If Republicans succeed in “defunding” Planned Parenthood, where will transgender patients go?

Karyn Logan, a 38-year-old veteran, came out as transgender in 2013 when she was living in Colorado Springs, Colorado, home to both conservative Christian ministry Focus on the Family as well as Army and Air Force bases. When she sought hormone replacement therapy as a Medicaid patient, she came up empty handed every time.

“Everywhere I turned, I ran into roadblocks,” Logan said in an interview with Mic. “They either didn’t know what I was talking about at all, or they didn’t know any specifics.”

She inquired with the local Veterans Health Administration center — which only just began covering HRT in 2011 and didn’t create an LGBT health services program until the following year — but their response was “very terse,” “almost dismissive,” Logan said. And while she did find online specialists who could treat her, she either couldn’t afford their services or had to sit on months-long waitlists before she could get an appointment.

The process of finding a doctor who could help Logan in her transition stretched over roughly a year and a half, she said, before a friend told her about Planned Parenthood. Having long promised judgement-free care to LGBTQ patients, the health care giant has, in recent years, began offering HRT and other transition-specific services at certain centers. The Colorado Springs Planned Parenthood wasn’t one of those, though, which means Logan had to make the roughly two-hour round-trip drive (assuming no traffic) to a Denver facility. Because Logan lacks a driver’s license, she regularly had to enlist friends — and, on one occasion, an accommodating Uber driver — to help her make the trip.

But with the House and Senate health care bills threatening to remove Planned Parenthood as an eligible provider of Medicaid services — the oft-cited effort to “defund” the organization — transgender individuals like Logan may have to find new doctors and clinics to meet their needs. And in many parts of the country, those doctors and clinics may not exist.

“The services that Planned Parenthood provides to the transgender community are vital, I think, because they are often the only place available to folks who have those specific needs,” Logan, now a patient advocate with Planned Parenthood, said. “That’s especially true for Medicaid patients.”

Transgender people face a perfect storm of health care barriers. It seems reasonable to speculate they have most to lose in a country without easily accessible, affordable reproductive health care.

The Senate health care plan represents congressional Republicans’ latest attempt to scrap federal funding for Planned Parenthood, which draws over $500 million — over 43% of its operating budget — from Medicaid reimbursements and Title X grants, which help fund cancer and STI screenings, breast exams, contraception and the like for low-income patients. Meanwhile, more than 50% of Planned Parenthood patients rely on Medicaid.

It’s unclear how many Planned Parenthood clinics the GOP plan would close, but for transgender patients — who, according to a 2011 report from the National Transgender Discrimination Survey, are more likely to be on Medicaid than the general population, more likely to be unemployed and more likely to face housing and food uncertainty — those closures promise to be disastrous. Many of these patients won’t have anywhere else to go.

Luca Maurer, a transgender man who runs Ithaca College’s Center for LGBTQ Education, Outreach & Services in upstate New York and is a patient advocate with Planned Parenthood of the Southern Finger Lakes, laid out the various health care barriers transgender people face, particularly in areas of the country — like his — with few provider options.

First, many patients face discrimination in medical environments from doctors whom Maurer says embed personal bias in their professional agendas. “I’ve had [doctors] lecture me and say, ‘What do you even think you’re doing, how do you think you’re going to make it in the world, why are you making it difficult for everyone?’” Maurer said in an interview with Mic.

Other doctors treat transgender patients as oddities to be studied regardless of whether they’re seeking gender-related health. That behavior is so common, it’s come to be called “trans broken arm syndrome,” Maurer explained: a transgender patient presents with a broken arm or other readily identified complaint, and instead of answering questions about the injury, they’re first subjected to a battery of irrelevant, insensitive questions about their genitalia from medical providers.

And that’s when doctors agree to treat transgender patients at all. According to the NTDS report, 19% of participants reported having been refused care on the basis of their gender or gender nonconforming status. Further, 28% said they had encountered harassment or disrespectful treatment in a doctor’s office or a hospital; 50% reported having been in the position of educating their providers; and 28% had postponed medical care to avoid discrimination.

“These are not unusual experiences,” Maurer said, “but they’re certainly enough to make somebody want to limit ... the time that they spend in any kind of health care facility or office.” In Maurer’s 20 years of experience as a Planned Parenthood patient, he’s seen the organization equip its staff members to provide “affirming transgender care.”

“I know I don’t have to work to educate my providers, I know that they will treat me with respect,” Maurer said. Walking through Planned Parenthood’s doors, Maurer shared that he never has to worry about dealing with providers who are hostile or inept; he can count on doctors who will welcome him, listen to his concerns, answer his questions and accommodate his needs.

“I pretty much feel that I’ve found a health care home at Planned Parenthood,” he said.

In areas like Maurer’s, access to providers is limited to begin with. According to Maurer, before Planned Parenthood of the Southern Finger Lakes began offering transgender services, transitioning people living in or around Ithaca often made the eight-hour round-trip to Philadelphia or New York City every time they need to see a doctor — for preliminary appointments, physical and mental health screenings, blood work, appointments to discuss or begin HRT or to ensure therapy is going smoothly.

Patients need to make these trips regularly, Maurer said — maybe once every three months for the first year, then once or twice a year for life.

Even though 54% of Planned Parenthood centers operated in rural or medically underserved areas as of 2014, not everyone is lucky enough to live near a clinic. With the pending House and Senate bills, those who do must face a tough question: Where will I go if and when it closes?