A Recent Move By the Biden Administration Gives the LGBTQ Community Reason to Worry

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To be clear from the start: Joe Biden has been the most consistently supportive President for full LGBTQ rights in American history.

Biden, remember, is the man who in 2012 forced Barack Obama’s public evolution on same-sex marriage more quickly than his White House would have liked. And since taking over the Over Office, he has staffed his administration with an intentional eye on making sure LGBTQ individuals have prominent seats at tables where decisions are being made. It’s not an exaggeration to say we currently have the gayest administration ever working down the street from the queerest Congress in history.

But in this particular moment, when a room full of conservatives can applaud a call for “transgenderism” being “eradicated from public life entirely,” all of that might be insufficient. Just 1.6% of American adults identify as trans. But in a country of almost 260 million adults, that’s still roughly 4 million individuals, or about five whole congressional districts. And the President’s recent flip-flop on Washington, D.C.’s right to govern itself has some wondering on what other issues he might turn wobbly as he prepares for a re-election bid.

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Which brings us to a little-noticed proposed rule from the Drug Enforcement Agency. The proposal, released on Feb. 24, would roll back a narrow piece of Covid-19-era telemedicine rules that allowed providers to prescribe long-term drugs to patients without seeing them first. On the surface, the change looks like a way to curb some of the profligate opioid prescriptions and overdoses. But for transgender individuals who not only often favor telehealth services for gender-affirming care, but in some cases can only access that care that way, the new policy could be life-changing.

“At the end of the day, it still is an in-person visit that has to happen” under the proposed rule, says Dr. Jerrica Kirkley, the medical director and co-founder of Plume, a telehealth service that is providing care to 12,000 trans patients right now. “Virtual care is a great access point for many communities, especially those that are marginalized and have a hard time getting into the traditional healthcare system in the first place.”

The rule change, advocates say, could mean a whole lot of trans individuals who don’t live near facilities that provide gender-affirming care, or feel comfortable going to in-person meetings, will see their medical treatment get much more difficult. In some cases, it may become impossible. And the providers who specialize in such care could end up curtailing the gender-affirming care they offer going forward if in-person initial meetings are now required.

In many states, the trans community is staring down a gauntlet of laws undermining their ability to exist. In Florida, lawmakers already passed a measure outlawing discussion of sexuality and gender for the youngest students in schools and the Republican-led state is considering expanding the so-called “Don’t Say Gay” policies all the way up until high school. Former South Carolina Gov. Nikki Haley says Florida Gov. Ron DeSantis’ “anti-woke” agenda in his state doesn’t go far enough and she would go further if she is successful in winning her party’s presidential nomination. Tennessee just banned drag performances at all public places or where kids could see them, one of a staggering 391 anti-LGBTQ pieces of legislation already introduced at the state level.

That’s right: at least 391 anti-LGBTQ pieces of legislation and counting, and it’s only March. Historically, most will fail, but some will get through, including possibly some severely restricting access to gender-affirming care.

Polling consistently shows LGBTQ rights are overwhelmingly popular; efforts to erase them are not. Public support for marriage equality swung faster than almost any other question in history after it became the law of the land in 2015, but the backlash among the holdouts was fierce. But you can say the same about abortion rights, which fell on a national level last year after a half-century as settled law.

All of which makes the proposed Biden rule—which has a six-month grace period after it kicks in come May—seem all the more short-sighted. The public can still weigh-in on the measure, and there is plenty of room for caveats to be added; the system allows rules to change from their first iterations. Activists and health providers are hoping some accommodation can be made and are quietly lobbying the DEA, the White House, and Congress to realize the downstream effects of this proposal on trans individuals. Kirkey herself was in Washington last week looking to raise the alarm for the rule’s implications.

“HHS in particular and the administration is very supportive of the trans community and has been vocal about that and is trying to do what they can,” Kirkley says, referring to the Department of Health and Human Services.

But it’s worth a pause here, because if even the pro-LGBTQ Biden team can get the details wrong, things are sure to get dicey even more easily in state legislatures with stated agendas to make life more difficult for their non-straight constituents. Especially so when many in those states are absorbing rhetoric about eliminating “transgenderism” and denying the medical science behind gender-affirming care for trans individuals—and then voting for candidates who share their views.

So if your LGBTQ friends are acting a little skittish these days, there are far too many good reasons why.

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Write to Philip Elliott at philip.elliott@time.com