An increasing number of U.S. states have passed laws that allow health care providers – including doctors, nurses and pharmacists – to refuse to treat patients based on their personal or religious beliefs. While these conscientious objection laws have long existed for issues such as abortion, their effects on LGBTQ+ people have not been well studied.
Specifically looking at sexual minorities, our research found that lesbian, gay, bisexual and queer adults living in states that passed conscientious objection laws were 28% less likely to report receiving a first-time HIV test, compared to peers in states without conscientious objection laws. These laws did not affect HIV testing rates for heterosexual adults.
We analyzed data from the Centers for Disease Control and Prevention on the health outcomes of more than 109,000 lesbian, gay, bisexual, queer and heterosexual adults from 2016 to 2018. We focused on eight states, comparing two that enacted conscientious objection laws during that period (Illinois and Mississippi) and six that did not (Louisiana, Minnesota, Ohio, Texas, Wisconsin and Virginia).
To isolate the effect of the laws themselves, we compared changes in health outcomes among LGBQ+ and heterosexual adults living in states with or without religious exemptions to health care, both before and after the laws passed. Making all these comparisons at once allowed us to identify differences in health outcomes due to the laws rather than preexisting differences between states.
Our findings highlight how laws permitting clinicians to refuse to provide health care to LGBQ+ patients deepen existing health disparities. Notably, conscientious objection laws are just one type of policy restricting LGBTQ+ people’s access to health care.
HIV preexposure prophylaxis, or PrEP, can lower the risk of contracting HIV from sex by 99%. However, patients are required to receive an HIV test before PrEP can be prescribed. If providers are unwilling or unable to engage with LGBQ+ patients on their sexual health, people who could benefit most from HIV prevention tools, such as PrEP, may never receive them.
Moreover, since the risk of contracting HIV is closely linked to the social determinants of health, such as having safe and stable housing and employment, barriers to HIV testing could further widen health gaps.
Acknowledging the health consequences of conscientious objection laws could help policymakers and the public better understand their impact.
A 2026 national study found that Americans were more motivated to support policies that address LGBTQ+ inequality when these laws were framed as improving health inequality rather than economic inequality or sense of belonging. This finding suggests that people perceive health inequality as unjust and are less likely to blame LGBTQ+ individuals for those circumstances.
A lot of states are passing laws that target the LGBTQ+ community — but these 15 are the absolute worst.
Over 1,000 anti-LGBTQ+ laws have been proposed across every state legislature in the U.S. over the past two years, according to the American Civil Liberties Union, and 126 have passed into law. Less than two months into the 2025 legislative session, 390 laws targeting LGBTQ+ people have been proposed.
While marriage equality and anti-discrimination protections based on sexual orientation and gender identity are still guaranteed federally by U.S. Supreme Court rulings (for now), LGBTQ+ people are still concerned about their rights being taken away, especially when only 15 states have “shield laws” protecting access to gender-affirming care and abortion.
Based on laws surrounding marriage, family rights, health care, education, and youth collected by the Movement Advancement Project, here are the 15 worst states for LGBTQ+ people.
Pride Parade in Huntsville, Alabama (October 1, 2022)
Nondiscrimination laws: Alabama does not have nondiscrimination laws in employment, housing, health care, education, public accommodations, or credit/lending. Its state code incorrectly defines sex as exclusively male or female, and it prohibits transgender people from using public facilities that align with their identities.
Marriage equality and parental rights: Alabama does not have adoption or foster care nondiscrimination protections for LGBTQ+ parents. It does not have second-parent adoption for unmarried couples, confirmatory adoption, nor recognition for parents using assisted reproductive technologies. It also does not have family leave laws that encompass LGBTQ+ people.
Education and youth policies: Alabama has a “Don’t Say Gay” law restricting discussion of LGBTQ+ identities in classrooms. It has banned trans students from participating in sports or using school facilities based on their identities, and it requires staff to forcibly out LGBTQ+ students to their guardians. The state also has a “religious exemption” law for Child Welfare Services.
Healthcare access and rights: Alabama has banned life-saving gender-affirming care for youth, though it permits the discredited and harmful practice of so-called conversion therapy for youth. Health insurance companies, including Medicaid, are not required to provide coverage related to gender transition or fertility treatments. The state also has a “religious exemption” law for healthcare providers.
