Access for all in the CHLPI clinics

Originally written by Olivia Klein and published on HLS Clinical and Pro Bono Programs on May 11, 2022.

Coming to law school with a passion for health care access, Kaixin Fan, J.D. ‘22, found her place at the Center for Health Law and Policy (CHLPI). Fan spent three semesters working with CHLPI, first in the Health Law and Policy Clinic, then in the Food Law and Policy Clinic, on projects spanning gender-affirming care access for transgender and non-binary individuals to advocacy on sugar reduction policies.  

Fan studied economics in college, and she came to law school hoping to dig deeper into the roots of structural inequities. “When I was studying economics, a lot of the problems I saw were rooted in how policies, institutions, and rules impact the lives of many people,” she said. “I felt like I needed to learn more about the institutions behind those economic questions.” 

Part of this learning began during her 1L summer, which she spent working with the California Attorney General’s Office, Healthcare Rights and Access Section on issues including disaster relief, elderly care, abortion access, and a case defending the Affordable Care Act. The positive experience there reignited Fan’s interest in health law, and she began working with the Health Law and Policy Clinic during the fall of 2020. The coronavirus pandemic inevitably effected the clinic’s work, and it influenced Fan’s motivations for joining the clinic as well: “It’s a really important time to talk about health care access in general, but especially health care access for the communities who already had a hard time accessing health care before Covid-19 and will have even more challenges because of Covid-19,” she said. 

“Access is one of the biggest challenges in healthcare today,” Fan said. “A lot of it boils down to whether a patient has transportation, or if they have the chance to learn about how to navigate the very complicated health care system to get to the right doctor and get the health care they need, and also the very difficult and complex insurance system that one has to understand in order to afford health care.” 

Fan’s clinical work began on the transgender health care rights team, where she contributed to several impact litigation cases.  While working on BAGLY v. HHS, a challenge to Trump-era rollbacks of non-discrimination protections in the health care space, Fan and fellow students were able to speak with health care providers that work closely with LGBTQ+ individuals to understand how the rollback would affect their work and their patients’ lives. “It’s a very heartbreaking experience in terms of understanding how different people suffer from different political consequences and why systemically and historically marginalized communities will suffer the most,” she reflected. 

While she was on the transgender health care rights team, Fan also examined a policy implemented during the pandemic that allowed transgender and non-binary individuals who need testosterone for their hormone transition therapy to have access to that medication without visiting a provider in person. The policy was temporarily put in place during the pandemic in order to reduce potential virus exposure, but the clinic saw the impact it has in expanding access to gender-affirming care, particularly for those living in rural areas. While in the clinic, Fan looked for ways to advocate to make the policy permanent. “I looked into why testosterone has the in-person visit requirement before the pandemic and explored advocacy options accordingly.” said Fan.

This advocacy and casework employed skill sets learned in the 1L classroom in new and exciting ways for Fan. “I did a lot of research into regulatory matters to understand how a regulatory agency arrived at their decision in order to look at how we can persuade a regulatory agency to change course,” she says. “I also did a lot of legal research, but not in the sense of what we did in 1L Legal Research and Writing class. There you do a lot of case law research. But in the clinic, because a lot of the writing was for declarations or amicus briefs, I had more opportunities to be creative about what I was writing. For example, for an amicus brief in a case against a state’s health insurance plan, we researched social science studies about how state-sponsored discrimination will have a downstream impact on marginalized communities. Social science research is something I didn’t imagine I would spend a lot of time looking into in law school, but it was really interesting.”  

Turning a creative lens towards existing regulatory bodies and policies allows issues to be addressed that may otherwise be overlooked. In the spring of 2021, Fan had the opportunity to introduce a new perspective into an existing system in a way that could benefit many Massachusetts citizens in the future. “In the spring semester, I gave a presentation to the Massachusetts Health Connector, which is the regulatory agency overseeing individual healthcare plans in Massachusetts. I presented about how they can employ a racial justice lens to the certification process for qualified health plans, i.e., whether a plan complies with various standards set forth in the Affordable Care Act,” she says. “Access is one thing, and another is raising awareness about how deeply systemic racism is ingrained in so much of our society – in the healthcare system, in insurance – and advocating for policies that correct those wrongs in the system.” 

The following fall semester, Fan tried out the other side CHLPI – the Food Law and Policy Clinic – and found that her work hit close to home. “In the clinic, I worked on a project around food donation laws in India and China. I learned about how these laws impact how people donate food globally. I grew up in China, so it was interesting to possibly have an impact and talk to people in the legal space in the country where I’m from.”  

“Food is a very important element when you think about how to improve health outcomes,” Fan adds. “I wanted to advocate for food access, especially access to healthy food, and policies that promote healthy consumptions.” 

On a personal level, the CHLPI clinical experience offered Fan with much needed structure during the remote year. “I was very fortunate to participate in the clinic during the remote year, because I really need that human contact,” Fan reflects. “Even though it was all online, we had weekly meetings, check-ins with our supervisors, and meetings among students to talk about projects and about life in general. That was a great opportunity to find hope during a difficult time.” 

With commencement quickly approaching, Fan smiles as she thinks back on her semesters spent with CHLPI. The work, she says, offered a grounded experience that is already proving valuable as she heads into her legal career. “CHLPI has equipped me with ideas about how the legal profession in the real world really is,” she says. “I’m really excited about graduating and finally becoming a lawyer.”