In 2024, state legislatures introduced an all-time record of 533 bills targeting LGBTQ+ populations. These policies create a patchwork of legal landscapes that vary widely between and within states, affecting aspects of everyday life ranging from how kids learn and play to where adults live and work.
All of these policies have implications for the health of not only LGBTQ+ people but also the general public.
I am a health policy researcher who studies how state and federal legislation affect public health. Research has shown that the social determinants of health – the opportunities and resources that affect how people live, learn, play, work and age – play a significant role in LGBTQ+ well-being. Newly published work from my colleagues and I show how anti-LGBTQ+ public policies can have lasting effects on everyone’s health.
Existing policies and LGBTQ+ health
Same-sex marriage provides a clear example of the direct and indirect ways public policies affect LGBTQ+ health.
Most people in the U.S. have health insurance through their employer, which usually offers coverage for employees and their family, including a spouse and children. A landmark 2015 study found that health coverage significantly increased for adults in same-sex marriages after its legalization in New York state. After same-sex marriage was legalized nationwide, a follow-up study also showed an increase in health insurance coverage among gay and lesbian couples.
Even among single LGBTQ+ people who did not get married, same-sex marriage may have also improved their health by improving social attitudes toward LGBTQ+ people overall. Researchers found that gay and bisexual men, regardless of whether they were single or married, spent less on medical visits, mental health visits and overall health care spending after Massachusetts legalized same-sex marriage in 2004.
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Get the newsletter Massachusetts was the first state to legalize same-sex marriage. Victoria Arocho/AP PhotoAccess to gender-affirming care provides another example of how public policies affect the health of LGBTQ+ people.
A 2020 national study of nearly 30,000 transgender and nonbinary people found that suicide attempts and mental health hospitalizations declined in states that passed policies requiring private insurers to equally cover services they already provide for cisgender people for transgender people. No other studies directly analyze how policies regulating access to care affect the health of trans and nonbinary people.
However, a large body of clinical research supports the health benefits of gender-affirming care. A randomized clinical trial and prospective study found that starting gender-affirming hormone therapy reduced depression and suicidality in transgender and nonbinary people. Several recent systematic reviews analyzing 124 peer-reviewed studies conducted over the past 50 years also found that gender-affirming surgery and hormone therapy improved quality of life and mental health.
Policies outside health affect LGBTQ+ well-being
Policies outside of health care – such as nondiscrimination, education and workplace protections – also affect LGBTQ+ well-being.
For example, transgender and nonbinary people living in states with policies that specifically include gender identity in hate crime and discrimination protections reported better mental health than those in states without protections. Similarly, LGBTQ+ students in schools with designated safe spaces reported lower rates of suicidal thoughts.
However, the surge in anti-LGBTQ+ policies in the U.S., initially focusing on youth, has significantly increased polarization between and within states. For example, while 17 states have implemented guidances to make schools safer and more inclusive for transgender youth, 25 states have banned transgender youth from using bathrooms and playing on sports teams that align with their gender. Meanwhile, South Dakota and Missouri have enacted laws to preempt progressive schools and districts from adding LGBTQ+ student protections and supportive resources.
The Trump administration is also actively targeting resources that support LGBTQ+ students by reducing funding to schools that offer these programs.
Inclusive spaces can help support the health of LGBTQ+ students. Jessica Hill/AP PhotoIn 2020, the Supreme Court ruled 6-3 in Bostock v. Clayton County that federal sex-based nondiscrimination protections in the workplace included discrimination based on gender identity and sexual orientation. Researchers found that LGBTQ+ older adults with co-workers supportive of their gender and sexuality experienced less workplace conflict and cognitive health problems compared with those who did not.
The Trump administration is working to restrict the scope of federal antidiscrimination protections to exclude LGBTQ+ people.
Harms of emerging anti-LGBTQ policies
Emerging anti-LGBTQ+ policies could also have consequences for large swaths of the population beyond LGBTQ+ people.
In 2025, the Supreme Court will hear Braidwood v. Becerra, a case arguing that requiring employers to cover PrEP – a once-a-day pill that is highly effective at preventing HIV infection – as part of the insurance plan they offer employees violates their religious freedom. Texas District Judge Reed O’Connor agreed that mandating PrEP coverage requires the plaintiffs to “facilitate and encourage homosexual behavior.”
O'Connor ruled in 2023 to overturn the Affordable Care Act’s requirement that insurers fully cover preventive care. He argues this can be done on the grounds that the U.S. Preventive Services Task Force – a group of physicians and researchers that evaluates the quality and efficacy of preventive services – is unconstitutional. This legal challenge puts free coverage of mammograms, vaccinations and other preventive services into limbo for millions of Americans.
The Trump administration has taken down CDC pages providing information about HIV.The Trump administration has scrubbed federal web pages of resources, programs and documents that reference gender and LGBTQ+ people. This order includes removing datasets that have been continuously updated since the 1980s to track public health issues such as homelessness, bullying in schools, and smoking and drinking, likely because they include LGBTQ+ demographic information.
