WEBVTT - How Trump is Changing Trans Healthcare 0:00:01.720 --> 0:00:07.560 Also media, Hi everyone, and welcomed. It could happen here 0:00:07.800 --> 0:00:10.560 a podcast about things falling apart and the people putting 0:00:10.560 --> 0:00:14.400 them back together. And today Garrison and I are joined 0:00:14.400 --> 0:00:18.720 by Haley and Dan. Both Haley and Dan are gender 0:00:18.760 --> 0:00:22.160 affirming care providers in the Northeast, and they both work 0:00:22.320 --> 0:00:26.320 at federally qualified health centers. Welcome to the show, guys, 0:00:26.640 --> 0:00:31.320 thank you so much in care. Okay, So for people 0:00:31.680 --> 0:00:34.240 who are not familiar, right, maybe they've been fortunate enough 0:00:34.240 --> 0:00:37.640 to have like really good healthcare their whole life, or 0:00:37.920 --> 0:00:39.680 fortunate enough to not live in the United States and 0:00:40.000 --> 0:00:44.199 have this bizarre like web of healthcare provision. Can you 0:00:44.240 --> 0:00:46.720 explain what a federally qualified healthcare center is? 0:00:47.120 --> 0:00:48.560 Sure you mind if I take this with Hailey? 0:00:50.040 --> 0:00:53.640 So I would start by saying that our industry, our 0:00:53.680 --> 0:00:57.800 advocacy arms would riot if they assumed that federally qualified 0:00:57.800 --> 0:00:59.040 health centers weren't good care. 0:00:59.240 --> 0:00:59.320 Right? 0:00:59.400 --> 0:01:01.200 So ye smiths with that to start. 0:01:01.240 --> 0:01:04.280 Oh, yeah, I get yeah, I guess good is a 0:01:04.319 --> 0:01:07.720 relative to Yeah. I've relied on a federally qualified healthcare 0:01:07.760 --> 0:01:08.280 center for a while. 0:01:08.319 --> 0:01:09.400 It was great. They were very nice. 0:01:09.640 --> 0:01:11.640 Actually, my prescriptions cost a lot less now than they 0:01:11.640 --> 0:01:13.960 do with my very expensive eyeigh insurance. 0:01:14.280 --> 0:01:14.960 Yeah. 0:01:15.160 --> 0:01:17.840 So around the nineteen sixties there was the sort of 0:01:17.840 --> 0:01:20.560 free clinic movement that got started, and what grew out 0:01:20.640 --> 0:01:23.160 of that became the federally qualified health center system in 0:01:23.200 --> 0:01:27.800 the United States. So there are roughly sixteen hundred unique 0:01:27.800 --> 0:01:31.200 federally qualified health centers all over the country and we 0:01:31.720 --> 0:01:36.320 as in sort of you know, confederated set of health 0:01:36.360 --> 0:01:39.800 centers all across the country, are responsible for treating those 0:01:40.160 --> 0:01:43.640 most in need in the United States, so the Medicaid population, 0:01:44.160 --> 0:01:46.640 those without insurance. We cannot turn anybody away if you 0:01:46.680 --> 0:01:50.280 do not have insurance, people in rural areas where healthcare 0:01:50.320 --> 0:01:54.120 is very difficult to access and to get, undocumented folks, 0:01:54.240 --> 0:01:57.040 and really everybody in between. At the health center that 0:01:57.080 --> 0:01:59.360 I work at, we mostly treat folks on Medicaid, which 0:01:59.400 --> 0:02:02.120 is pretty typical, although you'll find in states with no 0:02:02.200 --> 0:02:05.040 Medicaid expansion it's a lot more uninsured and less Medicaid. 0:02:05.080 --> 0:02:09.040 But we are the nation's safety net healthcare provider, and 0:02:09.080 --> 0:02:12.560 without us, there are roughly one in ten Americans would 0:02:12.560 --> 0:02:13.440 not get their healthcare. 