Criminal justice: Alabama’s hate crime laws do not encompass sexual orientation and gender identity, and it has not banned the so-called “LGBTQ+ panic” defense.
Arkansas
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3rd annual Pride Walk at Hot Springs National Park, Arkansas (June, 4 2021)
Nondiscrimination laws: Arkansas does not have nondiscrimination laws in employment, housing, health care, education, public accommodations, or credit/lending. The state bans cities and local ordinances from passing nondiscrimination laws, and it has law about “adult” performances that could be used to target or restrict drag.
Marriage equality and parental rights: Arkansas does not have adoption or foster care nondiscrimination protections for LGBTQ+ parents. It does not have second-parent adoption for unmarried couples, confirmatory adoption, nor recognition for parents using assisted reproductive technologies. It also does not have family leave laws that encompass LGBTQ+ people.
Education and youth policies: Arkansas has a “Don’t Say Gay” law restricting discussion of LGBTQ+ identities in classrooms. It has banned trans students from participating in sports or using school facilities based on their identities, and it requires staff to forcibly out LGBTQ+ students to their guardians.
Healthcare access and rights: Arkansas has banned life-saving gender-affirming care for youth, though it permits the discredited and harmful practice of so-called conversion therapy for youth. Medicaid is forbidden from providing coverage related to gender transition to minors, and insurance companies are not required to cover fertility treatments. The state also has a “religious exemption” law for healthcare providers.
Criminal justice: Arkansas’ hate crime laws do not encompass sexual orientation and gender identity, and it has not banned the so-called “LGBTQ+ panic” defense. It has an HIV criminalization law that may require sex offender registration.
Florida
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Mourners pay their respects to the fallen at the Pulse Nightclub memorial on the 5th anniversary of the Pulse mass shooting in Orlando, Florida (June 12, 2021)
Nondiscrimination laws: Florida has nondiscrimination laws in employment, housing, and public accommodations, but not in credit/lending, health care, nor education. The state prohibits transgender people from using public facilities that align with their identities, and it does not allow updating gender markers on driver’s licenses or birth certificates. It has law about “adult” performances that could be used to target or restrict drag
Marriage equality and parental rights: Florida does not have adoption or foster care nondiscrimination protections for LGBTQ+ parents. It does not have second-parent adoption for unmarried couples, confirmatory adoption, nor recognition for parents using assisted reproductive technologies. It also does not have family leave laws that encompass LGBTQ+ people.
Education and youth policies: Florida originated the “Don’t Say Gay” laws restricting discussion of LGBTQ+ identities in classrooms. It has banned trans students from participating in sports or using school facilities based on their identities, and it requires staff to forcibly out LGBTQ+ students to their guardians.
Healthcare access and rights: Florida has banned life-saving gender-affirming care for youth, though it permits the discredited and harmful practice of so-called conversion therapy for youth. Medicaid is forbidden from providing coverage related to gender transition for all ages, and insurance companies are not required to cover fertility treatments. The state also has a “religious exemption” law for healthcare providers.
Criminal justice: Florida’s hate crime laws only encompass sexual orientation, not gender identity. It has not banned the so-called “LGBTQ+ panic” defense, and it has an HIV criminalization law.
Idaho
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Rally in support of transgender youth and gender-affirming care in Boise, Idaho (February 24, 2023)
Nondiscrimination laws: Idaho has nondiscrimination laws in employment, housing, and public accommodations, but not in credit/lending, education, health care, nor for state employees. Its state code incorrectly defines sex as exclusively male or female.
Marriage equality and parental rights: Idaho does not have adoption or foster care nondiscrimination protections for LGBTQ+ parents. It has second-parent adoption for unmarried couples, but not confirmatory adoption nor recognition for parents using assisted reproductive technologies. It also does not have family leave laws that encompass LGBTQ+ people.
Education and youth policies: Idaho has banned trans students from participating in sports or using school facilities based on their identities, and it requires staff to forcibly out LGBTQ+ students to their guardians. The state also has a “religious exemption” law for Child Welfare Services, though it has protections for LGBTQ+ youth in the Child Welfare System.
