LGBTQIA+ In Service & Beyond: Understanding Healthcare Access & Experiences
By MaCherie Dunbar
It’s easy to believe those who wore the uniform are all the same because the assumption is that while we serve, we’re all the same. It’s true, our uniforms match, along with our codes of conduct/ethics and highlighted principles (per respective branch); and we all follow the Uniform Code of Military Justice. It’s also true that our backgrounds and personal nature vary vastly by race, color, religion, sex, gender expression/identity, and the unending intersections between. It’s even more so true that many of us leave military service with incurred varying abilities; some more visible than others. We all join with the promise of free healthcare, yet it is the unique challenges faced by the LGBTQIA+ community that often go unaddressed. The blog aims to educate Veteran service organizations and healthcare providers in hopes they will do more to recognize diversity, and proactively ensure their programs and services meet the needs of all who served; thereby filling much-needed gaps (saving lives) where a legislated healthcare system cannot.
Healthcare, in service, is a convoluted concept no matter your sexual identity or gender expression. There is an expectation of staying healthy no matter what challenges come before you. Some might even say the more difficult, or physically demanding the military occupation specialty, the higher the expectation of pristine health and wellness. Those who spend too much time receiving treatment often suffer harassment and ridicule from peers and leadership alike. Depending on the severity of medical challenges, service members face decreased opportunities for promotions or special assignments, or even losing their jobs altogether.
Often not discussed are the negative effects spousal health can have on a service member’s career. Mental health diagnoses, and care, can lead to the member being deemed non- deployable. All resulting in a tendency to avoid treatment, compounding healthcare challenges the longer they are ignored. Those who can, end up quietly seeking treatment from civilian providers (out of pocket) to stay healthy, preserve their careers, and still qualify for healthcare with the Department of Veterans Affairs (VA). Those who can’t, face early medical discharge/retirement, or the choice to separate at the end of current contractual obligations. Those who are unable to complete their contract to term, or fulfill the desire to be lifers, often suffer additional mental health challenges because they’ve “failed” in some way and may lose a sense of purpose.
Addressing the specific needs of LGBTQIA+ community requires understanding the barriers we face, from historical policies through current legislative hurdles, to ideological and social concepts perpetuating a general lack of safety and trust. The dynamic of needing specialized or individualized care adds challenges. This could include an intensive mental healthcare plan for someone with combat stress, reproductive care for a pregnant person, or gender-affirming care as a member of the LGBTQIA+ community. All can be a recipe for disaster without the proper legislation in place to authorize appropriate care plans, and without destigmatizing the use of healthcare. Service members staying in careers longer saves the Department of Defense (DoD) from losing highly skilled “warfighters'' through separation, be it forced or voluntary, and the millions (if not billions) it takes to maintain troop training requirements.
During the era of Don’t Ask Don’t Tell (and the time prior when homosexuality was still not permissible), tens (to hundreds) of thousands lost their livelihoods. Not only that, every single person who received a dishonorable discharge also lost the ability to participate in receiving a multitude of benefits from the VA. This includes healthcare, all for being who they are and who they were born to be. All because of an unjust political system and an outdated ideology allowed to permeate the system.
The battles for healthcare parity explicitly disparage those who would willingly Take the Oath, with ripple effects influencing both recruitment numbers and benefits available upon exiting service. DoD must recognize that not only is it hard to maintain healthcare while serving, but it is also equally challenging, if not more-so, to receive quality care once you’ve earned your DD-214. For generations, we’ve all witnessed the challenges faced by those attempting to receive healthcare after leaving military service. If you didn’t see it directly, you can read about it in history books. Whether it was from the Department of Veterans Affairs or civilian healthcare providers, the challenge is prevalent. Both insurance companies can deny care for pre-existing health issues, and both can deny care if you can’t prove how and when an injury occurred.
DoD’s healthcare policies are ever-changing, but gender-affirming care has been less than consistent. Even today, trans people who would willingly Take the Oath turn their backs on military service, and some exit after one contract. All because the US government refuses to take a permanent stance as to whether they are fit to serve. With constant international conflict, paired with consistent recruitment challenges, where is the logic in turning away those who are willing and able? the VA’s inconsistency is also directly tied to the lack of supportive legislation. This is especially true with gender-affirming care, which the VA can only provide under certain conditions. For example, you can receive pre-operative and post-operative care for gender-affirming surgery, but the VA itself will not provide the surgery. You must utilize an outside medical agency and insurance.
The Department of Veterans Affairs is extremely inconsistent with its deployment of benefits, healthcare, programs, and services. You can’t even rely on consistent treatment from one the VA Medical Center (VAMC) to the next, city by city or state to state, which speaks to ideology as much as legislation. Veterans, just like everyone else, relocate for the sake of employment or familial obligations. The change in locale means a change in the assigned VAMC and its respective program coordinators. While some locations do an excellent job of ensuring all who served feel welcome, there are others that make LGBTQIA+ Veterans feel unsafe the moment you enter the facility. Misgendering is a common issue, which can be the least offensive on its own and easily rectified with compassion and gentle correction. Once paired with denying bathroom access, harassment from staff and other patrons (who are often Veterans), and having to battle with providers over needed care, it becomes yet another recipe for disaster.
Sadly, these compound offenses are frequent and recurring, strengthening the divide between LGBTQIA+ Veterans and the VA. There are many who are also afraid that, due to the constant legal battles over LGBTQIA+ rights, care that has been earned is going to be lost, so the risk (of being outed) simply isn’t worth the reward. Outside the VA, necessary (gender-affirming) care can be more easily obtained, if you can afford insurance premiums and other out-of-pocket expenses and, of course, if you live in a state that allows gender-affirming care or trans-healthcare at all.
Access to healthcare is a promise made to all who enter the armed forces, so shouldn’t the government hold itself accountable? Politicking gender expression and gender identity, especially in relation to military service and the VA healthcare, is self-harm and it must stop. The Veteran service community has a unique opportunity to plug the gaps where the legislation falls short. Continue educating yourselves and your members. Ensure your programs meet the needs of all who served. Recognize our differences and remember how we’re the same. We all raised our hands to serve. We all want to be safe. We all want to be healthy. Not only are those basic human needs; they are also basic human rights.