the office that's 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 the very difficult position, and you know,
leadership in the very difficult position of figuring out, well,
do I worry about these trans youth and the fact
(10:36):
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.
Speaker 2 (10:54):
Yeah, that's tough.
Speaker 1 (10:55):
Can you briefly explain that, maybe lay out a timeline
because we talked about executive order, Say we talked about
a tro like there was a large dumber of executive
orders right in the last three weeks, so like maybe
people miss them. Can you explain the pertinent executive orders?
And then what's a tentative?
Speaker 2 (11:11):
Is training order. Yeah.
Speaker 3 (11:13):
So on Trump's first day in office, on the day
of his inauguration, so January twentieth, he signs one 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
(11:36):
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
(11:56):
got emails to every PI which is principal investor gator
on every federal grant that we had. That said because
of those two, and there was one about DEI which
also in 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
(12:17):
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 a threat. The following Tuesday, dog is
let loose and announces that they are freezing federal grant
funding tied to anything that is in opposition to those things.
Speaker 2 (12:40):
If you actually looked at.
Speaker 3 (12:41):
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
(13:02):
a judge come in and sort of put a halt
on it. And then later that day a press secretary says, oh,
we're just going to send the memo. We're still going
to freeze everything, and then the judge comes back and
puts a temporary straining order. So in theory, what that
should have meant is that all of that grant funding
once again flows. And it did not importantly too for us,
given how much medicaid dollars we take in Medicaid portals,
(13:24):
and all fifty states went down, so we could not
get any of those dollars in service of what we
were doing for twelve 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.
Speaker 2 (13:41):
A few more weeks.
Speaker 3 (13:42):
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 meet
at 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
(14:03):
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
potentially available for folks.
Speaker 2 (14:16):
Just seems unlikely to me.
Speaker 1 (14:17):
Yeah, we should pivot to advertisements here, So I'm going
to do that and then we'll.
Speaker 2 (14:22):
Be right back. Okay, we are back.
Speaker 1 (14:34):
So you talked about like these grants being turned off
or not coming.
Speaker 2 (14:38):
What does that mean?
Speaker 1 (14:40):
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.
Speaker 4 (14:50):
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 into the administration is really
the only way that I I have really been able
to get any updates. So as a healthcare provider, it's
been out or chaos. Basically every day we've gotten different
messaging around whether or not appointments can be scheduled, new patients,
(15:13):
can you know, schedule intakes, whether or not we're able
to prescribe these life saving medications, and no one knows exactly.
Gender firming 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
(15:38):
gender firming care, it literally doesn't make any sense in
terms of you know, 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
(15:58):
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 act
as 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
(16:21):
I believe is best for my patients, which is to
continue to provide them with a care that they need.
But it's terrifying.
Speaker 3 (16:27):
I think importantly, Haley and I have the eventage 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, it lose access
to their three thirty. They were scheduled to draw down
on a grant that was going to cover a whole
(16:48):
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 you know, how
do we decide what is the best thing to do.
But for me and what sort of started working with
in our agency at least to organize around this is
(17:09):
that like, this is an anti fascist practice. That is
the right medical thing to do, It is the 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
(17:31):
doing the poem the first they came for, the socialist thing,
and I just refused to be a part of that.
Speaker 1 (17:37):
Yeah, let's talk about what that means then, Like, like
you said, it's difficult to get any response from administration
right in terms of what you can do, in terms
what you can't do. How are staff and providers organizing
to make sure that they're able to keep providing for
their patients?
Speaker 4 (17:57):
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 FQHCs, but also hospital
affiliated clinics, academic medical clinics have basically clinic by clinic
decided on their own plan on how to manage this,
(18:19):
which is also incredibly confusing for providers and for patients.
But something that was really heartening was that NYU laying gone.
This was in the news 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
(18:40):
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 they're there are models out there, and I think
(19:03):
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.
Speaker 2 (19:18):
As of yet.
Speaker 3 (19:19):
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.
(19:40):
And so how does uncertainty sort of foster Well, people
don't talk to one another, right, Like this is true,
kind of an organizational census across the board. Right, if
you're in the union, you don't talk about your salary
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 going to treat, whether we're going to keep
doing it, or listen to them what we're being told,
we're not being told that we're consulting lawyers all these
(20:02):
other kind of things, then we're all just alone in
the dark kind of you know, 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
(20:22):
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, Hayley'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
(20:46):
amongst ourselves at our workplace, but are really not talking
about it amongst.
Speaker 2 (20:50):
Ourselves on a national level.
Speaker 3 (20:52):
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 to 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.
