By Yasmeen Saadi for The Daily Yonder.
Broadcast version by Nadia Ramlagan for West Virginia News Service for the Public News Service/Daily Yonder Collaboration

The history of medical treatment in the LGBTQ community is riddled with stigma and discrimination - from the view of homosexuality as an illness to the criminalization of same-sex intercourse.

While policies and discussions have helped improve these perceptions, according to recent research, there is much work left to be done to support the health of queer and trans people, especially in rural areas.

Zac Ramsey, a doctoral candidate at the West Virginia University (WVU) School of Public Health, set out to uncover some of the barriers in healthcare directly impacting rural LGBTQ individuals. He talked to five rural healthcare providers and five researchers who study the LGBTQ population and learned that health encompasses far more than physical well-being.

"These providers and these researchers were really talking about health as a holistic idea," Ramsey said. "Health as your physical, your mental and your social."

This broader definition that connects physical, mental and social health took into account factors like discrimination and heteronormativity that can impact a patient's relationship with healthcare. For example, assuming that a patient is cisgender or heterosexual, while that may not be the case, may lead doctors or healthcare providers to ask the wrong questions or give inaccurate advice.

"Go in without the assumptions and ask the questions, 'Are you seeing somebody,' not, 'Do you have a girlfriend? Do you have a boyfriend?'" Ramsey said. "Having that open language certainly opens the door."

Ramsey said asking open and inclusive questions allows individuals to believe that providers genuinely care about their health.

A specific challenge mentioned by two providers in the study was gaps in health insurance coverage for sexual and gender minorities. For example, many insurance companies do not understand prescribing testosterone to someone whose medical record is labeled female. Similarly, if all the markers are changed to male, insurance companies may not cover necessary procedures like a Pap smear.

Sensitivity training that makes physicians and providers more aware of their language and interactions with patients can lay a foundation to improve healthcare for the LGBTQ population.

"It just comes down to drilling into the individuals to not assume that they understand the patient just from a chart," Ramsey said.

A Social and Emotional Check Up

Beyond primary care, the last few years have been especially fraught, with the Covid-19 pandemic affecting not only physical, but social and emotional health as well.

Deputy director of the University of Minnesota Rural Health Research Center, Carrie Henning-Smith, conducted a study focused on individuals' systems of social and emotional support during the Covid-19 pandemic based on sexual orientation and rurality.

Research shows that being socially isolated or lonely is associated with higher risks of mortality, cognitive decline, hypertension, and a variety of other negative health outcomes. Therefore, social and emotional support are critical to ensuring an individual's ability to be healthy in the long-term.

Within her study, Henning-Smith used data from the 2020 National Health Interview Survey to compare the prevalence of social and emotional support between lesbian, gay and bisexual adults and heterosexual adults, in addition to comparing rural and urban populations. She found that rural lesbian, gay, and bisexual adults reported the lowest levels of having their social and emotional needs met and the greatest decrease in social and emotional support during the pandemic, with 23.5% saying they had less support than they had a year earlier.

"It's hard when you have a small population within a small population," Henning-Smith said. "It's hard to have adequate funding and adequate resources to make sure that you have funded programs and funded resources that you need."

Rural spaces have additional challenges, with fewer resources and fewer people who share the same lived experiences. With high-speed internet and public transportation harder to come by, rural residents are less able to travel and connect with those that might provide them the social and emotional connection they need.

To help increase support for the rural LGBTQ community, Henning-Smith suggested adding more welcoming spaces like community centers, parks or cafes that signal to people that they are safe and accessible. Further, she said anti-discrimination laws in every state need to be put in place to protect peoples' rights.

"There's a tendency to assume that rural places just don't understand LGBTQ issues or that if you're a member of the LGBTQ community you wouldn't want to live in rural places, and that's just absolutely false," Henning-Smith said.

"We know that LGBTQ folks live in every community across the country, so I think urban residents need to see and recognize their community and their peers in rural spaces."

Yasmeen Saadi wrote this article for The Daily Yonder.

After more than 50 years of use, some Michigan lawmakers say naloxone may not be the best choice in an overdose situation.

Naloxone is sometimes called the "Lazarus drug" because of its powerful ability to seemingly resurrect people after a drug overdose.

Sen. Kevin Hertel, D-St. Clair Shores, and some of his colleagues have introduced a bill which would open the door for what they say are more costly, but more powerful, antidotes.

"Given the prevalence of fentanyl in our communities, and how much stronger some of these drugs that we're now seeing are, we believe -- and in talking with others -- that there should be other tools to respond to an overdose," Hertel explained. "To make sure we're doing everything we can to save somebody's life."

Not everyone is on board with the proposed legislation, Senate Bill 542. Opponents argued the more expensive naloxone alternatives are not necessary, and using them would only increase profits for the pharmaceutical industry.

Jonathan Stoltman, director of the Opioid Policy Institute in Grand Rapids, said while the naloxone alternatives do help in overdose situations, they can also cause nasty side effects.

"The newer approaches, they put people into more severe withdrawal," Stoltman pointed out. "That's a pretty profound negative side effect. The one approach is very inexpensive and works great; the other approach is far more expensive and has this strong negative side effect."

Sponsors of the bill say they're hoping to give Michigan residents a chance to chime in on the issue in a public hearing sometime in June. Michigan saw more than 3,000 opioid overdose deaths in 2021.


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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.