Healthcare access and rights: Idaho has banned life-saving gender-affirming care for youth, though it permits the discredited and harmful practice of so-called conversion therapy for youth. Medicaid is forbidden from providing coverage related to gender transition for all ages, and insurance companies are not required to cover fertility treatments. The state also has a “religious exemption” law for healthcare providers.
Criminal justice: Idaho’s hate crime laws do not encompass sexual orientation and gender identity. It has not banned the so-called “LGBTQ+ panic” defense, and it has an HIV criminalization law.
Indiana
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Indiana University Bloomington Students walking at Indy Pride in Indianapolis, Indiana (June 4, 2008)
Nondiscrimination laws: Indiana has weaker nondiscrimination laws in employment, housing, and public accommodations, but not in credit/lending, education, nor health care. The state also has a broad “religious exemption” law.
Marriage equality and parental rights: Indiana has adoption or foster care nondiscrimination protections based on sexual orientation, but not gender identity. It has second-parent adoption for unmarried couples, but not confirmatory adoption nor recognition for parents using assisted reproductive technologies. It also does not have family leave laws that encompass LGBTQ+ people.
Education and youth policies: Indiana has a “Don’t Say Gay” law restricting discussion of LGBTQ+ identities in classrooms. It has banned trans students from participating in sports or using school facilities based on their identities, and it requires staff to forcibly out LGBTQ+ students to their guardians.
Healthcare access and rights: Indiana has banned life-saving gender-affirming care for youth, though it permits the discredited and harmful practice of so-called conversion therapy for youth. Medicaid and state health insurance plans are not required to provide coverage related to gender transition or fertility treatments, but it has trans-inclusive health benefits for state employees.
Criminal justice: Indiana’s hate crime laws do not encompass sexual orientation and gender identity, and it has not banned the so-called “LGBTQ+ panic” defense. It has an HIV criminalization law that may require sex offender registration.
Louisiana
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Southern Decadence Parade march through the French Quarter in New Orleans, Louisiana (September 1, 2024)
Nondiscrimination laws: Louisiana does not have nondiscrimination laws in employment, housing, health care, education, public accommodations, or credit/lending. Its state code incorrectly defines sex as exclusively male or female, and it prohibits transgender people from using public facilities that align with their identities. The state also has a broad “religious exemption” law.
Marriage equality and parental rights: Louisiana does not have adoption or foster care nondiscrimination protections for LGBTQ+ parents. It does not have second-parent adoption for unmarried couples, confirmatory adoption, nor recognition for parents using assisted reproductive technologies. It also does not have family leave laws that encompass LGBTQ+ people.
Education and youth policies: Louisiana has a “Don’t Say Gay” law restricting discussion of LGBTQ+ identities in classrooms. It has banned trans students from participating in sports or using school facilities based on their identities, and it requires staff to forcibly out LGBTQ+ students to their guardians.
Healthcare access and rights: Louisiana has banned life-saving gender-affirming care for youth, though it permits the discredited and harmful practice of so-called conversion therapy for youth. Health insurance companies, including Medicaid, are not required to provide coverage related to gender transition or fertility treatments, and state employees do not have trans-inclusive benefits.
Criminal justice: Louisiana’s hate crime laws only encompass sexual orientation, not gender identity. It has not banned the so-called “LGBTQ+ panic” defense, and it has an HIV criminalization law that may require sex offender registration.
Mississippi
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A rainbow flag supporting Pride month flies a the Biloxi VA Medical Center in Biloxi, Mississippi (June 5, 2023)
Nondiscrimination laws: Mississippi does not have nondiscrimination laws in employment, housing, health care, education, public accommodations, or credit/lending. Its state code incorrectly defines sex as exclusively male or female, and it prohibits transgender people from using public facilities that align with their identities. The state also has a broad “religious exemption” law.
Marriage equality and parental rights: Mississippi does not have adoption or foster care nondiscrimination protections for LGBTQ+ parents. It has second-parent adoption for unmarried couples, but not confirmatory adoption nor recognition for parents using assisted reproductive technologies. It also does not have family leave laws that encompass LGBTQ+ people.