0:02:13.720 --> 0:02:17.320 Jeez, well, I guess people who are not in the 0:02:17.520 --> 0:02:19.880 United States, do you want to go and give us 0:02:19.880 --> 0:02:24.000 a go one minute speedrun of what Medicaid is medicare Sure. 0:02:24.120 --> 0:02:27.760 So America does not have a nationalized insurance program, as 0:02:27.840 --> 0:02:30.040 we are very frustrated with. 0:02:30.200 --> 0:02:31.000 Most of the time. 0:02:31.520 --> 0:02:34.000 It's mostly commercial insurance that you mostly get through your job. 0:02:34.000 --> 0:02:36.040 But if you are not fortunate it's not the right word, 0:02:36.040 --> 0:02:38.760 but if you're not fortunate enough to get that. Medicaid 0:02:38.840 --> 0:02:40.880 is the system that gives health insurance to people who 0:02:40.919 --> 0:02:43.800 are living at or below the federal poverty line. With 0:02:44.080 --> 0:02:48.120 the Affordable Care Act or the ACABAMBACARE, that level raised 0:02:48.120 --> 0:02:49.840 a little bit, so you could still get Medicaid if 0:02:49.880 --> 0:02:52.200 you were at above the federal poverty line. 0:02:52.200 --> 0:02:55.120 But this is mostly for the working poor. That's who 0:02:55.120 --> 0:02:55.840 gets Medicaid. 0:02:56.160 --> 0:02:56.400 Cool. 0:02:56.480 --> 0:02:59.760 Yeah, it's a great system. Let's talk about how this 0:02:59.919 --> 0:03:01.919 is funded them And you said the US doesn't have 0:03:02.120 --> 0:03:05.600 like a single pair healthcare system. So how are these 0:03:05.639 --> 0:03:08.240 healthcare centers funded right now? Or maybe how were they 0:03:08.280 --> 0:03:09.720 funded like six weeks ago. 0:03:10.760 --> 0:03:13.480 Yeah, So most of the work that we do is 0:03:13.480 --> 0:03:15.320 fee for service. We're not a lot different than a 0:03:15.320 --> 0:03:17.120 lot of other places in that regard. Right, if you 0:03:17.120 --> 0:03:19.760 have Medicaid patients, we are a fee for Service program. 0:03:19.840 --> 0:03:22.680 We give provision of care to them on a per 0:03:22.760 --> 0:03:24.920 visit basis, same as anywhere else in the country and 0:03:24.919 --> 0:03:27.560 how that works, and we get reimbursed for it. What 0:03:27.680 --> 0:03:30.519 makes FQS different than everywhere else is two things. One, 0:03:30.680 --> 0:03:33.920 we get a special rate that is designated because of 0:03:33.960 --> 0:03:37.520 our willingness to take on these more expensive, more complicated 0:03:37.560 --> 0:03:40.480 patients and to ensure they are healthy enough to keep 0:03:40.840 --> 0:03:42.040 out of expensive. 0:03:41.560 --> 0:03:43.920 Systems of care like emergency rooms and things of that nature. 0:03:44.040 --> 0:03:44.240 Yeah. 0:03:44.360 --> 0:03:46.280 And two is that we have a grant called the 0:03:46.320 --> 0:03:50.480 FED three thirty And this is a sort of like large, 0:03:50.640 --> 0:03:53.560 sort of use it as you need to grant that 0:03:53.840 --> 0:03:57.720 depending on the agency, is anywhere from five to twenty 0:03:57.800 --> 0:04:00.320 five percent of your total annual funds and is to 0:04:00.360 --> 0:04:02.600 cover all of the folks who can afford care and 0:04:02.600 --> 0:04:03.280 are uninshort. 0:04:03.600 --> 0:04:05.600 Part of my funding also, I do a lot of 0:04:05.640 --> 0:04:09.080 work with HIV and HIV prevention, so a lot of 0:04:09.080 --> 0:04:12.320 my work is done via Ryan White funding, and there's 0:04:12.320 --> 0:04:15.840 some other kind of separate funding streams that's applicable specifically 0:04:15.880 --> 0:04:19.400 to gender firming care. However, it's all kind of messy 0:04:19.520 --> 0:04:21.799 and tied up in a lot of those other funding 0:04:21.800 --> 0:04:26.479 streams that Dan mentioned, and there's some specific limitations because 0:04:26.520 --> 0:04:31.120 of those funding streams again historically because who knows right now, 0:04:32.320 --> 0:04:35.400 but through something called the High Amendment, it means that 0:04:35.440 --> 0:04:38.599 our funding would be at jeoparty if we provided abortion care. 0:04:39.560 --> 0:04:42.400 So there are some kind of limitations. A lot of 0:04:42.400 --> 0:04:45.440 what we do as an FQT is providing really comprehensive, 0:04:45.600 --> 0:04:49.600 expansive care. We're kind of some of the few clinics 0:04:49.640 --> 0:04:53.120 that do everything that we do under one roof, but 0:04:53.160 --> 0:04:56.279 there have been some limitations specifically abortion to that. 0:04:56.800 --> 0:04:59.840 Yeah, it's more of a healthcare