Speaker 4 (21:09):
And one thing that's interesting, I think is that with transhealthcare,
transhelscare is inherently radical, Like transhalscare 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 healthcare before it became kind of
(21:30):
institutionalized into a lot of these spaces. So I think
we also have a lot of providers who are willing
to function 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
(21:52):
so easily able to collectivize and strategize and kind of
come together. It's a pretty small.
Speaker 2 (21:59):
World as well.
Speaker 3 (22:00):
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 us to dial. So that's a
huge thing that will help us if we can't prescribe
this anymore, if Medicaid stops covering it, yah, YadA, YadA.
Speaker 2 (22:15):
I was like, but I don't have a you know,
a DIY solution for TEA.
Speaker 3 (22:18):
If anyone knows of anybody, that'd be great, And immediately
someone's like, oh, yeah, absolutely, I do.
Speaker 2 (22:23):
It's tested.
Speaker 3 (22:23):
It's a ninety nine point nine percent pure we're ready
to go.
Speaker 2 (22:26):
So now, like I wouldn't have done that.
Speaker 3 (22:28):
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.
Speaker 1 (22:34):
Yeah, maybe we should explain like the inherent risks, like
legally and then then distinction between those two hormones legally, right,
like if people are unaware.
Speaker 4 (22:44):
Yeah, so you know, as a medical provider again, I
have to be a little bit careful here. But basically
because the stone has been used by mostly the cistmail
community as an anabolic steroid and used you know somewhat
would call it like animalic steroid misuse or steried use disorder.
(23:04):
It is a controlled substance. Estradial is not. They're both
bioidentical hormones. Every human on this planet, their body makes
estrogen and testosterone E and T estradyle and testosterone. However,
in the United States, testosterone is considered a controlled substance,
which makes it a little more tricky for folks to
(23:27):
access without a prescription and also can put them at
legal risk if they do so.
Speaker 1 (23:33):
Right, Like, there's a built in legal consequence for people
who are trying to manufacture there 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.
Speaker 5 (23:46):
Also, testosterone is yes, it is a controlled substance. It
does flow in the bodybuilding community.
Speaker 1 (23:54):
Yeah, it's not well controlled.
Speaker 5 (23:56):
Yeah, that is also like worth stating because yeah, so
if you go to your average gym.
Speaker 1 (24:02):
Oh yeah, you can walk across the borders to Tijuana
and see like gas stations have the prices like unleaded premium. Yeah,
you can get testosterone prices like displayed in the same fashion.
Speaker 4 (24:13):
I mean, I'm sure you're you're huge fans of Joe Rogan.
So many many of my other patients who are not
trans have been influenced to purchase disasterone because of our
good friends.
Speaker 1 (24:30):
Yeah, yeah, fascinating.
Speaker 3 (24:32):
Which is also gender affirming care for whatever that's worth,
like gender firm in care too.
Speaker 1 (24:37):
Yes they do. It's a little easier for them. Right now,
So let's talk about like what this organizing looks like
on the ground, right, Like if someone's working, maybe they're
(24:59):
not in an f QHC, right, maybe they're working in
academic health center. Maybe 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
(25:22):
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's 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 contac
(25:43):
people who are already organizing, Like, let's talk through that
nuts and bolts of it.
Speaker 4 (25:46):
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 gain lesbian medical association, because they have
some lawsuits and as a member of GLAMMA.
Speaker 2 (26:04):
That could possibly give you some additional protection.
Speaker 4 (26:07):
Following other orgs like Lambda Legal Stage, which is an
organization for an elder gay lesbian and queer folks. Trans
people have existed and have built organizations. A lot of
those organizations are fighting this on a national level, and
(26:28):
some of those are more geared toward healthcare professionals like Glamma.
Speaker 3 (26:32):
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 kind of things. Talk to them about the value
(26:53):
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
(27:17):
and the federal government and the sort of 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 you know, leadership
(27:40):
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 want to be on
the hook for. This is the leverage that we've got
right now. It seems to have slid things down a
little a little bit internally for us that they've had to
(28:02):
confront like a very well pointed out legal opinion that
said that like 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 like there's a real union sort
of feel to a lot of this, And as we
(28:24):
started coming together, a bunch of us realize, 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 are interested in your benefits,
they are interested in you as a worker, but they're
(28:46):
not interested in like your relationship to the work. And
so we are 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 toolblocks, and we don't have to
do anything more than declare it to strike to be
protected under the NLRB and some of these various different things.
(29:07):
And we can do it for political reasons instead of
for pay reasons, which means we could 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.
Speaker 2 (29:22):
You know what sort of managerial status you are.
