News
New HHS reg seeks non-discrimination in health care as monkeypox spreads
Proposed rule bars strengthens protections for LGBTQ patients
A new regulation proposed by the Biden administration seeks to ensure non-discrimination in health care settings for women who have had abortions and LGBTQ people at a time when monkeypox cases continue to increase and fears persist after the U.S. Supreme Court overturned Roe v. Wade.
The new regulation, announced Monday by the Department of Health & Human Services, would interpret Section 1557 of the Affordable Care Act to apply more broadly to the definition of sex after the court’s earlier 2016 decision in Bostock v. Clayton County, which determined anti-LGBTQ discrimination was an illegal form of sex discrimination. The rule would enhance the prohibition discrimination on the basis of sex in health care settings and federally funded health care programs consistent with the law.
The regulation also institutes non-discrimination protections for intersex traits; and pregnancy or related conditions, including pregnancy termination; and people with limited English proficiency.
Xavier Becerra, secretary of health and human services, announced the proposed rule on Monday during a conference call with reporters and said it would ensure communities that have had barriers to accessing health care would be able to obtain it.
“Everyone in America should be able to get the care that they need from any health provider in the country, especially if they’re that provider is receiving funding from HHS,” Becerra said. “We want to make sure that Americans are free from discrimination when they try to access the care that they need. Pretty simple proposition.”
Becerra, asked by the Washington Blade how he sees the proposed rule playing out as part of the Biden administration’s approach to the monkeypox outbreak among gay and bisexual men, said the rule makes clear discrimination in health care is unacceptable and enables LGBTQ people to file a complaint with the Office of Civil Rights at the Department of Health & Human Services.
“The reality is that today, the issue of monkeypox, you should not face any discrimination when it comes to the issue of accessing the health care services you might need to address monkeypox,” Becerra said.
The new regulation doesn’t appear to be timed as a means to address monkeypox, but a follow-up to an earlier commitment from the Biden administration to make the change.
The proposed rule is similar to a regulation in the final years of the Obama administration, which interpreted the language of Section 1557 to bar discrimination based on sex stereotypes and gender identity. The rule, however, was rescinded during the Trump administration under HHS Director of the Office of Civil Rights Roger Severino, who bucked the decision in Bostock and reversed the rule pursuant to an earlier lower federal court ruling in Texas.
Melanie Fontes Rainer, now the director of the Office of Civil Rights under the Biden administration, said on the call that restoring non-discrimination protections after they were rescinded makes health care more accessible for everyone.
“The 2020 version of this rule narrowed its scope to cover fewer health programs and activities, limiting vital non-discrimination protections for so many across the country,” Rainer said. “The proposed rule proposes revisions to Section 1557 implementing regulation by restoring and strengthening provisions that protect individuals from discrimination and health programs and activities”
The Biden administration rule, however, is different from the Obama-era rule in key aspects. For starters, the Biden-era rule explicitly prohibits discrimination on the basis of sexual orientation in addition to other sex-based categories that were articulated before, using the Supreme Court’s decision in Bostock as justification.
The newer regulation also contains language that interprets Medicare Part B as federally funded assistance and includes an explicit exemption for health care providers who have objections to certain procedures, such as abortion and gender reassignment surgery. The exact breadth of the religious exemption wasn’t immediately clear.
Becerra said during the call the religious conscience provision was included as a result of stakeholder feedback and is consistent with the Biden administration’s goal to protect the rights of people in health care settings.
“That is also part of the work that we do, and we don’t believe that there’s any inconsistency in making sure that people are accessing care without discrimination,” Becerra said.
Becerra, asked during the call about the timeline for the rule, said he expects it will be made final before the end of this year and after the formal 90-day comment period.
Noticias en Español
La X vuelve al tribunal
Primer Circuito examina caso del reconocimiento de personas no binarias en Puerto Rico
Hace ocho meses escribí sobre este tema cuando todavía no había llegado al nivel judicial en el que se encuentra hoy. En ese momento, la discusión se movía entre decisiones administrativas, debates públicos y resistencias políticas. No era un asunto cerrado, pero tampoco había alcanzado el punto actual.
Hoy el escenario es distinto.
La organización Lambda Legal compareció ante el Tribunal de Apelaciones del Primer Circuito en Boston para solicitar que se confirme una decisión que obliga al gobierno de Puerto Rico a emitir certificados de nacimiento que reflejen la identidad de las personas no binarias. La apelación se produce luego de que un tribunal de distrito concluyera que negar esa posibilidad constituye una violación a la Constitución de Estados Unidos.
