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Closing the Gap: LGBTQ+ Healthcare in Tennessee

Updated: Oct 16, 2023

Philip Heil has been a proud resident of the state of Tennessee since 2008. He is a member of the LGBTQ community in Nashville, attended Belmont University, and for the last several years, Philip has worked in event planning for a small business. “We didn't have benefits, and I wasn't making enough to afford health care at all, any kind of health insurance. So I just didn't.” In other states that have expanded Medicaid, Philip’s low income level would have made him eligible to receive medical coverage assistance. In Tennessee, Philip is one of hundreds of thousands of Tennesseans who fall into the coverage gap. “It was always a fear. I mean, I tried not to think about it too often, but in the back of my mind, it was always like ‘OK, if something happens, like what do I do?’ And I know my mom worried constantly for me. The closest thing I had to healthcare or seeing a doctor was going to the PrEP clinic every three months, and only because it was free. It's not the same as going to a doctor. But it was something.” In 2022, Tennessee slashed the budgets of several LGBTQ health-related programs, and PrEP lost nearly half its funding. The clinic is now no longer able to offer the free services it once did, leaving Tennesseans like Philip in an even more vulnerable position than before.

“Today, I’m very thankful to have a nice corporate job with really excellent benefits, so a lot of that stuff is covered for me now. But if I hadn't gotten this job and then the PrEP clinic lost their funding... it hurts to know that now, so many friends of mine don't have access to those kinds of things.” Even though Philip is now out of the coverage gap, over 300,000 Tennesseans are still trapped there, and with the Public Health Emergency unwinding, that number is expected to increase by more than double. To make matters worse, Tennessee has now passed legislation that bans gender-affirming care to minors, as well as criminalizes drag performances in public, including at events like Pride Festival. With this bill, Tennessee is forcing even more people into the coverage gap by taking away their source of income. The existing mental health crisis will also worsen as a result of the gender-affirming healthcare ban. Queer and trans youth in Tennessee are already at a high risk of suicide, and these bills together will increase the risk of children dying. “I want you to take how bad you think it is and then multiply that by tenfold, and if we're lucky, that’s how bad it's going to be. You're taking away those things that are so empowering and validating to so many people, when there's already so little to grasp onto. And when you take that away, it leaves next to nothing.”

Tennessee has passed these and other anti-LGBTQ laws in the name of protecting children. But we know that banning gender-affirming care and drag shows will only put children at greater risk. That greater risk, coupled with a lack of access to care, leaves Tennessee’s most vulnerable children and families with no support. Tennessee must make the morally just decision to expand Medicaid coverage in our state.

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