The minefield of United States politics is rife with issues that get to the heart of longstanding inequalities in the country. However, few issues impact the general welfare of the American people more than healthcare.

Looking past questions of public versus private, the realm of healthcare is not made for all, despite what we’d like to believe.

In a report surveying the LGBTQIA+ community of Los Angeles County by the UCLA School of Law Williams Institute, about 1 in 4 adults expressed an unmet need for care. The primary barrier was cost, but 31% of respondents could not find care supportive of LGBTQIA+ adults.

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Transgender and nonbinary adults were almost twice as likely than cisgender adults to report that they had not accessed healthcare to avoid unfair treatment. Of the individuals with a healthcare provider, approximately half reported being out to their providers, and 23% reported not being out to any of their providers.

Specialized healthcare for the LGBTQIA+ community — or the lack thereof — presents a danger in their lives and can lead to harmful narratives about the community that fuels discriminatory legislation.

This healthcare goes far beyond sexual health. Access to gender-affirming care and resources for queer couples looking to conceive a child are only some of the things that qualify as LGBTQIA+ healthcare.

At the heart of the issue is a deep-seated fear of judgment or discrimination. Close friends of mine who are a part of the LGBTQIA+ community have told me how negative experiences in a doctor’s office have made them more wary about the quality of care they were receiving because of their identity.

The experience of members of the LGBTQIA+ community in healthcare settings is often a gamble and can leave the patient worse off than how they came in. A key part of preventing these negative experiences is education.

Matthew Hernandez, a patient navigator with the USC Gender-Affirming Care program, which is part of Keck Medicine of USC, emphasized the importance of representation and education in ensuring that healthcare providers can be inclusive of marginalized identities.

“Education, unfortunately, is lacking in many places … USC has actually started training their current providers, their residents, their students. I’ve also been invited to speak in some of their classes,” Hernandez said.

Hernandez is also a transgender man, something he says helps him to better serve the transgender, nonbinary and intersex community.

USC’s medical facilities — Keck Hospital Center of USC and its various hospitals and USC Student Health, a branch of Keck Medicine of USC — received the distinction of “LGBTQ+ Healthcare Equality Leader” in March 2022. The work of USC’s medical facilities and the work Hernandez does represents the gold standard for what inclusive healthcare looks like.

With anti-trans legislation and bills aimed at limiting the autonomy and freedom of LGBTQIA+ individuals becoming more commonplace, inclusive healthcare represents one front in the fight for equality for this marginalized community. Hernandez, however, is hopeful for the future.

“I am hopeful. I have seen the hope and the growth in our own family medicine clinic where when you did an interview in 2022, we’ve doubled in patients since then and it’s been an amazing growth to witness. So I’m very hopeful this could be spread elsewhere as well,” Hernandez said.

Dr. Laura Taylor, medical director of the USC Gender-Affirming Care program, said her own experience as a queer person informed her interest in caring for the community. But beyond that, there was no formal training provided to her when she was in medical school, and she had to seek that out on her own.

“My feeling is that it [LGBTQIA+ inclusive healthcare] should be a part of medical education for everybody. The reality is that the number of hours spent in medical education specific to the needs of the LGBTQIA+ community is extremely low on average,” Taylor said. “It still does depend on students having personal interests, taking a personal interest, to get a really in-depth education.”

Access to care that is gender-affirming and inclusive of the various lifestyles that encompass the queer experience is rare and underscores the importance of why public health is such a drastically undercovered thing for the LGBTQIA+ community.

Understanding LGBTQIA+ individuals means understanding intersectional identities. To take the experience of a Black transgender woman and a white cisgender gay man and lump them together is to do a disservice, as they will undoubtedly have dramatically different needs. So the solution isn’t to come up with a one-size-fits-all handbook but rather adjust public health to be inclusive of all these different experiences.

Unfortunately, the future is uncertain. Following a divisive election, Donald Trump will return to the White House. With him comes a disproportionately negative and bleak outlook for transgender individuals.

Taylor said she worries but still remains optimistic about developing the next generation of physicians.

“As a physician who treats the trans community, seeing the recent legislative attacks on the existence of transgender people and political debates on what is evidence-based gender-affirming health care that improves people’s lives, makes me scared that people will be able to access it safely,” Taylor said.