New Supreme Court presents an uncertain future for LGBTQ health

The newly confirmed Supreme Court Justice Amy Coney Barrett worries me and she should be a cause for concern to the LGBTQ community too. Though people usually think of medications and surgery when they think of medicine, public policy and court decisions are some of the key drivers of LGBTQ health.

In 2015, Obergefell v. Hodges established marriage equality in the U.S. But just this month, two conservative justices blasted the decision, raising concern from LGBTQ legal experts that new cases will be brought to challenge its precedent. Given that Barrett publicly defended the dissenters in the Obergefell decision, it seems likely she could join those conservative justices. 

Should Obergefell be successfully challenged, public health would be substantially impacted. A 2012 study in The American Journal of Public Health found that legalization of same sex marriage in Massachusetts, which was established in 2003, resulted in decreased health care utilization among gay and bisexual men. Five years later, a landmark study in The Journal of the American Medical Association (JAMA) Pediatrics found that marriage equality resulted in  fewer suicide attempts among gay and bisexual adolescents. 

The authors explained that legal protections have health impacts far beyond marriage itself, “laws and policies shape attitudes and how people treat one another.” If the Supreme Court overturns Obergefell v. Hodges, and we take into account the results of these rigorous studies, we should expect cultural shifts that will likely result in the worsening mental health — and potentially deaths — of more young LGBTQ people in America.

Barrett joins a bench that will decide whether to uphold The Affordable Care Act (ACA) when the justices hear oral arguments for California v. Texas on Nov. 10. In a 2017 law review article, Barrett disagreed with Chief Justice Roberts’s decision to uphold the act, which raised concerns that she might vote to dismantle it. Many have noted that repeal of the law will have implications for all Americans, as people lose health insurance and protection from discrimination based on preexisting conditions. But the impact will be more dramatic for LGBTQ people. One key reason lies in section 1557 of the ACA, which prohibits health care discrimination against LGBTQ people. The Trump administration recently tried to remove these protections and failed, and the recent decision in Bostock v Clayton County will work towards protecting them. But if the court dismantles the entire ACA, these protections will be gone. This is important because LGBTQ people frequently avoid medical care out of fear of discrimination, which can lead to fewer preventative health screenings and skirting treatment for medical conditions. 

In an interview with me, Dr. Kenneth Mayer, Professor of Medicine at Harvard Medical School, explained that U.S. public health is in a precarious position with this new court, “There is no other industrialized democracy that is currently trying to remove access to health care or basic human rights for their population at this time… Judge Barrett’s elevation to the high court is a giant leap backward for mankind.” 

The fears over uncertainty for the LGBTQ community don’t stop there. 

On Nov. 4, the court will hear Fulton v. City of Philadelphia, in which they will decide whether faith-based taxpayer-funded organizations can discriminate against LGBTQ people. The court recently side-stepped a similar question in the 2017 Masterpiece Cakeshop v. Colorado Civil Rights Commission decision. The plaintiffs in that case, who argued that they should be allowed to discriminate against LGBTQ people because of their religious beliefs, were supported by the legal powerhouse Alliance Defending Freedom (ADF), which has paid Barrett for multiple speaking engagements. The CEO of ADF attended the announcement of Barrett’s nomination in the White House rose garden.  

Barrett also served on the board of Trinity Schools, which discriminates against LGBTQ people and bars admission for the children of same-sex couples. Because of Barrett’s connections to ADF and Trinity Schools, LGBTQ legal advocates worry about how Barrett will vote on this case. 

Research has shown that denial of services to same-sex couples based on their sexual orientation results in substantial adverse mental health outcomes for LGBTQ people. We’ve seen that rejection of a person’s sexual orientation or gender identity is associated with an increased risk of suicide attempts, regardless of whether this rejection comes in a secular or religious context. 

Homophobia and transphobia are public health crises. They require legislative interventions that must be upheld by the courts. I urge the Supreme Court to remember this and to protect LGBTQ lives.

Jack Turban, MD, MHS, is a physician and researcher at Stanford University School of Medicine, where he studies LGBTQ health.