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HHS affirms trans protections in health care reform

Sex discrimination prohibition said to apply to gender identity

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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.”

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National

Advocacy groups issue US travel advisory ahead of World Cup

Renee Good’s death in Minneapolis among incidents cited

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(Photo by fifg/Bigstock)

More than 100 organizations have issued a travel advisory for the U.S. ahead of the 2026 World Cup.

The World Cup will take place in the U.S., Canada, and Mexico from June 11-July 19.

“In light of the deteriorating human rights situation in the United States and in the absence of meaningful action and concrete guarantees from FIFA, host cities, or the U.S. government, the undersigned organizations are issuing this travel advisory for fans, players, journalists, and other visitors traveling to and within the United States for the June 2026 FIFA Men’s World Cup. World Cup games will be played in 11 different cities across the United States, which, like many localities, have already been the target of the Trump administration’s violent and abusive immigration crackdown,” reads the advisory that the Council for Global Equality and other groups that include the American Civil Liberties Union issued on April 23.  “The impacts of these policies vary by locality.”

“While the Trump administration’s rising authoritarianism and increasing violence pose serious risks to all, those from immigrant communities, racial and ethnic minority groups, and LGBTQ+ individuals have been and continue to be disproportionately targeted and affected by the administration’s policies and, as such, are most vulnerable to serious harm when traveling to and/or within the United States,” it adds. “This travel advisory calls on fans, players, journalists, and other visitors to exercise caution.”

The advisory specifically mentions Renee Good.

A U.S. Immigration and Customs Enforcement agent on Jan. 7 shot and killed her in Minneapolis. Good, 37, left behind her wife and three children.

The full advisory can be read here.

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State Department

Democracy Forward files FOIA request for State Department bathroom policy records

April 20 memo outlined anti-transgender rule

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(Photo courtesy of the Library of Congress)

Democracy Forward on Tuesday filed a Freedom of Information Act request for records on the State Department’s new bathroom policy.

A memo titled “Updates Regarding Biological Sex and Intimate Spaces, Including Restrooms” that the State Department issued on April 20 notes employees can no longer use bathrooms that correspond with their gender identity.

“The administration affirms that there are two sexes — male and female — and that federal facilities should operate on this objective and longstanding basis to ensure consistency, privacy, and safety in shared spaces,” State Department spokesperson Tommy Piggot told the Daily Signal, a conservative news website that first reported on the memo. “In line with President Trump’s executive order this provides clear, uniform guidance to the department by grounding policy in biological sex as determined at birth.”

President Donald Trump shortly after he took office in January 2025 issued an executive order that directed the federal government to only recognize two genders: male and female. The sweeping directive also ordered federal government agencies to “effectuate this policy by taking appropriate action to ensure that intimate spaces designated for women, girls, or females (or for men, boys, or males) are designated by sex and not identity.”

Democracy Forward’s FOIA request that the Washington Blade exclusively obtained on Tuesday is specifically seeking a copy of the memo that details the State Department’s new bathroom policy. Democracy Forward has also requested “all” memo-specific communications between the State Department’s Bureau of Global Public Affairs and the Daily Signal from April 1-21.

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Federal Government

House Republicans push nationwide ‘Don’t Say Gay’ bill

Measures would restrict federal funding for LGBTQ-affirming schools

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(Washington Blade photo by Michael Key)

Republicans have been gaining ground in reshaping education policy to be less inclusive toward LGBTQ students at the state level, and now they are turning their focus to Capitol Hill.

Some GOP lawmakers are pushing for a nationwide “Don’t Say Gay” bill, doubling down on their commitment to being the party of “traditional family values” by excluding anyone who does not identify with their sex at birth.

The largest anti-LGBTQ education legislation to reach the House chamber is House Bill 2616 — the Parental Rights Over the Education and Care of Their Kids Act, or the PROTECT Kids Act. The PROTECT Kids Act, proposed by U.S. Rep. Tim Walberg (R-Mich.), and co-sponsored by U.S. Reps. Burgess Owens (R-Utah), Mary Miller (R-Ill.), Robert Onder (R-Mo.), and Kevin Kiley (R-Calif.), would require any public elementary and middle schools that receive federal funding to require parental consent to change a child’s gender expression in school.

The bill, which was discussed during Tuesday’s House Rules Committee hearing, would specifically require any schools that get federal money from the Elementary and Secondary Education Act of 1965 — which was created to minimize financial discrepancies in education for low-income students — to get parental approval before identifying any child’s gender identity as anything other than what was provided to the school initially. This includes getting approval before allowing children to use their preferred locker room or bathroom.

It reads that any school receiving this funding “shall obtain parental consent before changing a covered student’s (1) gender markers, pronouns, or preferred name on any school form; or (2) sex-based accommodations, including locker rooms or bathrooms.”

LGBTQ rights advocates have criticized both national and state efforts to require parental permission to use a child’s preferred gender identity, as it raises issues of at-home safety — especially if the home is not LGBTQ-affirming — and could lead to the outing of transgender or gender-curious students.

A follow-up bill, HB 2617, proposed by Owens, one of the bill’s co-sponsors, prevents the use of federal funding to “advance concepts related to gender ideology,” using the definition from President Donald Trump’s 2025 Executive Order 14168, making that an enshrined definition in law of sex rather than just by executive order. There is also a bill making its way through the senate with the same text— Senate Bill 2251.

Advocates have also criticized this follow-up legislation, as it would restrict school staff — including teachers and counselors — from acknowledging trans students’ identities or providing any support. They have said that this kind of isolation can worsen mental health outcomes for LGBTQ youth and allows for education to be politicized rather than being based in reality.

David Stacy, the Human Rights Campaign’s vice president of government affairs, called this legislation out for using LGBTQ children as political pawns in an ideology fight — one that could greatly harm the safety of these children if passed.

“Trans kids are not a political agenda — they are students who deserve safety and affirmation at school like anyone else,” Stacy said in a statement. “Despite the many pressing issues facing our nation, House Republicans continue their bizarre obsession with trans people. H.R. 2616 does not protect children. It targets them. This bill is cruel, and we’re prepared to fight it.”

This is similar to Florida House Bills 1557 and 1069, referred to as the “Don’t Say Gay” bill and “Don’t Say They” bill, respectively, restricting classroom discussions on sexual orientation and gender identity, prohibiting the use of pronouns consistent with one’s gender identity, expanding book banning procedures, and censoring health curriculum.

The American Civil Liberties Union is tracking 233 bills related to restricting student and educator rights in the U.S.

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