Op-ed: We Must Protect Disabled LGBT Adults From Conversion Therapy

When I heard earlier this month that Oregon is about to join California and New Jersey in passing a "Leelah's Law"* that bans so-called conversion therapy for LGBT minors, I was elated. Though I've never had such "therapy" myself, as trans woman uncomfortable with being out as trans until adulthood, I understand deeply how important it is for trans youth to be able to live authentically and to get needed support and health care in their formative years.

But, here's the issue: as with all Leelah's Laws, this new one only covers the practice of conversion therapy for those under 18 years of age. Of course, it is very reasonable that young people would be enumerated in such legislation, as they are often uniquely vulnerable to mental or even physical coercion from adults, along with being protected by a general social consensus that the young must be kept from harmful influences.

But are LGBT youth the only people who are particularly vulnerable to the harmful effects of conversion therapy? Not by a long shot.

An invisible reality remains: LGBT disabled people of all ages are a second demographic that's at risk of receiving conversion therapy.

I've come to realize this through being not only a transgender person but a person living with a disability. In my life, I have been discriminated against or marginalized because of both of these identities — sometimes separately and sometimes because of their intersection. Activism on both regards shares a general theme of respect of autonomy and self-determination. And in both arenas, our society falls short in too many ways.

According to the American Civil Liberties Union, "People in the United States are profoundly uncomfortable with people who have disabilities, especially significant or visible disabilities." This has led, the ACLU says, to both conscious and unconscious segregation of disabled people within health care, housing, and employment. "Even when that segregation costs the government and taxpayers more money than integration would cost, the predisposition to keep people with disabilities away from public view has been a guiding force in the structure of society and government-funded programs," they conclude.

What does this look like? For one, often times those with disabilities are unemployed. If we are lucky enough to have employment credits, we can receive Medicare, but if not, we receive Medicaid, which is often subject to the subpar reimbursement rates compared to the more "respectable" Medicare — an institutional bias that favors funding of institutionalization over home-based care and community integration for disabled people. Therefore, there are a limited number of providers that accept Medicaid.

Yet, lo and behold, some conversion therapy "clinics" do accept Medicaid dollars, most notably one co-owned by ex-Minnesota congresswoman Michele Bachmann and her husband, Marcus. As the Washington Blade reported in 2011, the Bachmanns' clinic "has been collecting annual Medicaid payments totaling more than $137,000 for the treatment of patients since 2005. These payments are on top of the $24,000 in federal and state funds that Bachmann & Associates received in recent years under a state grant to train its employees."

It's worth noting that Minnesota is a state that has banned coverage of gender-confirmation surgeries through Medicaid. So Minnesota, which like other states jointly administers the Medicaid program with the federal government, has basically said no to affirming and medically necessary surgeries for trans patients, but said yes to health care providers that practice "therapy" denying the existence of trans people altogether. And though it's difficult to analyze the status of funding of conversion therapy due to health insurance coding loopholes, this practice may be more common than one would think.

What does this mean for disabled LGBT people? For one, being on disability benefits means we cannot afford any health care providers besides those that accept Medicaid, and we are therefore sometimes stuck with providers like this — ones that are willing to erase our very existence. It means at the very least that even if we would not consider using conversion therapy, we are still subtly exposed to its messages and messengers when we are present in their clinics.

The danger becomes even more starkly clear when we consider transgender people with disabilities who are held in institutions. According to Lydia Brown on her blog Autistic Hoya:

"When you live in an institution, you lose the right to control even the smallest aspects of your day-to-day life. ... You are not allowed to decide which staff provide you with your services and supports. ... You are not allowed to decide how you will look, what clothes you will wear. ... You are not allowed to decide what medications or therapies are right for you, or which are not. You are not allowed to make your own decisions about dating, romance, or sexuality. If you are queer or trans, you will most likely be denied the right to even express who you are."

Pay attention to the word "therapies" here. Conversion therapy is a multimillion-dollar "therapeutic" industry that has financial incentive, at the very least, to find potential markets. With conversion therapy slowly but surely becoming banned for our LGBT youth, then the industry will have to find other susceptible targets over the age of 18. Are many targets better than the captive audience of LGBT disabled adults in institutions? Or even simply those who, due to inability to find alternative housing, are housed with unsupportive caregivers?

There are no easy answers to these questions. However, I believe that a companion version of Leelah's Law preventing any public funding going to "ex-trans" or "ex-gay" conversion therapy for adults would help prevent the coercion of such especially defenseless individuals from being exposed to this harmful "therapy," while affirming therapy and medical services that assist transgender individuals should be funded by Medicaid programs. Though I've focused on trans people with disabilities because of my personal insights into this group's risk factors, groups with compounded vulnerabilities also include trans seniors and incarcerated individuals, who already are marginalized and are often denied choices by publicly funded systems, which often do not have their best interests in mind when it comes to gender self-determination.

Ultimately, it is a major gain that LGBT youth are being protected by statewide Leelah's Laws. But in a system where those who cannot work are often thrown into restrictive, publicly funded programs, we must pay attention to the risk factors for LGBT individuals with disabilities, seniors, and prisoners, and to focus equally on their gender and sexual self-determination in the face of "conversion therapy."

*Author's Note: I have chosen to refer to all trans-inclusive conversion therapy bans as "Leelah's Laws" in order to center the experience of transgender individuals and urge state legislators considering such bills to name their bill "Leelah's Law" when possible.