In 2019, the Trump administration dramatically expanded upon discriminatory, anti-LGBTQ policies implemented in the first two years of this administration that are harming the health and well-being of LGBTQ people not just in America, but around the world.

It rolled back sexual orientation and gender identity nondiscrimination provisions in health care, employment, and housing. It appointed more anti-LGBTQ federal court judges. And it retreated even further from global leadership on the moral stance that LGBTQ rights are human rights.

Alarmingly, other policies that are not specifically aimed at LGBTQ people, such as restricting asylum hearings in the United States only to people who have been denied asylum in another country, and global religious “freedom” initiatives, are disproportionately affecting LGBTQ people.

Collectively, these policies are unwinding decades of progress that have been made by LGBTQ people and their allies to build access and equity for LGBTQ people in public life. Most tragically, people are dying as a result.

In June 2019, a transgender woman from El Salvador seeking asylum in the United States and who received a “credible fear” finding — which meant that she could not be deported until her case had been fully considered — died just days after being released from a detention camp in New Mexico. The 25-year-old had spent six weeks in custody at the Otero County Processing Center, during which time she became severely ill but did not receive medical treatment. After falling unconscious, she was transferred to a hospital where she died four days later.

Three months before her death, the ACLU and Santa Fe Dreamers Project had requested a meeting with U.S. Immigration and Customs Enforcement officials and the warden of the Otero camp to discuss allegations by LGBTQ migrants that they were being denied medical care and also subjected to “rampant sexual harassment, discrimination, and abuse” by guards.

Last year also saw the announcement of new policies aimed directly at harming LGBTQ people. In June, the Department of Health and Human Services released a proposed rule that, if finalized, would reverse a provision in the Affordable Care Act which prohibits anti-LGBTQ discrimination in health care settings. Six regulations prohibiting anti-LGBTQ discrimination in health insurance and elder care were also repealed in 2019. In November, HHS released another proposed rule that would remove regulatory provisions that explicitly prohibit organizations that receive HHS grant funding from discriminating on the basis of sexual orientation, gender identity, sex, and religion. HHS awards more than $500 billion in grant funding annually, and its grantees include organizations that provide a wide array of health and social services, including health care at federally funded community health centers, HIV and STI testing and prevention, refugee resettlement, elder care programs, childcare and after-school programs, community meal programs, and adoption and foster care services. These programs are vital to millions of Americans, especially for marginalized communities, including LGBTQ people, who already experience pervasive discrimination that acts as a barrier to accessing care and services.

Last year also saw the implementation of discriminatory policies first announced in 2017. In April, a ban on transgender people serving in the U.S. military that was first announced via a series of tweets by President Trump in 2017 went into effect after the Supreme Court ruled in favor of the ban, lifting injunctions imposed by lower courts. An estimated 13,600 transgender servicemembers are now at risk of being discharged.

Last year also saw new discriminatory policies that would likely have been met with fierce resistance earlier in his presidency. For example, during President Trump’s first year in office, foreign embassies were permitted to continue the practice of flying rainbow flags during Pride month. Last year, that guidance was reversed after the U.S. Embassy in Brazil requested to fly the rainbow pride flag in June, citing an increasingly hostile anti-LGBTQ environment in Brazil after the election last year of President Jair Bolsonaro. The State Department not only refused the request, but alerted its entire diplomatic corps that the rainbow flag could not be displayed on any public-facing flagpole at embassies across the globe.

Things don’t look any better for 2020. On Martin Luther King, Jr. weekend, Vice President Mike Pence attended services at Holy City Church of God in Christ in Memphis, Tenn., where he also addressed the congregation. After Pence spoke, Bishop Jerry Wayne Taylor sermonized that LGBTQ people have been possessed by a “demonic spirit” and that the devil was “trying to destroy the foundation of marriage and cut off the reproductive process” because “two men can’t have a baby, two women can’t have a baby.” The service was streamed live over the White House’s YouTube channel, where it can still be viewed.

The harm experienced by LGBTQ people under the Trump administration is extensive and dangerous. We have every reason to believe things are only going to get worse in 2020. Simply hoping that these proposals never gain traction is not a strategy. We must mobilize to oppose and reverse them.

Sean Cahill, PhD, is Director of Health Policy Research at The Fenway Institute at Fenway Health and co-author of the report, “In its third year in office, the Trump Administration dramatically expanded discriminatory anti-LGBT policies.”