experience. So I'm used 0:04:59.880 --> 0:05:02.160 to with someone from Europe like going to one of 0:05:02.200 --> 0:05:04.120 these centers and like the American one where you get 0:05:04.160 --> 0:05:07.000 referral and then yeah, get it approved and blah blah blah, 0:05:07.000 --> 0:05:07.719 and like a lot. 0:05:07.560 --> 0:05:09.240 Of the ways that I talk to friends who live 0:05:09.240 --> 0:05:11.560 in other countries, Like, I feel like my role is 0:05:11.600 --> 0:05:14.200 kind of more similar to like a GP as a 0:05:14.279 --> 0:05:17.279 nurse partitioner. There isn't necessarily an equivalent, but I feel 0:05:17.320 --> 0:05:20.640 like a GP is kind of a very similar universal 0:05:21.360 --> 0:05:22.800 way to understand a lot of what I do. 0:05:23.400 --> 0:05:26.760 Yeah, that makes sense. So can you explain Ryan White funding? 0:05:26.839 --> 0:05:29.080 Like where does that come from? Why is it called 0:05:29.200 --> 0:05:29.760 Ryan White? 0:05:29.960 --> 0:05:34.960 So basically, Ryan White Funding was initiated in I believe 0:05:35.000 --> 0:05:39.320 the early nineties during the AIDS crisis and was a 0:05:39.400 --> 0:05:43.039 large government initiative. It's named after Ryan White, who was 0:05:43.640 --> 0:05:48.880 a patient who contracted HIV through a blood transfusion. Yeah, 0:05:49.080 --> 0:05:54.040 so Ryan White funding right now is a major source 0:05:54.080 --> 0:05:57.920 for funding things like PREP, which is medication for prevention 0:05:58.040 --> 0:06:01.679 for HAV as well as direct HIV treatment. 0:06:02.440 --> 0:06:06.480 Yeah, so a number of these things, right, gender affirming care, 0:06:06.880 --> 0:06:10.520 perhaps care for people with HIV or preventing people from 0:06:10.560 --> 0:06:13.400 getting HIV through pre exposure prophylaxis. Like you said, like 0:06:13.800 --> 0:06:15.919 these are things that have been like like at the 0:06:15.960 --> 0:06:21.520 center of the culture war for the current government, right, 0:06:21.560 --> 0:06:24.840 like that they're like the things that they point to 0:06:25.120 --> 0:06:29.479 is you know whatever they're sort of like Impacton's impacts 0:06:29.480 --> 0:06:32.000 in Sunstruction of Fascist and he talks about moral decline, right, 0:06:32.040 --> 0:06:34.280 and this is their moral decline that this is what 0:06:34.560 --> 0:06:37.159 they use when they're constructing their kind of we will 0:06:37.160 --> 0:06:42.800 save you narrative. What does that mean for funding? And 0:06:42.880 --> 0:06:45.320 like what does that mean more importantly for your patients 0:06:45.320 --> 0:06:47.400 of people who come to you for these different types 0:06:47.440 --> 0:06:48.520 of care I mean, I. 0:06:48.440 --> 0:06:51.280 Think it's terrifying. I think I'm more on the fusion 0:06:51.279 --> 0:06:54.320 facing side. So a lot of the conversations I've been 0:06:54.360 --> 0:06:58.640 having are just about the uncertainty. I'm a prescriber for 0:06:58.720 --> 0:07:04.039 a lot of tras, youth adolescents and young adults, and 0:07:04.120 --> 0:07:10.000 so moreover, the uncertainty of just being able to get 0:07:10.040 --> 0:07:15.640 their medication. The stress of being publicly named and targeted 0:07:15.880 --> 0:07:20.840 in this culture war has just created a climate of fear. 0:07:21.640 --> 0:07:24.480 As my job, I want to be able to reassure 0:07:24.720 --> 0:07:27.200 patients that I am going to fight for them and 0:07:26.920 --> 0:07:30.400 do all that I can. But it's really scary. As 0:07:30.480 --> 0:07:34.120 Dan mentioned, a lot of our patients don't have financial 0:07:34.120 --> 0:07:37.280 safety net, they don't have a medical safety net. We're 0:07:37.320 --> 0:07:40.680 really the one option for them, and if our clinic 0:07:41.360 --> 0:07:44.600 does not continue to offer this type of care, these 0:07:44.640 --> 0:07:46.840 are our kids who are going to go without hormones. 