Working people are facing ever more drastic restrictions on their ability to access both abortion and gender-affirming care.

Rolling back the rights of working people in America is a long-term project of the Republican extremists, which has been gathering pace since they took control of the federal government in 2017.

During that previous administration, important appointments were made to the Supreme Court, which laid the groundwork for overturning the Roe v Wade decision in 2022, removing the constitutional right to abortion.

In June, the Supreme Court is due to rule on a case that could have far reaching effects on the ability of transgender people to also access healthcare.

On top of the legal threats [as this edition went to press], devastating cuts to the Medicaid budget looked likely in order to fund the massive spending cuts the Republican-led administration in Washington D.C. needs to pay for tax cuts largely benefiting the billionaire class.

Hundreds of 1199ers work at clinics which enable working people to access both safe abortion and gender-affirming health care. Sweeping cuts to Medicaid would also put the care they provide at risk.

“Cuts to Medicaid are very scary for us,” said Gwen, an 1199 Paralegal at Whitman-Walker Health, a community clinic in Washington, D.C. which specializes in LGBTQ+ health an HIV care.

“We are required to accept Medicaid and work with a lot of patients on Medicaid. The only way we can budget is if we have stable reimbursement rates. Pharmacists can buy lower-priced drugs and provide medication at reduced rates.

“We provide treatment for sexually transmitted infections, HIV and hormone therapy for transgender people who are transitioning.”

Gracie is an 1199 Delegate and RN who works at a Planned Parenthood of Greater NY clinic in New York City which has been experiencing ever-growing patient numbers since Roe v Wade was overturned.

“We’ve seen an increase for more than a year,” she said. “Every day we have patients from out of state, sometimes multiple patients. Often, they come by themselves. We help them find accommodation. Sedation [during the abortion procedure] requires another person to pick them up, so we need to find volunteers. Sometimes, they take them straight back to the airport.

As a surgical abortion nurse, Gracie administers sedation in the ER and provides support in the recovery room. Since 1976, the Hyde Amendment has blocked federal Medicaid funding for abortion services. But other rightwing attempts to “defund” Planned Parenthood has meant blocking patients who depend on public health care funds from accessing preventative services like birth control, as well as lifesaving cancer and STD screenings.

Even before any looming cuts to Medicaid, the clinic where Gracie works was forced to lay off their anesthesiologists.

“That means that we can only provide moderate sedation, as opposed to heavy sedation, meaning that we can only perform abortions at 19 weeks and 6 days gestation,” she said. “Previously, we could do the procedure up to 24 weeks. In these cases, we were often seeing people who just arrived in the U.S. after traveling for many weeks. There is always a back story.”

The lessons of history are clear. Restricting access to both reproductive and gender-affirming healthcare will not prevent either abortions or gender reassignment from taking place. It will just mean that Black and Brown people who disproportionately rely on clinics that depend on Medicaid will be forced to resort to underground providers at grave risk to their health and well-being.

“People are already dying in Texas from sepsis and miscarriages,” says Janet, an 1199 member who works at the front desk of another New York City provider where gender-affirming care is currently being provided.

“Gay marriage was legalized when Barack Obama was president. Less than 20 years later, and we’re looking down the barrel of losing that right again. We thought that we were safe and fine and that Transgender people had been normalized,” added Janet who was assigned male at birth. “Early on, I felt female and I changed my name when I was 25.”

At the clinic where she works as a PCA she helps patients obtain surgery letters, support letters for Medicaid, find voice coaches and navigate support services once their transition surgery is scheduled. She plans to become a behavioral health therapist in the future.

“Roughly half of our population depends on Medicaid. We provide care for marginalized communities, especially LGBTQ+ people,” said Janet.

In Boston, Xenia, works as a bilingual outreach navigator at a similar clinic whose target demographic is people of color who may be unable to access the healthcare they need in other settings. She is very worried about threats to Medicaid funding, which are coming at the same time as the legal restrictions. Trans people are under attack from all sides. Xenia does not want to apply for a new passport in case they confiscate her driver’s license.

“It is so important to take a stand now,” she said, “because if we don’t, the injustices will just keep on coming.”

Note: Some members preferred not to identify the clinics where they worked and only use their first names to protect themselves and their patients.