Education and youth policies: Mississippi has a “Don’t Say Gay” law restricting discussion of LGBTQ+ identities in classrooms. It has banned trans students from participating in sports or using school facilities based on their identities, and it requires staff to forcibly out LGBTQ+ students to their guardians. The state also has a “religious exemption” law for Child Welfare Services.
Healthcare access and rights: Mississippi has banned life-saving gender-affirming care for youth, though it permits the discredited and harmful practice of so-called conversion therapy for youth. Medicaid is forbidden from providing coverage related to gender transition for youth, and insurance companies are not required to cover fertility treatments. The state also has a “religious exemption” law for healthcare providers.
Criminal justice: Mississippi’s hate crime laws do not encompass sexual orientation and gender identity. It has not banned the so-called “LGBTQ+ panic” defense, and it has an HIV criminalization law.
Missouri
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A view down one of the streets filled with celebrants during Saint Louis PrideFest in Missouri (June 24, 2023)
Nondiscrimination laws: Missouri has weaker nondiscrimination laws in housing, and public accommodations, but not in employment, credit/lending, education, nor health care. The state also has a broad “religious exemption” law.
Marriage equality and parental rights: Missouri’sadoption or foster care nondiscrimination protections only encompass sexual orientation, not gender identity. It does not have second-parent adoption for unmarried couples, confirmatory adoption, nor recognition for parents using assisted reproductive technologies. It also does not have family leave laws that encompass LGBTQ+ people.
Education and youth policies: Missouri has banned schools and districts from passing nondiscrimination or anti-bullying policies protecting LGBTQ+ students. It has banned trans students from participating in sports based on their identities, but not from using facilities that align with their identities.
Healthcare access and rights: Missouri has banned life-saving gender-affirming care for youth, though it permits the discredited and harmful practice of so-called conversion therapy for youth. Medicaid is forbidden from providing coverage related to gender transition for all ages, and insurance companies are not required to cover fertility treatments. The state also has a “religious exemption” law for healthcare providers.
Criminal justice: Missouri’s hate crime laws encompass sexual orientation and gender identity, though it has not banned the so-called “LGBTQ+ panic” defense, and it has an HIV criminalization law.
Montana
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“Say Gay” sign at Missoula Pride in Montana (March 29, 2024)
Nondiscrimination laws: Montana does not have nondiscrimination laws in employment, housing, health care, education, public accommodations, or credit/lending.Its state code incorrectly defines sex as exclusively male or female, and it has a broad “religious exemption” law. The state has also explicitly restricted drag performances, and does not allow updating gender markers on birth certificates
Marriage equality and parental rights: Montana’sadoption or foster care nondiscrimination protections only encompass sexual orientation, not gender identity. It has second-parent adoption for unmarried couples, but not confirmatory adoption nor recognition for parents using assisted reproductive technologies. It also does not have family leave laws that encompass LGBTQ+ people.
Education and youth policies: Montana requires that parents be notified of LGBTQ+ curricula so they can opt out. It has banned trans students from participating in sports based on their identities, but not from using facilities that align with their identities. The state requires staff to forcibly out LGBTQ+ students to their guardians.
Healthcare access and rights: Montana has banned life-saving gender-affirming care for youth, though it permits the discredited and harmful practice of so-called conversion therapy for youth. Health insurance companies and Medicaid are required to cover care related to gender transition, and there is some coverage for fertility treatments. However, the state has a “religious exemption” law for healthcare providers.
Criminal justice: Montana’s hate crime laws do not encompass sexual orientation and gender identity. It has not banned the so-called “LGBTQ+ panic” defense, and it has an HIV criminalization law.
Oklahoma
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Pride Parade in Oklahoma (June 26, 2023)
Nondiscrimination laws: Oklahoma does not have nondiscrimination laws in employment, housing, health care, education, public accommodations, or credit/lending. Its state code incorrectly defines sex as exclusively male or female, and it prohibits updated gender markers on birth certificates. It also has a broad “religious exemption” law.
Marriage equality and parental rights: Oklahoma does not have adoption or foster care nondiscrimination protections for LGBTQ+ parents. It has second-parent adoption for unmarried couples, but not confirmatory adoption nor recognition for parents using assisted reproductive technologies. It also does not have family leave laws that encompass LGBTQ+ people.