0:07:47.200 --> 0:07:50.680 I prescribe puberty blockers. My work as a gender forming 0:07:50.760 --> 0:07:54.120 care provider isn't just blockers and hormones, but those are 0:07:54.160 --> 0:07:57.640 medications that we know are life saving. We know that 0:07:57.640 --> 0:08:00.760 that unfortunately, kids will suicide if they don't have access 0:08:00.880 --> 0:08:04.800 to those mendications, and so I think you know, talking 0:08:04.800 --> 0:08:09.840 about funding, talking about kind of these bigger shifts politically, 0:08:10.520 --> 0:08:12.840 you know, are sayings that unfortunately a lot of the 0:08:12.880 --> 0:08:16.480 conversations I'm having are really coming just down to safety 0:08:16.560 --> 0:08:20.880 and safety planning and figuring out support networks and talking 0:08:20.960 --> 0:08:23.760 about creative ways to get hormones if if we can't 0:08:23.800 --> 0:08:24.960 prescribe them. 0:08:25.040 --> 0:08:28.000 Yeah, I think it's worth talking about the fact that, 0:08:28.080 --> 0:08:30.240 like there are there are so many angles of attack 0:08:30.320 --> 0:08:31.960 on this right, there is the one that is just 0:08:32.080 --> 0:08:34.959 very clearly aimed at trans kids, right, the EO that 0:08:35.120 --> 0:08:40.559 specifies like protecting children it's nonsense, but that is aimed 0:08:40.600 --> 0:08:42.960 at ending this care everywhere. 0:08:43.080 --> 0:08:43.400 Yeah. 0:08:43.480 --> 0:08:45.400 Now are they going to be able to do it everywhere? 0:08:45.720 --> 0:08:47.760 I don't know. Maybe, but not quickly. 0:08:48.160 --> 0:08:51.240 But they can end it for FQHCs all across the 0:08:51.280 --> 0:08:54.520 country by simply making it like the High Amendment. If 0:08:54.559 --> 0:08:57.720 we were to perform abortion services at the place that 0:08:57.760 --> 0:09:00.880 I work, then we would lose our three thirty funding 0:09:00.880 --> 0:09:02.800 and we would lose our a FQ designation, which would 0:09:02.800 --> 0:09:05.600 cut our rate in half, and that would devastate the 0:09:05.600 --> 0:09:07.840 business and put us out and mean that we could 0:09:07.880 --> 0:09:11.160 not care for the thousands and thousands and thousands of 0:09:11.160 --> 0:09:14.959 other people that we care for besides those kids. Right, 0:09:15.080 --> 0:09:18.600 then there are also the just the doge fuckery that 0:09:18.800 --> 0:09:21.920 is going to harm all of this and may create 0:09:21.960 --> 0:09:24.559 a lot of the same outcomes, right, which is they 0:09:24.640 --> 0:09:28.280 turned off grants kind of just across the board. Yes, 0:09:28.320 --> 0:09:30.520 some of them were targeted on things like gender affirming, 0:09:30.920 --> 0:09:33.360 most of them were just like it's a grant, we're 0:09:33.400 --> 0:09:36.640 turning it off. And then there was the tro but 0:09:37.120 --> 0:09:39.920 much of that funding has remained frozen. We have been 0:09:40.160 --> 0:09:42.600 told that the system is up and running and that 0:09:42.679 --> 0:09:45.320 they undid what they did, and the courts stepped in, 0:09:45.360 --> 0:09:47.040 and oh don't we have the courts still here in 0:09:47.040 --> 0:09:49.440 the United States. Isn't that a good thing? But they 0:09:49.640 --> 0:09:52.079 just kept the funding off. Whether because they're incompetent or 0:09:52.080 --> 0:09:55.040 because they're actively defying the law doesn't really matter. And 0:09:55.080 --> 0:09:57.480 as a result, federally qualified health centers all across the 0:09:57.520 --> 0:10:00.840 country have laid people off, They have closed clinics and 0:10:00.960 --> 0:10:04.439 have entirely gone underwater in some cases. And then those 0:10:04.520 --> 0:10:07.360 people are not there to treat the community that needs 0:10:07.400 --> 0:10:10.880 them so badly. And all of these systems are grounded 0:10:10.920 --> 0:10:13.440 in their communities. So when you lose you know the 0:10:13.480 --> 0:10:15.880 clinic that's in LA that had to close its doors 0:10:15.960 --> 0:10:18.800 for the office that's on