HHS affirms trans protections in health care reform

Discrimination against transgender people in federal health programs or health programs that receive federal funds is prohibited under the health care reform law, the Department of Health & Human Services affirmed in a letter to LGBT advocates made public on Monday.

The letter, dated July 12 and signed by Leon Rodriguez, director of the Office of Civil Rights for HHS, says the Obama administration has interpreted existing non-discrimination law — including Title VII of the Civil Rights Act of 1964 and Title IX of the Education Amendments of 1972 — to mean that the sex-discrimination protections under the Affordable Care Act apply to transgender people, and, in some cases, individuals who are lesbian, gay and bisexual.

“We agree that Section 1577′s sex discrimination prohibition extends to claims of discrimination based on gender identity or failure to conform to stereotypical notions of masculinity or femininity and will accept such complaints for investigation,” Rodriguez writes. “Section 1557 also prohibits sexual harassment and discrimination regardless of actual or perceived sexual orientation or gender identity of the individuals involved.”

The letter states that the Office of Civil Rights for HHS intends to issue future guidance on this section. In the meantime, Rodriguez says HHS is “currently accepting and investigating complaints” and is making determinations on whether discrimination has happened on a case-by-case basis.

Health programs that receive federal funds include hospitals, clinics and mental health facilities that receive Medicare and Medicaid funding. According to a National Transgender Discrimination Survey published by the National Gay & Lesbian Task Force, one in five transgender people have been denied care by a medical provider.

The HHS interpretation that sex discrimination statues apply to transgender people under the health care reform law follows a recent trend of reading such laws to cover transgender people. Most notably, the U.S. Equal Employment Opportunity Commission ruled that existing employment non-discrimination law on sex discrimination extends to transgender people, as well as the U.S. Eleventh Circuit Court of Appeals in the case of Glenn v. Brumby and the Department of Housing & Urban Development in federally funded housing programs.

Mara Keisling, executive director of the National Center for Transgender Equality, said transgender people could previously file complaints if they felt they faced discrimination in health programs, but the clarification from HHS streamlines the process.

“You can always file a complaint, but now HHS is saying they interpret sex discrimination laws to cover gender identity discrimination,” Keisling said. “You don’t have to claim sex stereotyping, and then prove sex stereotyping because gender identity discrimination is sex discrimination.”

Keisling maintained that the clarification from HHS doesn’t mean that health care providers have to provide aid for gender transitioning, saying “nothing in federal law says any insurance plan — public and private — has to cover transition-related care.”

Kellan Baker, a health policy analyst for the Center for American Progress’ LGBT research and communications project, said this policy affirmed in the letter isn’t new — having already been openly discussed by Obama administration officials — and HHS’s response simply provides clarification of the issue.

“This is something that has been in the Affordable Care Act the entire time,” Baker said. “This is just a clarification that the department is aware of the fact that making sure that transgender people have access to the same services, the same health care, that non-transgender people do is an essential principle of health care reform, is an essential principle of the Affordable Care Act.”

The main addressee on the letter is Maya Rupert, federal policy director for the National Center for Lesbian Rights, which was among the 12 LGBT groups that co-sigend a letter to HHS requesting the information. HHS’s response carbon copies the other groups.

The advocates’ letter, dated June 5, calls for clarification on the issue, saying groups have previously submitted memoranda detailing the problem and calling for implementing regulations to prohibit discrimination in health care to LGBT individuals. Advocates make the case that recent determinations that sex discrimination protections apply to transgender people should make it easy for HHS to conclude such non-discrimination is possible in health care.

“While the need for regulations for section 1557 remain, we believe recent developments have it made it necessary for HHS to issue clarifying guidance on the application of the law in this area in advance of formal rulemaking,” the letter states.

In a statement, Rupert expressed gratitude to HHS for clarifying existing law protects transgender people from discrimination in health care, saying they “face several discrimination in healthcare settings and are often denied care completely.”

“This announcement affirms that all patients in federally funded health care settings must be treated equally and may not be denied care simply because of who they are,” Rupert said. “We are grateful to HHS for clarifying this important policy and providing transgender people with the security of knowing they are included in the administration’s commitment to the health and well-being of all Americans.”