HB 68 is a continuation of focusing on issues that are grounded in moral panic. It sends a signal to marginalized folks that they are not worthy, seen, or respected as citizens in our society.

LeeAnne Cornyn

Director 

Ohio Department of Mental Health & Addiction Services

30 East Broad Street 

36th Floor

Columbus, Ohio 43215-3430

For your consideration:

As a 2nd year Ph.D. student in human sexuality, a member of the LGBTQIA2S+ community, and a Board member of Planned Parenthood of Advocates of Ohio, I am compelled to voice my concerns against the proposed rules 5122-14-12and 5122-26-19, drawing upon insights from several scholars and my lived experience. The rules, while aiming to standardize care, overlook the unique needs of transgender and gender-diverse individuals, potentially exacerbating healthcare disparities. The additional concerns I want to raise are about how the proposed rules 5122-14-12 and 5122-26-19 may disproportionately affect Black and Brown transgender individuals; it becomes evident that these rules risk exacerbating existing health disparities. Research indicates that Black, Indigenous, and People of Color (BIPOC), including those who are transgender or nonbinary, often encounter significant barriers in accessing healthcare and experience bias in healthcare settings; this has often been my experience here in the state of Ohio as a pansexual cis Black Indigenous woman. This is crucial to consider, especially in the context of gender-affirming care and psychiatric services.

It is necessary to highlight some of my key concerns:

Rule 5122-14-12 lacks specific provisions for transgender and gender-diverse individuals, risking increased stigma and overlooking the need for specialized transgender and gender-diverse-centric psychiatric care and training. This oversight can hinder inclusive and effective treatment in psychiatric settings.

Rule 5122-26-19 imposes stringent requirements on gender transition care, potentially limiting access to essential gender-affirming treatments. Such restrictions contradict the established need for accessible, inclusive, gender-affirming care and overlook the importance of provider training in gender identity matters.

Perpetuation of bias and discrimination in healthcare: A study found that bias towards historically marginalized patients, including BIPOC and LGBTQ+ individuals, affects patient-provider interactions and can lead to lower quality of care and poor health outcomes (Casanova-Perez et al., 2021). This underlines the need for rules and regulations to address and mitigate such biases.

"Transgender individuals also report having lower quality of care, with 34 percent of Black respondents and 32 percent of Latino/a respondents of a 2015 US Transgender Survey report having at least one negative experience during their visit with a health care provider because of their gender identity, such as being verbally harassed or refused treatment. They also face additional barriers when accessing care, including gender-affirming and mental health services. One study found that 85 percent of transgender youth of color stated they needed or wanted mental health care, but only 30 percent were able to receive it; another study found that half of transgender and nonbinary youth ages 13 to 24 wanted to use gender-affirming care but were not using it, for complex reasons including geography and lack of parental support" (Azevedo et al., 2023).

An increase in risks for Trans and Nonbinary BIPOC youth; an additional study highlighted that Trans and Nonbinary BIPOC youth face significantly higher rates of violence victimization and suicide attempts and have foregone healthcare, particularly when experiencing discrimination by ethnicity or culture (Chan et al., 2023). This further emphasizes the need for healthcare policies that are sensitive to the intersectional experiences of BIPOC individuals in the Transgender community.

The proposed rules risk perpetuating the disparities and challenges faced by BIPOC individuals in the Transgender community by not adequately addressing these intersectionalities. As Kimberlé Crenshaw's (1991) theory of intersectionality suggests, the interconnected nature of social categorizations such as race, class, and gender creates overlapping systems of discrimination or disadvantage. Therefore, healthcare policies and rules must be developed with a thorough understanding of these intersecting identities to ensure equitable and effective care for all, especially the most marginalized groups.

Both rules, in their current form, will inadvertently intensify challenges for transgender and gender-diverse individuals, failing to provide equitable and effective healthcare. As an advocate and educator, I urge revisions that consider the specific needs and experiences of the transgender and gender-diverse community and leave such sensitive decisions to be made by healthcare and mental health providers and individuals under their care.

Thank you,

Courtney A. Johnson-Benson, MAEd, CDP 

she/they 

Human Sexuality Doctoral Student 

California Institute of Integral Studies Student Trustee