one side of town. The 0:10:18.880 --> 0:10:22.240 people there knew that place. It was part of their community, 0:10:22.280 --> 0:10:24.559 part of their existence. It was grounded in that community 0:10:24.600 --> 0:10:28.040 and its community's needs. And that's just gone. And this 0:10:28.120 --> 0:10:30.160 puts us in the very difficult position, and you know, 0:10:30.280 --> 0:10:33.160 leadership in the very difficult position of figuring out, well, 0:10:33.200 --> 0:10:36.240 do I worry about these trans youth and the fact 0:10:36.240 --> 0:10:38.720 that they might kill themselves, or do I worry about 0:10:38.760 --> 0:10:41.600 the impact that standing up on principle and saying I 0:10:41.600 --> 0:10:44.280 won't toss them to the wolves might have on the 0:10:44.320 --> 0:10:47.120 rest of the system. And it becomes a very difficult 0:10:47.160 --> 0:10:49.880 sort of situation for us as providers to navigate. But 0:10:50.240 --> 0:10:52.880 you know, in fairness to leadership, which I disagree with 0:10:53.120 --> 0:10:53.600 for them too. 0:10:54.080 --> 0:10:55.319 Yeah, that's tough. 0:10:55.679 --> 0:10:58.600 Can you briefly explain that, maybe lay out a timeline 0:10:58.600 --> 0:11:00.800 because we talked about executive order, Say we talked about 0:11:00.840 --> 0:11:05.640 a tro like there was a large dumber of executive 0:11:05.760 --> 0:11:08.080 orders right in the last three weeks, so like maybe 0:11:08.080 --> 0:11:10.760 people miss them. Can you explain the pertinent executive orders? 0:11:10.760 --> 0:11:11.840 And then what's a tentative? 0:11:11.920 --> 0:11:13.800 Is training order. Yeah. 0:11:13.840 --> 0:11:17.200 So on Trump's first day in office, on the day 0:11:17.240 --> 0:11:20.880 of his inauguration, so January twentieth, he signs one hundred 0:11:20.880 --> 0:11:24.480 some odd executive orders. The ones that are particularly of 0:11:24.520 --> 0:11:29.520 interest to us in healthcare were protecting children against chemical 0:11:29.559 --> 0:11:32.160 and surgical mutilation is the name of it, which is 0:11:32.160 --> 0:11:36.000 a disgusting and vile name. Yeah, and then protecting women 0:11:36.280 --> 0:11:40.520 something something something defending women, Yeah, defending women, which is 0:11:40.760 --> 0:11:45.520 similarly aimed at transgender individuals and I think will be 0:11:45.679 --> 0:11:48.480 used after we are under attack for trans youth, to 0:11:48.480 --> 0:11:51.280 come after trans adults in federally qualified health centers as well. 0:11:52.040 --> 0:11:56.520 Those eos led to Later that week, on Friday, we 0:11:56.760 --> 0:12:00.319 got emails to every PI which is principal investor gator 0:12:00.360 --> 0:12:04.480 on every federal grant that we had. That said because 0:12:04.640 --> 0:12:08.400 of those two, and there was one about DEI which 0:12:08.480 --> 0:12:11.560 also in executive order, you are not allowed to use 0:12:11.600 --> 0:12:14.440 any of these grant dollars in service of anything in 0:12:14.480 --> 0:12:17.160 defiance of these three executive orders. So that was the 0:12:17.160 --> 0:12:19.800 first shot we got, and it came only four days later. 0:12:20.400 --> 0:12:23.319 It's threatening, but it wasn't specific right, It didn't specifically 0:12:23.360 --> 0:12:25.080 say we're going to do X, Y or Z but 0:12:25.160 --> 0:12:29.800 it was here's a threat. The following Tuesday, dog is 0:12:30.280 --> 0:12:34.360 let loose and announces that they are freezing federal grant 0:12:34.360 --> 0:12:39.600 funding tied to anything that is in opposition to those things. 