Years ago, when I first began wanting to transition, I looked for a therapist so I could get the letter that endocrinologists want before they prescribe hormones. I went through the list of doctors that were in my insurance network and found a woman who specialized in women's counseling and rolled the dice on her. I figured any shrink that advertised "holistic feminist centered counseling" in south Mississippi had to at least know one or two LGBTQ people. I lucked out and wasn't the first person that she had counseled through a transgender coming out. Mind you, this is Mississippi in the 'Aughts so it was kind of like hitting a bullseye blindfolded, drunk on absinthe, with an inner ear infection.
The Trump administration's move to allow medical practitioners to refuse to provide services based on their religious objections of course has consequences for LGBTQ people, cis women's reproductive health, and potentially even cis straight men, but those consequences increase to incalculable levels once you move away from urban areas. As it already stands, residents in rural areas are already disproportionately suffering a shortage of health care availability. We're not even talking about women's reproductive health in places like Texas or Mississippi where women drive for hours to attend a clinic (in Mississippi there's only one and it's barely able to stay open), we're talking access to dentists.
In non-metropolitan counties, on average there are about 13 doctors for every 10,000 people compared to about 32 in urban ones. That's doctors in general; specialists varying from obstetricians to gynecologists are in even shorter supply. Over 33 million Americans have limited access to mental health care, much less mental health care that caters to specific concerns of LGBTQ people. Health care for cisgender and straight people in these areas is already precarious enough, with serious injuries only being able to be treated by helicopter flight or ambulances that can take almost 30 minutes to arrive and then take you to a medical facility that may lack the necessary equipment to save your life. Death rates increase exponentially after the first 10 minutes of a severe injury without medical treatment, meaning some people die from simply waiting for an ambulance.
When it comes to LGBTQ people, while these concerns overlap with the cisgender and straight, it increases when faced with the lack of access and options for medical care. Even in urban areas, LGBTQ people have reported that doctors have refused to treat them for issues that have nothing to do with their identity, including one trans man finding out that a doctor refused to treat him for cancer and not referring him to another doctor who would. Image the concerns of visiting the one hospital in the entire county and seeking treatment for HIV, or getting on PrEP? Pharmacists are not bound by the same expectations of care, so imagine the feeling of being loudly turned away by the only drug store for miles for trying to get your hormone prescription filled.
While I loathe the stereotypes of everyone who chooses to live in rural states and the South being ignorant, religious rednecks, it's kinda true. Look, just because you're a doctor doesn't mean you don't thump a bible or have terrible social values. In fact, of the 16 physicians currently serving in Congress, 14 of them are Republicans. In fact, the two OB/GYNs in Congress are both Republican men, and both of them are pro-life Southerners. How's that for irony, Alanis?
It's already a crap shoot for LGBTQ people to find medical care in urban areas, never knowing if you'll get treatment or a lecture on how your lifestyle offends their god, but at least there are options. One medical provider turns out to be a total bastard, you just go find another one. But for rural people, that simply is just not going to be an option available. Rural people are already disproportionately impoverished and can't afford to spend the money to drive into "the city" to visit a doctor, and yes I mean drive since there aren't Ubers and buses out in rural Wyoming. So the few doctors they have access to are basically it for them. If Ol' Doc McGillicuty decides he doesn't like your ho-mo-seckshul ways, honestly, you're kinda shit outta luck. No, moving isn't an option for them. If they were poor, oppressed, discriminated before and couldn't move, what makes you think this will be that last straw for them to spend money they don't have to move to the big city? As it stands, something like 40 percent of homeless youth are LGBTQ and we don't seem to be doing much about that now already.
Trump's discriminatory policy will get people hurt or killed. There's no doubt about that. The number of people who will be harmed by it will certainly be disproportionately rural, poor, LGBTQ people, who actually aren't as white as many would think. When you consider that Mississippi, Louisiana, and Georgia per capita have more black people than California or New York, not to mention Latinos in Arizona, Texas, and New Mexico, as well as Native Americans pretty much anywhere, they're going to bear a disproportionate burden of this policy. This is a double punishment for not only being queer, but rural and poor. Not everyone will get as lucky as me when pulling a name out of a hat to get medical care.
AMANDA KERRI is an Oklahoma City-based comedian and a regular contributor to The Advocate. Follow her on Twitter @AmandaKerri.