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Iowa's LGBTQ policies offer protection, but there's still work to be done

Health care, health insurance, firmer workplace policies needed for better inclusion

Oct 7, 2020 at 8:30 am
    Jennifer Rowray, left, and Kwynton DeLarm, both with Cedar Rapids PFLAG, play with their dogs Lumen, a 7-year-old whippet and 7-week-old Simba, while catching up at Rowray’s home in Newhall on Saturday, July 11, 2020. (Andy Abeyta/The Gazette)

    When Kwynton DeLarm came out as a transgender man on Facebook in 2016, he prepared himself for a backlash.

    Instead, he received love and support from his friends and family as he began navigating health care, health insurance and the workforce as a transgender man.

    DeLarm, 31, of Cedar Rapids, always knew he wasn’t straight. But growing up in Delmar with a population of 500, there wasn’t much room to explore his gender identity, he recalled.

    “Growing up in a small town where it’s man, woman, children, cat, dog and cow, that’s the way life was. If you’re interested in a woman, you’ve got to be a man, and if you’re interested in a man, you’ve got to be a woman,” DeLarm said.

    It wasn’t until he got the internet when he was around 10 years old that he learned about what it means to be transgender and realized he could affirm his gender.

    About 3.6 percent or 87,000 Iowans are LGBTQ — lesbian, gay, bisexual, transgender or queer — according to a 2018 Gallup data by the Williams Institute at the University of California, Los Angeles.

    Even at a young age, DeLarm knew gender affirmation surgery was way out of his budget. He convinced himself it would never happen and came out to his family as a lesbian when he was in high school.

    DeLarm was biologically identified as female at birth.

    “It would have been easier to live this fake life and less disappointing if (gender affirmation surgery) never happened,” DeLarm said.

    Three years ago, however, DeLarm started working for insurance carrier Geico, and the health insurance he gets through the company makes testosterone treatment affordable at $8 a month and covers other gender affirmation procedures he may need.

    The one time his health insurance tried to deny a claim, his doctor, Dr. Nicole Nisley at the LGBTQ Clinic in Iowa City, fought successfully to have it approved.

    Health care

    For LGBTQ people and especially transgender people, it can be difficult to find a doctor who is educated about sexuality and gender identity, said Dr. Katherine Imborek, co-director of the LGBTQ Clinic in Iowa City.

    Since the clinic’s opening in 2012, the staff has seen around 1,200 to 1,500 LGBTQ patients, Imborek said.

    “It’s not because we don’t have providers who are interested or willing to take care of (LGBTQ) patients, but it’s really because this is not necessarily something that is widely taught in medical school,” Imborek said.

    “I think that is changing.”

    Imborek, who teaches at the University of Iowa and is a lesbian, said it is her job and “passion” to teach students, residents, faculty and staff about LGBTQ medical care.

    A lot of doctors in Iowa have good intentions, Imborek said, but “good intentions can’t get you there.”

    Doctors need to do the homework, beginning with how to ask patients about preferred pronouns, how to treat patients who are LGBTQ and be educated on gender affirmation care, Imborek said.

    “I think it’s important to get care from a provider who is well-versed in all the ways you should be potentially screened or tested,” Imborek said.

    Patients shouldn’t have to teach doctors how to properly care for them, said Nisley, co-founder of the LGBTQ clinic with Imborek.

    A “significant number” of the clinic’s patients are transgender. Nisley said before coming to the clinic, they were receiving inadequate health care and were afraid of doctors telling them they weren’t welcome.

    But Nisley thinks the future for LGBTQ care is bright.

    “I would love a time when an LGBTQ clinic is not needed,” she said. “For the moment, it’s a space that is visible and feels safe.”


    Before working at Geico, DeLarm held a job where he found it challenging to explain to co-workers, after he began transitioning, why he went from using the women’s restroom to the men’s restroom.

    “It was the anxiety of the unavoidable,” DeLarm said.

    Instead of working to feel comfortable, he switched jobs.

    DeLarm isn’t sure what solution there might be to making people transitioning feel more comfortable at work, but he thinks at the root of it is better education about what it means to be LGBTQ.

    Megan Kissel, 36, of Des Moines, has a similar story. When she came out as transgender in March 2019, she was subject to “crude jokes” at her job as a welder in Ida Grove.

    The facility she worked at also didn’t have a nongendered bathroom, so she was transferred to another facility instead. When asked why, she was told the women in the building were uncomfortable with her using the women’s bathroom.

    “I waited for all my legal documents to be updated (from male) to female before I tried to use the women’s restroom,” Kissel said.

    After continual harassment at work, Kissel decided to find a new job and began working for Quality Manufacturing as a welder in Urbandale.

    “I couldn’t ask for a better place to work,” she said. “They also just updated their insurance policy to cover transition-related care.”

    A welcoming state

    Overall, Iowa appears to be a welcoming and inclusive state for LGBTQ people, according to a 2019 municipal equality index scorecard by the Human Rights Campaign Foundation, which works to improve the lives of LGBTQ by increasing understanding and encouraging the adoption of LGBTQ-inclusive policies and practices.

    The scorecard evaluates the following:

    Whether discrimination on the basis of sexual orientation and gender identity is prohibited by city, county or state in areas of employment, housing and public accommodations.

    Whether workplaces and cities commit themselves to treating LGBTQ employees equally by offering equivalent benefits and protections to LGBTQ employees, awarding contracts to fair-minded businesses and taking steps to ensure an inclusive workplace.

    The efforts of cities to ensure LGBTQ constituents are included in city services and programs.

    Fair enforcement of the law that includes responsible reporting of hate crimes and engaging with the LGBTQ community in a thoughtful and respectful way.

    The city’s commitment to fully include the LGBTQ community and advocate for full equality.

    Of the nine Iowa cities scored, Cedar Rapids, Iowa City and Dubuque received a perfect score of 100, Des Moines received a score of 93, and the other cities received a score between 57 and 95.

    14 bills

    Jennifer Rowray, 51, of Newhall, president of PFLAG Cedar Rapids (Parents, Families and Friends of Gays and Lesbians), said Iowa is ahead of the curve when it comes to protecting LGBTQ rights. That doesn’t mean there aren’t still areas where progress is needed, she said.

    This past legislative session,

    14 bills were introduced in the Iowa Legislature — none of which advanced — that targeted LGBTQ Iowans or were created in a way that was discriminatory, said Keenan Crow, One Iowa director of policy and advocacy.

    A Religious Freedom Restoration Act, introduced by Republican lawmakers, would have allowed people to cite their religious beliefs in denying LGBTQ people access to housing, medical care and employment.

    Health care workers would have been able to deny care or refuse to perform gender affirmation procedures; adoption and foster care agencies would have been allowed to discriminate against same-sex couples; and government workers

    could have refused to issue or process marriage licenses to same-sex couples.

    House File 2201 would have required Iowa school districts to notify parents if a curriculum focused on sexual orientation or gender identity, possibly marginalizing students who are LGBTQ, Crow said.

    And House Study Bill 698, which did not advance, would have banned conversion therapy, a controversial therapy aimed at changing a person’s sexual orientation or gender identity. The bill would have exempted pastors or religious counselors from the ban. Nineteen other states have adopted such a ban.

    The proposals, while not adopted, still have a negative impact, Crow said.

    “When a young person sees in the news someone is trying to create legislation to prevent them from engaging in extracurricular activities or teaching about them in history class, it sends a message that there is something wrong with them or less than other students,” Crow said.

    “We see an uptick in mental health reports from LGBTQ youth when this comes out.”

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