0:12:40.080 --> 0:12:41.320 If you actually looked at. 0:12:41.200 --> 0:12:44.360 The excel file that they released with the actual grants, 0:12:44.559 --> 0:12:48.240 it froze everything. Like it was not just the stuff 0:12:48.280 --> 0:12:50.160 that they felt was in opposition to this, it was 0:12:50.200 --> 0:12:52.560 like everything. We have a ton of grants that were 0:12:52.600 --> 0:12:54.440 on that list at the agency that I work at, 0:12:54.800 --> 0:12:56.720 and boy, oh boy, oh boy, was there a lot 0:12:56.760 --> 0:13:01.800 of panic going around. Wednesday rolls around and they get 0:13:02.000 --> 0:13:04.840 a judge come in and sort of put a halt 0:13:04.880 --> 0:13:08.440 on it. And then later that day a press secretary says, oh, 0:13:08.440 --> 0:13:10.679 we're just going to send the memo. We're still going 0:13:10.720 --> 0:13:13.360 to freeze everything, and then the judge comes back and 0:13:13.400 --> 0:13:15.360 puts a temporary straining order. So in theory, what that 0:13:15.440 --> 0:13:17.720 should have meant is that all of that grant funding 0:13:17.760 --> 0:13:21.840 once again flows. And it did not importantly too for us, 0:13:21.960 --> 0:13:24.880 given how much medicaid dollars we take in Medicaid portals, 0:13:24.880 --> 0:13:26.720 and all fifty states went down, so we could not 0:13:26.880 --> 0:13:29.280 get any of those dollars in service of what we 0:13:29.280 --> 0:13:33.040 were doing for twelve hours, but still it was this 0:13:33.600 --> 0:13:36.200 very concerning situation because medicaid was not on their list 0:13:36.240 --> 0:13:38.600 of things that they were after, and yet we couldn't 0:13:38.679 --> 0:13:40.640 even access it on the state level. 0:13:41.280 --> 0:13:42.400 A few more weeks. 0:13:42.080 --> 0:13:46.120 Go by and there's news popping about, Hey, you said 0:13:46.120 --> 0:13:50.800 you unfroze stuff, but it's still frozen. Another judge issued 0:13:51.280 --> 0:13:53.640 an order saying that, like, no, for real, I meet 0:13:53.679 --> 0:13:56.320 at this time unfreeze everything. I know some of the 0:13:56.320 --> 0:13:58.240 grants that we had that we couldn't access seem to 0:13:58.320 --> 0:14:01.520 have come back online, but I don't know, you know, 0:14:01.520 --> 0:14:03.080 I think it would be an impossible thing to do 0:14:03.080 --> 0:14:05.640 an accounting of like every single one that might have 0:14:05.720 --> 0:14:07.920 been turned off that might might or might not be 0:14:07.960 --> 0:14:10.080 back on right now. But I am doubtful that at 0:14:10.080 --> 0:14:13.760 this point every single grant across the federal agency is 0:14:14.280 --> 0:14:15.800 potentially available for folks. 0:14:16.160 --> 0:14:17.160 Just seems unlikely to me. 0:14:17.760 --> 0:14:21.520 Yeah, we should pivot to advertisements here, So I'm going 0:14:21.600 --> 0:14:22.440 to do that and then we'll. 0:14:22.280 --> 0:14:33.840 Be right back. Okay, we are back. 0:14:34.320 --> 0:14:37.240 So you talked about like these grants being turned off 0:14:37.520 --> 0:14:38.440 or not coming. 0:14:38.840 --> 0:14:39.760 What does that mean? 0:14:40.040 --> 0:14:43.600 Does that mean people don't get care? Does that mean 0:14:43.600 --> 0:14:45.920 providers don't get paid, does that mean they can't access 0:14:45.960 --> 0:14:47.720 their prescriptions? Like, what does it look like if I'm 0:14:47.720 --> 0:14:50.000 trying to access care through one of your clinics. 0:14:50.160 --> 0:14:52.120 So yeah, I'll speak to that a little bit on 0:14:52.160 --> 0:14:56.280 the prescriber side, because I think, you know, having direct 0:14:56.360 --> 0:14:58.960 contact with someone who works into the administration is really 0:14:59.000 --> 0:15:01.360 the only way that I I have really been able 0:15:01.400 --> 0:15:04.280 to get any updates. So as a healthcare provider, it's 0:15:04.280 --> 0:15:08.640 been out or chaos. Basically every day we've gotten different 0:15:08.720 --> 0:15:13.840 messaging around whether or not appointments can be scheduled, new patients, 0:15:13.920 --> 0:15:18.000 can you know, schedule intakes, whether or not we're able 0:15:18.040 --> 0:15:23.640 to prescribe these life saving medications, and no one knows exactly. 