State laws are thwarting HHS efforts to improve LGBTQ health

To foster a healthier future for all Americans, the U.S. Department of Health and Human Services has launched Healthy People 2030. This ambitious and important plan outlines key goals to “Build a healthier future for all.”  

Yet recent legislation is turning “all” to "all except LGBTQ," making it impossible to reach HHS’s goals.

At its core, Healthy People 2030 outlines data-driven national goals across five pivotal social determinants of health: healthcare access and quality, education access and quality, social and community context, economic stability and neighborhood and built environment.  

While these goals strive to create a society where all can live their healthiest lives, conflicting state legislation — 522 bills introduced in 2024 alone — has severely constrained the program's use on specific populations, particularly gay, lesbian, and transgender people. These measures pose significant barriers to their health and well-being.  

This legislative action, which has a pronounced focus on transgender individuals potentially affects all five social determinants of health. Here’s how. 

• Provide access to comprehensive, high-quality health care services. Research highlights the urgent need to address health disparities for sexual and gender minority populations, including increased insurance coverage for relevant healthcare needs. But recent bills, such as Mississippi’s 2023 HB1125, stand to widen this gap by targeting transgender youth health care. Currently, 105,200 transgender youth — about one-third of all U.S. transgender youth — reside in states that ban access to gender-affirming care. Among those who saw a healthcare provider within the last 12 months, nearly half (48 percent) reported experiencing at least one negative incident because they were transgender, including being refused healthcare, being misgendered, encountering harsh or abusive language from providers or experiencing physical roughness or abuse during treatment.  
• Increase educational opportunities and help children do well in schools. The 2023 legislative session introduced new laws and policies that do not help all youth do well in school. Gender and sexually diverse students are facing unique challenges. Policies in K–12 schools that restrict classroom discussions around specific sexual topics, commonly termed “Don’t Say Gay” laws, have been passed in states such as Florida, Iowa and Arkansas. Laws that silence, exclude, and exacerbate shame around students' sexual orientation and gender expression can lead sexual and gender minority youth to develop negative mental health and increased depression. These issues affect their academic performance and school engagement, creating worse outcomes.  
• Increase social and community support. To date, four states have passed legislation asserting that “in human beings, there are two, and only two, sexes: male and female.” This contributes to a hostile social and community environment. Transgender and nonbinary people often struggle with social acceptance. The enactment of this legislation establishes them as less than human beings, makes nonbinary and transgender individuals invisible and excludes them as valuable and meaningful members of society. Research shows that news about anti-transgender legislation and perceived support for such legislation has negative impacts on transgender youth and young adults, including physical health issues, depressive symptoms and fear of disclosing one’s identity. In addition, nearly one in three sexual minority youth report their mental health is poor most of the time or always due to such policies and legislation.  
• Help people earn steady incomes that allow them to meet their health needs. Currently, 12 percent of the LGBTQ population lives in states with no policy prohibiting discrimination in public employment based on sexual orientation or gender identity. At the federal level, Title VII of the federal Civil Rights Act prohibits discrimination based on sex in employment, and in June 2020 the Supreme Court extended that to include sexual orientation and gender identity. Yet 16 states and two territories have not affirmed this extension nor added additional protections through state-level laws. Research suggests that LGBTQ young adults adjust their career plans because of identity-related challenges at work, contributing to labor market segregation and financial disparities between LGBTQ and other workers. Research shows that bisexual women and transgender individuals experience higher rates of poverty than their peers.  
• Create neighborhoods and environments that promote health and safety. In Mississippi and Utah, legislation targets bathroom access and usage, creating physical, structural environments that further marginalize transgender individuals. Increases in such policies correlate with increased violence, which in turn contributes to a sense of safety. According to research, transgender and gender-nonconforming youth feel unsafe in bathrooms, which has led to significantly lower resilience and quality of life and greater levels of perceived stigma and problematic anxiety. This sets them up on a path of future negative mental and physical health outcomes. In general, transgender individuals who experience discrimination using a public bathroom have higher rates of attempting and completing suicide. Furthermore, the interpersonal stigma they experience in public spaces is associated with poor health outcomes.

It is 2024, and the clock is ticking. We can make progress in achieving Healthy People 2030’s bold and inclusive agenda for improving health and well-being across the United States. But first, we need to stop enacting legislation that bars the way. 

Maria Valenti is a senior research scientist and behavioral health expert at Education Development Center, a global nonprofit organization to improve education, promote health and expand economic opportunity.