By Chris Everett, executive director, UAF Legacy Health

There was a moment in the late 2010s when it seemed like LGBTQ+ people might finally access care like everyone else — no special hoops, no separate systems — just dignified, competent treatment within the mainstream. Unfortunately, that moment is slipping away. Politically and socially, we’re watching old fault lines reopen. Institutions that once felt welcoming are now hesitating, recalibrating, or quietly pulling back.

This isn’t just a wave of discomfort — it’s a structural test of healthcare resilience in a time of mounting hostility.

Symbolic support — rainbow logos, Pride sponsorships, June declarations — may raise visibility, but visibility without permanence isn’t safety. LGBTQ+ Americans are more than twice as likely as their non-LGBTQ+ peers to experience discrimination in healthcare settings, according to a 2021 study by the Center for American Progress. And nearly 1 in 3 transgender adults report having to teach their provider about trans-specific healthcare. In this context, the difference between symbolic allyship and competent, affirming care becomes life-altering.

This moment calls for a rethinking of how we build systems and which institutions we entrust with our care. Healthcare, mental health, and supportive services for queer communities must no longer be treated as add-ons or profit-seeking gestures.

Academic, for-profit, and nonprofit healthcare systems in Utah have made meaningful gestures toward
LGBTQ+ inclusion. But no matter how well-intentioned or well-designed, these programs are often embedded within institutions constrained by budgets, return on investment (ROI), and reputational risk. A 2022 report from the American Medical Association found that LGBTQ+ initiatives in academic medical centers are especially vulnerable to legislative backlash and internal budget cuts—leading to clinic closures, staff reassignment, and fragmented care.

These systems, however well-intentioned, are built on foundations that shift with political decisions. State-affiliated institutions operate within volatile legislative frameworks, while even large nonprofits adjust priorities in response to risk management and policy pressure. In a climate where queer health is routinely
politicized, sustained, reliable care becomes difficult — if not impossible — to guarantee.

What we’re building is different. At UAF Legacy Health, queer care isn’t an add-on — it’s the foundation.
Piecemeal solutions can’t meet full-spectrum needs. Our community deserves care that doesn’t disappear
under pressure.

When LGBTQ+ programs exist within healthcare systems, they often follow a familiar pattern: they attract
insured patients, generate grants, and enhance the organization’s public image—while the resulting profits are redirected back into the broader institution. This has long been the status quo.

But even without legislative or policy hostility — even with consistent institutional support — the model
remains flawed. It pushes uninsured and underinsured queer people into public systems that may offer basic primary care but lack the specialized knowledge, training, and cultural competency to meet the specific needs of LGBTQ+ populations.

At UAF Legacy Health, we’re making a different kind of commitment: to build a healthcare institution that
outlasts individual providers, with governance rooted in community values and care models designed to
withstand the volatility of shifting administrative priorities. Our approach reinvests the revenue from insured queer patients — and their allies — back into queer care itself, ensuring access for those who can’t afford to pay, those with gaps in insurance or employment, and those navigating high deductibles or delays in coverage. We’re not extracting value from the community — we’re circulating it, sustaining it, and protecting it.

Reciprocity matters — our community gives us its trust. In return, we’re building something that won’t
vanish.

We are at a crossroads. Queer patients, affirming providers, and allies each have a chance to shape the future of healthcare in Utah. That future won’t build itself. It will require a coordinated and structured commitment.

Make UAF Legacy Health your medical home. Not just because it is affirming, but because it is designed for long-term resilience. When you bring your insured care here, you are taking care of your own health and helping fund free and sliding-scale care for uninsured and underinsured community members.

Refer your LGBTQ+ patients who need affirming primary, sexual, or gender-affirming care. Tell your colleagues about what we do. Help us spread the word about a healthcare system built for resilience, not just visibility. Whether you’re sending patients our way, amplifying our mission, or looking for a place to practice that aligns with your values, your support matters.

Get your regular healthcare here. Each visit strengthens a system designed to protect vulnerable access. You don’t have to be queer to invest in our mission. Showing up matters.

At UAF Legacy Health, we’re not just providing queer care — we’re anchoring it. We’re:

• Embedding governance rooted in trust, self-determination, and human flourishing
• Creating trauma-informed, peer-accountable models
• Shielding patients from the volatility of policy and legislative changes
• Designing an institution that will protect the continuity of care regardless of ability to pay

We are building a clinic that says — no matter the climate — you still have somewhere to go. A place where queer people don’t have to explain themselves, brace for judgment, or second-guess their safety.