0:15:24.760 --> 0:15:29.000 Gender firming care is basically healthcare. There's nothing that separates it. 0:15:29.040 --> 0:15:32.080 There's no hard line, there's no clear distinction. It is 0:15:33.440 --> 0:15:38.640 medically indicated, evidence based care. So saying you can't do 0:15:38.760 --> 0:15:42.120 gender firming care, it literally doesn't make any sense in 0:15:42.200 --> 0:15:46.120 terms of you know, what we do as prescribers. And 0:15:47.160 --> 0:15:50.680 on my end, I've been faced with intimidation, I've been 0:15:50.800 --> 0:15:55.080 faced with kind of whisper networks of misinformation coming from 0:15:55.080 --> 0:15:58.760 administration trying to get us to stop prescribing because they 0:15:58.800 --> 0:16:01.880 do see this type of care as a liability. I'm 0:16:01.920 --> 0:16:06.640 still prescribing. There is no state law in the state 0:16:06.720 --> 0:16:10.600 that I am in that prevents my ability to act 0:16:10.640 --> 0:16:13.040 as to the full extent of my scope. There are 0:16:13.040 --> 0:16:17.240 also no medical indications for me to stop prescribing, and 0:16:17.320 --> 0:16:21.040 I'm ethically bound as a nurse practitioner to do what 0:16:21.120 --> 0:16:23.160 I believe is best for my patients, which is to 0:16:23.240 --> 0:16:25.720 continue to provide them with a care that they need. 0:16:26.000 --> 0:16:27.320 But it's terrifying. 0:16:27.800 --> 0:16:30.200 I think importantly, Haley and I have the eventage of 0:16:30.240 --> 0:16:34.280 working for a more economically stable institution. There's a lot 0:16:34.280 --> 0:16:37.400 of health clinics out there that have a week's worth 0:16:37.440 --> 0:16:39.720 of working capital, right, so if all of a sudden 0:16:39.880 --> 0:16:43.320 they lose access to every grant dollar, it lose access 0:16:43.320 --> 0:16:46.440 to their three thirty. They were scheduled to draw down 0:16:46.480 --> 0:16:48.000 on a grant that was going to cover a whole 0:16:48.040 --> 0:16:50.120 bunch of upcoming expenses, but they haven't done it yet, 0:16:50.120 --> 0:16:52.760 and then they can't, Like in very real ways, that 0:16:52.840 --> 0:16:55.000 may mean that the doors are closed and the place 0:16:55.040 --> 0:16:57.240 goes under and that no one can get care there. 0:16:57.800 --> 0:17:00.560 And there is this real challenge of you know, how 0:17:00.560 --> 0:17:03.600 do we decide what is the best thing to do. 0:17:03.720 --> 0:17:06.919 But for me and what sort of started working with 0:17:06.960 --> 0:17:09.520 in our agency at least to organize around this is 0:17:09.560 --> 0:17:11.639 that like, this is an anti fascist practice. That is 0:17:11.640 --> 0:17:13.359 the right medical thing to do, It is the right 0:17:13.440 --> 0:17:15.880 ethical thing to do, But it is also our chance 0:17:15.960 --> 0:17:19.000 to take an anti fascist stance against this government because 0:17:19.000 --> 0:17:21.400 if we don't stand now for the very first group 0:17:21.400 --> 0:17:24.359 they're coming for, then the next group, which is without 0:17:24.480 --> 0:17:29.239 question trans adults and undocumented people, then those groups will 0:17:29.240 --> 0:17:31.760 fall just as quickly. And then at some point we're 0:17:31.760 --> 0:17:34.520 doing the poem the first they came for, the socialist thing, 0:17:34.600 --> 0:17:36.719 and I just refused to be a part of that. 0:17:37.400 --> 0:17:41.959 Yeah, let's talk about what that means then, Like, like 0:17:42.080 --> 0:17:46.920 you said, it's difficult to get any response from administration 0:17:47.040 --> 0:17:48.400 right in terms of what you can do, in terms 0:17:48.480 --> 0:17:53.000 what you can't do. How are staff and providers organizing 0:17:53.200 --> 0:17:55.600 to make sure that they're able to keep providing for 0:17:55.680 --> 0:17:56.840 their patients? 