This study analyzes how U.S. healthcare organizations implemented legal requirements to treat patients in a manner consistent with their gender identity under Section 1557 of the Affordable Care Act. The ways that healthcare organizations determine gender and track complaints constitute socio-technical systems for compliance, and they shape what discrimination protections look like on the ground. We interviewed grievance handlers about how they use information technologies to process possible civil rights claims from patients and argue that their work demobilizes and erases civil rights, especially claims such as transgender harassment. Mobilized physician-led implementation groups, by contract, enacted a version of gender identity recognition by tracking identities and bodies in electronic medical records and material objects such as specimen labels. Default structures—the dropdown menus of healthcare software—both shape and are shaped by professional norms, financial incentives, and conceptions of justice and deservingness. These socio-technical structures allow conflicting stories of transgender rights to continue on in different parts of the healthcare organization, making it difficult for law to transform healthcare delivery.

本研究分析了美国医疗保健组织如何根据《平价医疗法案》第 1557 条实施法律要求，以符合其性别认同的方式治疗患者。医疗保健组织确定性别和跟踪投诉的方式构成了合规的社会技术系统，它们塑造了实际歧视保护的样子。我们采访了申诉处理人员，了解他们如何使用信息技术处理患者可能提出的公民权利主张，并认为他们的工作使公民权利复员并抹杀了公民权利，尤其是变性骚扰等主张。动员医生领导的实施小组，按合同，通过跟踪电子病历和标本标签等实物中的身份和身体，制定了一种性别身份识别版本。默认结构——医疗保健软件的下拉菜单——既塑造了专业规范、财务激励以及正义和应得的概念，又受其塑造。这些社会技术结构允许跨性别权利的冲突故事在医疗保健组织的不同部分继续存在，使法律难以改变医疗保健服务。