By DANIEL BRUNER & ERIN LOUBIER
The Affordable Care Act is the most far-reaching reform of our nation’s health care system in decades. There are particularly exciting implications for the LGBT community and for persons living with HIV/AIDS. The ACA’s sweeping prohibition of health care discrimination on the basis of sex promises to give advocates and the federal government a powerful new tool against LGBT discrimination by health insurers and health care providers. And, the new health insurance exchanges will give LGBT individuals and families, and persons living with HIV/AIDS, new access to nondiscriminatory and affordable health insurance that includes coverage of a broad range of “essential health benefits.”
A new tool to fight transgender and sexual orientation discrimination in health care, Section 1557 of the ACA prohibits discrimination on the basis of sex, disability, age, race, color or national origin, by a broad range of health insurers and health care providers. The actual scope of the new law will be fleshed out in federal regulations and court decisions, but the law clearly covers any doctor, hospital or health clinic that accepts Medicare or Medicaid, and any health insurer operating under the new exchanges. There is a strong argument that the statute’s prohibition of sex discrimination includes discrimination against transgender persons, and also discrimination based on sexual orientation.
Whitman-Walker Legal Services will be urging an expansive interpretation of the law. You can help by contacting us at 202-939-7627 if you encounter any health care discrimination because you are transgender or gay, lesbian, or bisexual. In addition, the Office of Civil Rights at the U.S. Department of Health and Human Services, which is planning to issue regulations under the new law, is seeking information about the extent of discrimination in health care. If you have encountered health care or health insurance discrimination because of being LGBT or living with HIV, you can tell your story directly to OCR by submitting a formal comment online, through Sept. 30, at https://www.federalregister.gov/articles/2013/08/01/2013-18707/request-for-information-regarding-nondiscrimination-in-certain-health-programs-or-activities.
Starting Jan. 1, 2014, health insurers will be required to provide nondiscriminatory coverage, including a package of “essential health benefits,” without regard to HIV status or other health conditions. This is great news for the LGBT community, which has lower levels of health insurance than the general population, and for people living with HIV/AIDS, who have been subjected to systematic discrimination by health insurance companies since the beginning of the epidemic.
Starting Oct. 1 of this year, health insurance exchanges in D.C. and in Maryland, and a federally run exchange for Virginia residents, will begin operations. With some exceptions, starting Jan. 1, everyone will be required to carry health insurance. If you are currently uninsured or are dissatisfied with your current insurance, there will be web sites that will enable you to see what health plans are available and what they will cost. Specially trained experts – In-Person Assisters (also called Navigators or Connectors in Maryland) – will be available at numerous sites to provide free counseling and help with enrollment. Depending on your income, you may be eligible for help with the premiums and with deductibles and co-payments. Very low-income individuals and families may be eligible for free coverage through Medicaid.
This year’s open season will run from Oct. 1, 2013 until March 31, 2014. D.C. residents can receive help from Assisters at Whitman-Walker. Information on other Assister programs in D.C. is available from the D.C. Health Benefits Exchange Authority at http://hbx.dc.gov or (202) 715-7576. Maryland residents should contact the Maryland Health Connection Call Center at 855-642-8572, and Virginia residents should call 1-800-318-2596 or visit https://www.healthcare.gov/how-can-i-get-ready-to-enroll-in-the-marketplace.
Dan Bruner is director of legal services and Erin Loubier is director of public benefits for Whitman-Walker Health.