0:17:57.160 --> 0:17:58.960 So just to provide also like a little bit of 0:17:58.960 --> 0:18:01.639 a peek into kind of the broader landscape of this. 0:18:01.920 --> 0:18:04.359 Our clinic is not alone in their confusion on how 0:18:04.359 --> 0:18:10.440 they've been handling this not only FQHCs, but also hospital 0:18:10.440 --> 0:18:16.200 affiliated clinics, academic medical clinics have basically clinic by clinic 0:18:16.600 --> 0:18:19.199 decided on their own plan on how to manage this, 0:18:19.760 --> 0:18:23.879 which is also incredibly confusing for providers and for patients. 0:18:24.520 --> 0:18:27.600 But something that was really heartening was that NYU laying gone. 0:18:27.840 --> 0:18:30.399 This was in the news recently. They canceled appointments for 0:18:30.760 --> 0:18:34.920 two kids, literally just two kids, which is more than enough, 0:18:35.040 --> 0:18:39.879 and it sparked this enormous outcry and protests. And so 0:18:40.520 --> 0:18:43.719 I think there's also, on my end, a lot of 0:18:43.840 --> 0:18:47.080 solidarity building with other providers who are doing this work, 0:18:47.440 --> 0:18:50.040 and a lot of inspiration. There are clinics out there, 0:18:50.280 --> 0:18:54.240 some who are FQHCs like us, who have stood firm 0:18:54.400 --> 0:18:57.040 and they've said our doors are going to stay open, 0:18:57.160 --> 0:18:59.639 We're going to keep providing this care, and so I 0:18:59.640 --> 0:19:03.439 think they're there are models out there, and I think 0:19:03.520 --> 0:19:08.520 that there are networks of healthcare providers who are committed 0:19:08.760 --> 0:19:12.000 to continue to advocate and just continue to do this 0:19:12.280 --> 0:19:14.880 right because a lot of what we're facing right now 0:19:14.960 --> 0:19:19.240 is intimidation. It's not actual legal threats. 0:19:18.840 --> 0:19:19.480 As of yet. 0:19:19.880 --> 0:19:23.280 Yeah, I think the organizing side has been challenging but 0:19:23.320 --> 0:19:26.880 also hugely rewarding. Right, it became really obvious really early 0:19:26.920 --> 0:19:30.080 on that both from the federal government's perspective as well 0:19:30.080 --> 0:19:34.560 as from our organization's perspective, that the uncertainty was where 0:19:34.600 --> 0:19:37.320 they wanted us all to live and die. That was 0:19:37.359 --> 0:19:40.040 the place that served them and their goals the most. 0:19:40.600 --> 0:19:43.760 And so how does uncertainty sort of foster Well, people 0:19:43.800 --> 0:19:45.720 don't talk to one another, right, Like this is true, 0:19:45.800 --> 0:19:47.959 kind of an organizational census across the board. Right, if 0:19:48.000 --> 0:19:50.000 you're in the union, you don't talk about your salary 0:19:50.320 --> 0:19:52.719 doesn't benefit you, it benefits the boss. And so if 0:19:52.720 --> 0:19:55.640 we're not talking to one another about where our lines are, 0:19:55.680 --> 0:19:57.160 who we're going to treat, whether we're going to keep 0:19:57.160 --> 0:19:59.000 doing it, or listen to them what we're being told, 0:19:59.080 --> 0:20:02.040 we're not being told that we're consulting lawyers all these 0:20:02.040 --> 0:20:04.119 other kind of things, then we're all just alone in 0:20:04.160 --> 0:20:07.320 the dark kind of you know, trying not to scream 0:20:07.359 --> 0:20:09.720 and cry about the horrors that are happening around us. 0:20:10.080 --> 0:20:14.200 So we pulled together folks with conversation here, conversation there. 0:20:14.600 --> 0:20:17.720 Folks who before anything was going on internally, you know, 0:20:17.800 --> 0:20:20.000 made really bold statements about what they would and would 0:20:20.040 --> 0:20:22.719 not do around this kind of stuff, And now all 0:20:22.760 --> 0:20:26.439 of a sudden, there's an internal network that's looking at well, Okay, 0:20:26.440 --> 0:20:29.119 So individually we can keep doing this care because it's 0:20:29.160 --> 0:20:31.280 the right thing to do. But as a group, if 0:20:31.280 --> 0:20:33.920 they start coming after us, we have a lot more power. 0:20:33.920 --> 0:20:37.000 There's a lot more that we can do. And I suspect, 0:20:37.400 --> 0:20:39.639 and you know, Hayley's getting at this point that like, 0:20:40.080 --> 0:20:42.720