A new study suggests that more than 300,000 transgender adults in the US  have pre-existing health conditions that can worsen the risk of COVID-19.

Examining data from the US Transgender Population Health Survey, researchers at the Williams Institute of UCLA School of Law identified an estimated 319,800 transgender Americans that have one or more medical conditions that can increase risk for COVID-19. These conditions include asthma, diabetes, heart disease, and HIV.

More than 360,000 transgender adults also reported being in fair or poor health, while 278,000 are current smokers. 217,000 transgender adults are also 65 or older.

Not only are many transgender Americans at a health risk, butdia many also experience financial strain that could inhibit treatment during the pandemic. 138,000 transgender adults don’t have health insurance, 450,400 have not visited a doctor in the past year because they couldn’t afford it, and 96,400 reported experiencing homelessness in the past year and were therefore unable to carry out social distancing or regular hand washing.

The researchers also noted that the public response to the pandemic—like shelter-in-place orders and social distancing—can exacerbate mental illness and other risk factors for suicide. More than 40 percent of transgender adults have attempted suicide in their lifetimes.

“In addition to age and health, social and economic conditions can contribute to mental and physical vulnerabilities related to the pandemic,” lead author Jody L. Herman said in a statement. “Transgender people are disproportionately affected by poverty, homelessness, suicidal thoughts and attempts, and a lack of health insurance, which puts this population at risk.”

This research comes as the Department of Health and Human Services has moved forward in scrapping an Obama-era rule protecting transgender individuals from discrimination in health care. The rule in question is Section 1557 of the Affordable Care Act, which bans discrimination on the basis of sex. The Obama administration interpreted sex to include transgender individuals, but the Trump administration has consistently rejected that interpretation.

If the rule is changed, hospitals and health care workers would be legally allowed to discrimination against transgender people, potentially preventing at-risk groups from receiving necessary COVID-19 treatment.

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