The administration has also ordered federal health agencies to retract scientific research that may be inclusive of LGBTQ+ people by searching for specific keywords, such as “gender.” The National Science Foundation is also screening active scientific research projects that use words like “women,” “trauma” and “disability.” Removing this data not only hamstrings public health research and programming for LGBTQ+ populations, but also restricts it for all Americans.
These decisions are in stark contrast to countries such as England, Wales, New Zealand and Australia, which have collected or are planning to collect LGBTQ+ demographic data as part of their national census. Including LGBTQ+ people in demographic data reflects best practices that were outlined in the Federal Evidence Agenda on LGBTQI+ Equity issued under the Biden administration. These guidelines have since been removed.
Far-reaching consequences
The rapid escalation of anti-LGBTQ+ policies in recent years is already taking its toll on youth, with negative news coverage of LGBTQ+ issues causing spikes in suicidal thoughts.
These policies also have far-reaching consequences for the broader public. Rigorous and long-standing research demonstrates that LGBTQ+-inclusive policies support safer communities and stronger economies for everyone, while exclusionary laws worsen and limit access to essential services.
Ongoing legal battles and policy shifts will shape the future of LGBTQ+ rights, with rippling effects on public health, workplace protections and health care access for all Americans.
Anti-LGBTQ+ policies harm the health of not only LGBTQ+ people, but all Americans was originally published by The Conversation and is shared with permission.
Dr. Tran is an Assistant Professor of Health Policy and Administration (HPA) in the School of Public Health at the University of Illinois at Chicago.
Children watch a July Fourth Parade along the Walkway of Heroes and Independence Avenue on July 04, 2026 in Tappan, New York.
The Great American Grumpfest
Our nation’s 250th birthday party didn’t feel especially patriotic and wasn’t as much fun as the 200th anniversary was.
President Trump, who did his best to co-opt our holiday for his personal aggrandizement, was a major reason. The party he threw in Washington, D.C., was crankier than uplifting, and less about celebrating our shared past and a promising future than about reminding us how far we have strayed from our founders’ plan to create a republic that future Americans would keep in good working order.
Credit Trump this much. He has a singular gift for picking at scabs that other politicians would rather ignore and pushing us into reckonings we don’t need.
The thing is, Americans have seen all this before. Sometimes the makeover we were encouraged to undertake was more conservative, sometimes more liberal. Whatever direction we were pushing, however, the reckoning we had in mind this time had to be more forthright and the conclusion more definitive than it was the last time.
Our current discontents, the ones behind the reckoning President Trump has been trying to inspire, are not trivial. Included among them are immigration, birthright citizenship, exploding healthcare costs, election rigging, a gag-inducing national debt, how we educate our children, too many genders, racial differences we can’t move past, a lopsided economy that favors more well-off Americans, and historic levels of political corruption and graft. Add to these the several foreign adventures he has pushed us into or is anxious to undertake, and you have the makings of a national headache the likes of which we haven’t had in half a century.
All the elbow-throwing and overheated rhetoric we’re using today have begun to look almost normal in all the ways that bickering neighbors and feuding family members appear normal. But they have also made us look mean-spirited and have portrayed our differences as irreconcilable. To ourselves, of course, but also to many people outside the United States who might be forgiven for turning their heads and not looking at the national car wreck we Americans show no interest in avoiding.
The good news, as I suggested above, is that Americans have had a great deal of practice dealing with challenges and national car wrecks like these.
This essay begins to lay out the reasons why.
By way of illustration, we have our seemingly insatiable demand for more bad news about race in America.
Sixty years after being released from the legal constrictions that bedeviled both white and black Americans, many white people have come to believe the color that used to make them unassailable is now a sign of a moral inferiority born of a racial animus they can never wash off. Many black people, on the other hand, are insisting that America is as hopelessly stacked against them as the formerly unassailable white people’s ancestors used to tell their black ones.
The result is that many people today are buying into racist nightmares and mumbo jumbo that their black and white ancestors worked hard and effectively to put in each other’s heads.
This might be dismissed as crazy behavior if it weren’t so important to rituals Americans have long used to express their deepest fears about each other while figuring out what move they can make that won’t end with their world crashing down on everybody’s head.
Unfortunately, the kind of cultural sleight of hand we have used to ramp up our racial differences has been appropriated by people who have many other cultural fears and unresolved differences with each other. Their clumsy but culturally prescribed missteps are making all these other issues look as irremediable as our racial problems.
A good place to start an answer to how we back away from ledges is Alexis de Tocqueville’s writing on early-19th-century American democracy. He had an optimistic take on Americans’ unscripted displays of public bravado, recrimination, and payback.
For him, these were occasions when people tried to mitigate the effects of the unfair hand they were dealing someone else or had themselves been dealt by behaving in ways quite at odds with how they would otherwise be expected to act. These inversions of what Tocqueville called “the natural order of conscience” presented themselves as a loud but culturally muted challenge to the hypocrisies that people had built into the world they’d made together.