Education and youth policies: Oklahoma has a weaker version of a “Don’t Say Gay” law that restricts the discussion of “homosexuality” in specific school subjects. It has banned trans students from participating in sports or using school facilities based on their identities. The state also has a “religious exemption” law for Child Welfare Services, though it has protections for LGBTQ+ youth in the Child Welfare System.
Healthcare access and rights: Oklahoma has banned life-saving gender-affirming care for youth, though it permits the discredited and harmful practice of so-called conversion therapy for youth. Health insurance companies, including Medicaid, are not required to provide coverage related to gender transition or fertility treatments, and state employees are not permitted trans-inclusive benefits.
Criminal justice: Oklahoma’s hate crime laws do not encompass sexual orientation and gender identity. It has not banned the so-called “LGBTQ+ panic” defense, and it has an HIV criminalization law.
South Carolina
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Rainbow flag on a map of South Carolina
Nondiscrimination laws: South Carolinadoes not have nondiscrimination laws in employment, housing, health care, education, public accommodations, or credit/lending. It has a broad “religious exemption” law.
Marriage equality and parental rights: South Carolina‘sadoption or foster care nondiscrimination protections only encompass sexual orientation, not gender identity. It does not have second-parent adoption for unmarried couples, confirmatory adoption, nor recognition for parents using assisted reproductive technologies. It also does not have family leave laws that encompass LGBTQ+ people.
Education and youth policies: South Carolinahas banned trans students from participating in sports based on their identities, but not from using facilities that align with their identities. The state requires staff to forcibly out LGBTQ+ students to their guardians. The state also has a “religious exemption” law for Child Welfare Services.
Healthcare access and rights: South Carolina has banned life-saving gender-affirming care for youth, though it permits the discredited and harmful practice of so-called conversion therapy for youth. Medicaid is forbidden from providing coverage related to gender transition for all ages, and insurance companies are not required to cover fertility treatments. The state also has a “religious exemption” law for healthcare providers.
Criminal justice: South Carolina‘s hate crime laws do not encompass sexual orientation and gender identity. It has not banned the so-called “LGBTQ+ panic” defense, and it has an HIV criminalization law.
South Dakota
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South Dakota state flag with rainbow stripes
Nondiscrimination laws: South Dakota does not have nondiscrimination laws in employment, housing, health care, education, public accommodations, or credit/lending. It has a broad “religious exemption” law.
Marriage equality and parental rights: South Dakota’sadoption or foster care nondiscrimination protections encompass sexual orientation and gender identity. However, it does not have second-parent adoption for unmarried couples, confirmatory adoption, nor recognition for parents using assisted reproductive technologies. It also does not have family leave laws that encompass LGBTQ+ people.
Education and youth policies: South Dakotahas banned schools and districts from passing nondiscrimination or anti-bullying policies protecting LGBTQ+ students. It has banned trans students from participating in sports based on their identities, but not from using facilities that align with their identities. The state also has a “religious exemption” law for Child Welfare Services, though it has protections for LGBTQ+ youth in the Child Welfare System.
Healthcare access and rights: South Dakota has banned life-saving gender-affirming care for youth, though it permits the discredited and harmful practice of so-called conversion therapy for youth. Health insurance companies, including Medicaid, are not required to provide coverage related to gender transition or fertility treatments, and state employees are not permitted trans-inclusive benefits.
Criminal justice: South Dakota‘s hate crime laws do not encompass sexual orientation and gender identity, and it has not banned the so-called “LGBTQ+ panic” defense. It has an HIV criminalization law that may require sex offender registration.
Tennessee
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Pride Parade on Beale Street in Memphis, Tennessee (September 28, 2018)
Nondiscrimination laws: Tennessee does not have nondiscrimination laws in employment, housing, health care, education, public accommodations, or credit/lending. It instead bans cities and local ordinances from passing nondiscrimination laws. State code incorrectly defines sex as exclusively male or female, and it does not allow updating gender markers on driver’s licenses or birth certificates. The state has a broad “religious exemption” law that even allows officials to deny marriage licenses based on their personal beliefs. It has also explicitly restricted drag performances.