Este elemento marca la diferencia. Ya no se trata de una discusión conceptual. Existe una determinación judicial que identificó un trato desigual.
El planteamiento de la parte demandante se sostiene en el propio marco legal vigente en Puerto Rico. Los certificados de nacimiento de identidad no son registros históricos inmutables. Son documentos utilizados para fines actuales y esenciales. Permiten acceder a empleo, educación y servicios, y son requeridos en múltiples gestiones ante el Estado. Su función es operativa.
En ese contexto, la exclusión de las personas no binarias no responde a una limitación jurídica. Puerto Rico permite la corrección de marcadores de género en certificados de nacimiento para personas trans binarias desde el caso Arroyo González v. Rosselló Nevares. Además, el Código Civil reconoce la existencia de certificados que reflejan la identidad de la persona más allá del registro original.
La diferencia radica en la aplicación.
El reconocimiento se concede dentro de categorías específicas, mientras que se excluye a quienes no se identifican dentro de ese esquema. Esa exclusión es el eje de la controversia actual.
El argumento presentado por Lambda Legal es preciso. Obligar a una persona a utilizar documentos que no reflejan su identidad implica someterla a una representación incorrecta en procesos fundamentales de la vida cotidiana. Esto puede generar dificultades prácticas, exposición innecesaria y situaciones de vulnerabilidad.
Las personas demandantes, nacidas en Puerto Rico, han planteado que el acceso a documentos precisos no es una cuestión simbólica, sino una necesidad básica para poder desenvolverse sin contradicciones impuestas por el propio Estado.
El hecho de que este caso se encuentre en el sistema federal introduce una dimensión adicional. No se trata de un proyecto legislativo ni de una política pública en discusión. Es una controversia constitucional. El análisis gira en torno a derechos y a la aplicación equitativa de las leyes.
Este proceso tampoco ocurre en aislamiento.
Se desarrolla en un contexto donde los debates sobre identidad y derechos han estado marcados por una mayor presencia de posturas conservadoras en la esfera pública, tanto en Estados Unidos como en Puerto Rico. En el ámbito local, esa influencia ha sido visible en discusiones legislativas recientes, donde argumentos de carácter religioso han comenzado a formar parte del debate sobre política pública. Esa intersección introduce tensiones en torno a la separación entre iglesia y Estado y tiene efectos concretos en el acceso a derechos.
Señalar este contexto no implica cuestionar la fe ni la práctica religiosa. Implica reconocer que, cuando determinados argumentos se trasladan al ejercicio del poder público, pueden incidir en decisiones que afectan a sectores específicos de la población.
Desde Puerto Rico, esta situación no se observa a distancia. Se experimenta en la práctica diaria. En la necesidad de presentar documentos que no corresponden con la identidad de quien los porta. En las implicaciones que esto tiene en espacios laborales, educativos y administrativos.
El avance de este caso abre una posibilidad de cambio en el marco legal aplicable. No porque resuelva de inmediato todas las tensiones en torno al tema, sino porque establece un punto de análisis jurídico sobre una práctica que hasta ahora ha operado bajo criterios restrictivos.
A diferencia de hace ocho meses, el escenario actual incluye una determinación judicial que ya identificó una violación de derechos. Lo que corresponde ahora es evaluar si esa determinación se sostiene en una instancia superior.
Ese proceso no define un resultado inmediato, pero sí establece un nuevo punto de referencia.
El debate ya no es teórico.
Ahora es judicial.
New York
Court orders Pride flag to return to Stonewall
Lambda Legal, Washington Litigation Group filed federal lawsuit
The Pride flag will once again fly over the Stonewall National Monument in New York following a court order requiring the National Park Service to raise it over the site.
The decision follows a lawsuit filed by Lambda Legal and the Washington Litigation Group in the U.S. District Court for the Southern District of New York, which challenged the removal as unconstitutional under the Administrative Procedure Act and argued that the government unlawfully targeted the LGBTQ community.
In February, the NPS removed the Pride flag from the Stonewall National Monument, the first national monument dedicated to LGBTQ rights and history in the U.S. The move followed a Jan. 21 memorandum issued by President Donald Trump-appointed NPS Director Jessica Bowron restricting which flags may be flown at national parks. The directive limited displays to official government flags, with narrow exceptions for those deemed to serve an “official purpose.”
