The non-discrimination clause of the Affordable Care Act, known as Section 1557, formally expanded patients’ civil rights in nearly every healthcare setting in the U.S. in 2010. Sex discrimination was a protected category for the first time in healthcare, and the Obama administration interpreted sex discrimination to include transgender discrimination. Regulations required healthcare organizations to name a person to handle grievances and set up an internal grievance process for resolving them. Drawing on interviews with 58 healthcare grievance handlers in four U.S. states about how they process patient complaints, this study examines how medical organizations have responded to expanded patient rights. What does it mean to bring civil rights into U.S. healthcare settings, and what implications are there for transgender healthcare rights in particular? We found a range of approaches to rights in healthcare settings and a dominant approach devoted to patient experience that served to diminish the power of healthcare rights. The project also extends to health insurance problems and coverage for transgender care, religious non-discrimination rules as competing values in healthcare settings, and the Trump administration's efforts to undo the Obama efforts to advance transgender rights.

Bio: Anna Kirkland, J.D., Ph.D., is an Arthur F. Thurnau Professor in Women’s Studies at the University of Michigan. She received her law degree (2001)and Ph.D. in Jurisprudence and Social Policy (2003) from the University of California, Berkeley. Prof. Kirkland served as a committee member on the National Academies panel charged with studying sexual harassment in the STEM fields of academia, published in June 2018 as Sexual Harassment of Women: Climate, Culture, and Consequences in Academic Sciences, Engineering, and Medicine. She is the author of Fat Rights: Dilemmas of Difference and Personhood(New York University Press, 2008), Vaccine Court: The Law and Politics of Injury (NYU 2016), and co-editor with Jonathan Metz lof Against Health: How Health Became the New Morality (New York University Press, 2010).