Marriage equality and parental rights: Tennessee’sadoption or foster care nondiscrimination protections encompass sexual orientation and gender identity. However, it does not have second-parent adoption for unmarried couples, confirmatory adoption, nor recognition for parents using assisted reproductive technologies. It also does not have family leave laws that encompass LGBTQ+ people.
Education and youth policies: Tennessee requires that parents be notified of LGBTQ+ curricula so they can opt out. It has banned trans students from participating in sports based on their identities and from using facilities that align with their identities. The state requires staff to forcibly out LGBTQ+ students to their guardians. The state also has a “religious exemption” law for Child Welfare Services, though it has protections for LGBTQ+ youth in the Child Welfare System.
Healthcare access and rights: Tennessee has banned life-saving gender-affirming care for youth, though it permits the discredited and harmful practice of so-called conversion therapy for youth. Medicaid is forbidden from providing coverage related to gender transition for all ages, and insurance companies are not required to cover fertility treatments. The state also has a “religious exemption” law for healthcare providers, and state employees are not permitted trans-inclusive benefits.
Criminal justice: Tennessee’s hate crime laws encompass sexual orientation and gender identity, though it has not banned the so-called “LGBTQ+ panic” defense, and it has an HIV criminalization law that may require sex offender registration.
Nondiscrimination laws: Texas has nondiscrimination laws in employment and for state employees, but not in housing, public accommodations, credit/lending, education, nor health care. The state does not allow updating gender markers on driver’s licenses or birth certificates, and it has a broad “religious exemption” law.
Marriage equality and parental rights: Texas does not have adoption or foster care nondiscrimination protections for LGBTQ+ parents. It does not have second-parent adoption for unmarried couples, confirmatory adoption, nor recognition for parents using assisted reproductive technologies. It also does not have family leave laws that encompass LGBTQ+ people.
Education and youth policies: Texas has a weaker version of a “Don’t Say Gay” law that restricts the discussion of “homosexuality” in specific school subjects. It has banned trans students from participating in sports based on their identities, but not from using facilities that align with their identities. The state also has a “religious exemption” law for Child Welfare Services without protections for LGBTQ+ youth.
Healthcare access and rights: Texas has banned life-saving gender-affirming care for youth, though it permits the discredited and harmful practice of so-called conversion therapy for youth. Medicaid is forbidden from providing coverage related to gender transition for all ages, and insurance companies are not required to cover fertility treatments. State employees are not permitted trans-inclusive benefits.
Criminal justice: Texas’s hate crime laws only encompass sexual orientation, not gender identity. It has not banned the so-called “LGBTQ+ panic” defense.
Wyoming
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Double rainbow against a black sky in Wyoming
Nondiscrimination laws: Wyoming does not have nondiscrimination laws in employment, housing, health care, education, public accommodations, or credit/lending.
Marriage equality and parental rights: Wyoming does not have adoption or foster care nondiscrimination protections for LGBTQ+ parents. It does not have second-parent adoption for unmarried couples, nor confirmatory adoption. It also does not have family leave laws that encompass LGBTQ+ people. However, it does have recognition for parents using assisted reproductive technologies.
Education and youth policies: Wyoming has a weaker version of a “Don’t Say Gay” law that restricts the discussion of “homosexuality” in specific school subjects. It has banned trans students from participating in sports based on their identities, but not from using facilities that align with their identities.
Healthcare access and rights: Wyoming has banned life-saving gender-affirming care for youth, though it permits the discredited and harmful practice of so-called conversion therapy for youth. Health insurance companies, including Medicaid, are not required to provide coverage related to gender transition or fertility treatments.
Criminal justice: Wyoming’s hate crime laws do not encompass sexual orientation and gender identity, and it has not banned the so-called “LGBTQ+ panic” defense.
Dishonorable mentions
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People carry large balloon letters that spell out “Proud” as they walk in the annual pride parade in Atlanta, Georgia (October 15, 2023)
Other states that ranked below average include: Alaska, Arizona, Georgia, Iowa, Kansas, Kentucky, Nebraska, North Carolina, North Dakota, Ohio, Utah, and West Virginia.
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