Plaintiffs successfully argued that the Pride flag meets that standard, given Stonewall’s status as the birthplace of the modern LGBTQ rights movement. They also contended that the policy violated the APA by bypassing required public input and improperly applying agency rules.
The lawsuit named Interior Secretary Doug Burgum, Bowron, and Amy Sebring, superintendent of Manhattan sites for the NPS, as defendants. Plaintiffs included the Gilbert Baker Foundation, Village Preservation, Equality New York, and several individuals.
The court found that the memorandum — while allowing limited exceptions for historical context purposes — was applied unlawfully in this case. As part of the settlement, the NPS is required to rehang the Pride flag on the monument’s official flagpole within seven days, where it will remain permanently.
“The sudden, arbitrary, and capricious removal of the Pride flag from the Stonewall National Monument was yet another act by this administration to erase the LGBTQ+ community,” said Karen Loewy, co-counsel for plaintiffs and Lambda Legal’s Senior Counsel and Director of Constitutional Law Practice. “Today, the government has pledged to restore this important symbol back to where it belongs.”
“This is a complete victory for our clients and for the LGBTQ+ community,” said Alexander Kristofcak, lead counsel for plaintiffs and a lawyer with Washington Litigation Group. “The government has acknowledged what we argued from day one: the Pride flag belongs at Stonewall. The flag will be restored and it will fly officially and permanently. And we will remain vigilant to ensure that the government sticks to the deal.”
“Gilbert Baker created the Rainbow Pride flag as a symbol of hope and liberation,” said Charles Beal, president of the Gilbert Baker Foundation. “Today, that symbol is restored to the place where it belongs, standing watch over the birthplace of the modern LGBTQ+ rights movement.”
“The government tried to erase an important symbol of the LGBTQ+ community, and the community said no,” said Amanda Babine, executive director of Equality New York. “Today’s accomplishment proves that when we stand together and fight back, we win.”
“The removal of the Pride flag from Stonewall was an attempt to erase LGBTQ+ history and undermine the rule of law,” said Andrew Berman, executive director of Village Preservation. “This settlement restores both.”
With Loewy on the complaint are Douglas F. Curtis, Camilla B. Taylor, Omar Gonzalez-Pagan, Kenneth D. Upton Jr., Jennifer C. Pizer, and Nephetari Smith from Lambda Legal. With Kristofcak on the complaint are Mary L. Dohrmann, Sydney Foster, Kyle Freeny, James I. Pearce, and Nathaniel Zelinsky from Washington Litigation Group.
Sri Lanka
Sri Lankan government withdraws support for LGBTQ tourism initiative
Prominent religious leaders criticized campaign
The Sri Lankan government has withdrawn its support for an initiative that encourages LGBTQ tourists to visit the country.
The Sri Lanka Tourism Development Authority last September partnered with Equal Ground, an LGBTQ rights group, on the initiative.
The Daily Mirror, a Sri Lankan newspaper, reported Sri Lanka Development Authority Chair Buddhika Hewawasam in a letter to Equal Ground Executive Director Rosanna Flamer-Caldera said his agency recognizes “the potential of this project to diversify our tourism markets and position Sri Lanka as a safe, inclusive, and welcoming destination for all travelers.”
Cardinal Malcolm Ranjith, the archbishop of Colombo, along other prominent Christian and Buddhist leaders criticized the initiative. Attorney General Parinda Ranasinghe on Feb. 10 indicated the Sri Lanka Tourism Development Authority had rescinded its support for the campaign.
Flamer-Caldera on April 10 acknowledged the criticism over the initiative but added “the fact that the letter has been rescinded doesn’t make any difference.”
“We’re still doing work with the tourism industry who have basically opened up to us and are willing participants in the project,” said Flamer-Caldera. “They realize the potential of the boost to our tourism industry as well as boosting our economy.”
Sections 365 and 365A of Sri Lanka’s colonial-era penal code criminalizes consensual same-sex sexual relations.
The U.N. Committee on the Elimination of Discrimination Against Women in 2022 ruled the criminalization law violated Flamer-Caldera’s rights. The Sri Lankan Supreme Court in 2023 said a bill that would decriminalize homosexuality is constitutional.
Transgender people in Sri Lanka since 2016 have been able to request a Gender Recognition Certificate that allows them to legally change their name and gender on ID cards. Flamer-Caldera noted to the Blade that LGBTQ rights opponents have challenged the Gender Recognition Certificate in the Supreme Court.
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