One of his favorite illustrations of early-American hypocrisy involved slave masters sleeping with their less-than-worthy slaves. To the best of my knowledge, he didn’t pick up on all the ways that slaves messed with their owners. Their well-chronicled and quiet resistance showed that even severely ill-treated people can exercise more control over their lives than outsiders appreciate.
Be that as it may, such inversions of a people’s “natural order of conscience” make a good public show of them wrestling with demons they can’t or may not want to shake off, but in any case, are nowhere close to figuring out how to cast out.
Implicit in these disruptions was the discomforting idea that people might flip the entire script and turn the world on its head in more permanent ways. That kind of flipping worked out better for us in our revolution against England than in our Civil War. These events taught us the value of stepping back from historically unprecedented ledges.
Americans of late have been giving loud expression to a long list of things they don’t like about each other and the last makeover they started but didn’t finish a half-century ago. The outcome of our fights today will be as revealing as they are embarrassing to everyone who imagined they could recast our country in a way that privileged their favorite kind of Americans.
Their disappointment with the accommodations they strike will be palpable, but the middling results they achieve with all their pushing and shoving won’t be anything they can’t live with.
Anthropologists who have written about such moments in other cultures less “advanced” than our own show that people find ways to work around their seemingly irreconcilable differences without ever fully resolving them. Indeed, the patches and repairs people make have the unheralded effect of reinforcing rather than undermining the legitimacy of the practices and values they thought were fundamentally flawed.
For example…
White guilt and black pessimism do more good than putting cash into the pockets of professional shamers and handwringers. They give the rest of us who don’t feel guilty or powerless more time to make the world less racially unequal. Good news.
Regarding illegal immigration, the entrance requirements for future immigrants will remain stringent. Americans will applaud the continued detention and deportation of the few illegal immigrants who commit serious crimes. Good news.
All the people who came to the United States without being legally vetted and were locked up for a time will be released in numbers small enough to avoid serious media attention. Along with the several million other good people who snuck in but avoided capture, the former detainees will go to school, find gainful employment, pay their taxes, and stay out of trouble. Many will eventually become citizens. Good news.
Investigations into election tampering and Donald Trump’s 2020 presidential loss will come to an unceremonious conclusion the day after his second term ends. Many Americans will grumble about this, but there will also be some quiet partying, too. Good and bad news.
Congressional hearings into all the grifting accomplished by people tied to the Trump administration will end without anyone having to pay a dime back to the American taxpayers. Bad news, we’ll learn to live with.
New laws and regulations will be created in the hope that the kind of corruption practiced by President Trump will not be repeated for another 250 years. Good news, I hope we’ll live long enough to enjoy.
Show trials for people who allegedly vandalized the Lincoln Memorial Reflecting Pool, if they happen, will get big television viewer ratings. Good news.
Trials for pardoned Capitol insurrectionists who committed serious crimes after their release should get more attention, but won’t. Bad news.
We will continue to hear nothing from most of the people who were pardoned for crimes they committed in the insurrection at the Capitol on January 6, 2021. They will keep their mouths shut and their heads down for the rest of their life. Good news.
The gold-gilded ornaments that Donald Trump had plastered all over the White House will be shipped to Mar-a-Lago, where the former president will sell them on eBay. Fun news.
American taxpayers end up paying for most of the new East Wing, the removal of the miniature gladiatorial arena that was built behind the White House, and the restoration of the White House rose garden. Bad news.
The Triumphal Arch was never built. Good news.
Trad wives and gay couples raise perfectly lovely children. Good but unsurprising news.
Trans men and women learn that most Americans can’t figure out who they used to be. No one gives a second thought to their use of “family bathrooms” or “unisex bathrooms” in public settings, businesses, and schools. Communities will sponsor athletic teams that have trans boys and girls just to show they can. Good news.
Budget deficits will be kicked down the road for someone else’s children to pay down. Bad news.
Federal agencies that had their budgets and employee ranks slashed during President Trump’s second term are getting some of the money and lost positions back. Good news.
Elite universities will buy their way out of DEI purgatory by competing for conservative scholars whose inflated salaries dwarf those of their liberal colleagues, who will think about suing their institutions for reverse discrimination but won’t be able to figure out who would pay for it or care. More fun news.
Okay. I’ve probably missed some ways that Americans will step back from the ledges they have been making noises about leaping off. But to the extent that my predictions pan out, the best and most important moral of the stories about us stepping away is this: everything we lost and took back, or had returned to us, will have happened without our government collapsing, civic traditions crumbling, or our people beating each other up.
The reason why is that the differences Americans have with each other really weren’t as irreconcilable as we made them out to be. The empty-sounding bromide that Americans have more that unites us than divides us turns out to be true, not just metaphorically but in fact.
Now that is really something to celebrate.
Daniel J. Monti (danieljmonti.com) is Professor of Sociology at Saint Louis University and the author of American Democracy and Disconsent: Liberalism and Illiberalism in Ferguson, Charlottesville, Black Lives Matter, and the Capitol Insurrection.