Speaker 1 (29:26):
Yeah, yeah, I think that's a very good point. I
read a book recently about how the long shoremen in
San Francisco stopped weapons going to the gil by striking
and refusing to load weapons onto ships and like that's
a union energy we could use right now. Yeah, yeah,
I think people be well advised to, Like I will
say that they'd be well advised to check with federal
(29:47):
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
eighteen are like right in the center. The President of
(30:10):
the United States called out a friend of mine personally
by name recently. She's a trans athlete, and like they're
really coming up to people. I understand that people are afraid,
Like what should they know if they're concerned about their
hormone supply or they're own puberty blockers? Right now, like
people are listening, what would you Maybe they don't know
where their provider stands, you know, Yeah.
Speaker 4 (30:33):
I mean I tell my patients, says, But I'm in
awe of them. They're incredible. And a lot of them
are nerdy theater 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
(30:55):
with everything that I've got for them, and I really
hope they know that.
Speaker 3 (31:01):
I think one of the mantras I've been given to
fellow colleagues as well as to our leadershift to like
get their heads on straight, is that like pascism is messy, right,
Like it's a scary messy. There are a lot of
throwing stuff with the law on sea and what sticks,
but the things that in theory are still in place,
like when and if they fall, we have different problems
(31:23):
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 your trends 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
(31:44):
in because HIPPA 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 you know, camouflage
(32:05):
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 going to stop until they make us. And
right now they can't make us, and so we're going to.
Speaker 2 (32:21):
Keep doing it.
Speaker 4 (32:22):
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.
Speaker 5 (32:38):
Then it is good to hear. I know a lot
of trans people have essentially trauma with aspects of the
medical community, establishment, whatever, and like you know, not not
all practitioners, maybe as much in our camp as maybe
you are. And I would encourage people as they are
if they're still looking for care through like these these
(32:59):
sorts of channels, you should you should try to find
out where other trans people in your city are already going. Yes,
there's certainly like clinics will have stuff on the website
that indicate that they either specialize in this or they
offer this as opposed to you know, maybe just a
general general practitioner who may not be you know, the
greatest in this vein, and like this, this still happens.
(33:20):
I've I've talked to a lot of friends recently who've
spoken about having increasingly uncomfortable experiences with nurses or doctors
where they're trying out like different clinics or different 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
(33:42):
an unfortunate reality of being trands. But that is that
has been the case for for a long time and
it only continues to be a factor when when considering care.
Speaker 3 (33:50):
Absolutely it's really important to ask ask your friends that
that's 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.
Speaker 2 (34:04):
We are not trying to draw that attention.
Speaker 3 (34:06):
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.
Speaker 2 (34:11):
It just means we.
Speaker 3 (34:12):
Don't really want to totally fly a trans flag on
the roof right now because it's just going to 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.
Speaker 2 (34:33):
Yeah.
Speaker 4 (34:34):
Yeah, I was just going to 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
(34:54):
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.
Speaker 1 (35:07):
Yeah, yeah, I think that's really good.
Speaker 2 (35:09):
I think that was really great.
Speaker 4 (35:10):
Guy.
Speaker 1 (35:10):
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, there's an organization you
could direct them to, or maybe like the way people
coming shout out to you, or I know a lot
of people. There are people in my family who are
healthcare providers who have substantially changed their outlook on the
(35:32):
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.
Speaker 4 (35:51):
The gender liberation movement is incredible. They're doing a lot
of work, kind of public feasing to really get 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
(36:12):
you're on the healthcare side, and you know 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.
Speaker 3 (36:30):
I think if you're looking as a SIS 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.
Speaker 2 (36:51):
So force them on the record. Ask them.
Speaker 3 (36:53):
If they don't tell you, send them an email. If
they don't know, respond to the email, send a follow
up email, Like make people we'll 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.
(37:14):
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 because we just like are figuring
this as we go to But you can email us
at Community Health Resistance at proton dot 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
an Amazon or a Starbucks like diy union project where
(37:36):
we're all working on this together for the politics rather
than the pay as the primary sort of reason for it.
Speaker 2 (37:41):
Let's let's let's be a red union and get something going.
I don't know that we can.
Speaker 3 (37:46):
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.
Speaker 1 (37:51):
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. You'll be able to keep taking care
of people.
Speaker 2 (38:05):
We hope so too.
Speaker 5 (38:09):
It Could Happen Here is a production of cool Zone Media.
Speaker 4 (38:12):
For more podcasts from cool Zone Media, visit our website
coolzonmedia dot com, or check us out on the iHeartRadio 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,
It Could Happen Here News
Hosts And Creators
Robert Evans
Garrison Davis
James Stout
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