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Obama admin says insurers can’t discriminate against gay unions

Prohibits discrimination even in non-marriage equality states

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Centers for Medicare & Medicaid Services, gay news, Washington Blade
Centers for Medicare & Medicaid Services, gay news, Washington Blade

The Centers for Medicare & Medicaid has issued guidance clarifying insurers can’t discriminate against same-sex couples. (Image public domain)

The Obama administration clarified on Friday that insurers are prohibited from discriminating against same-sex marriages for the purposes of non-grandfathered family coverage — even if applicants are applying in non-marriage equality states.

In guidance dated March 14, the Centers for Medicare & Medicaid says existing provisions in the health care reform law prohibiting discrimination by insurers on the basis of gender — which the Obama administration has interpreted to extend non-discrimination protections based on sexual orientation and gender identity — also requires insurers not to refuse family coverage for married same-sex couples.

The guidance is set up as Q&A. The question is “If a health insurance issuer in the group or individual market offers coverage of an opposite-sex spouse, may the issuer refuse to offer coverage of a same-sex spouse?” The response starts off simply, “No.”

“This section prohibits an issuer from choosing to decline to offer to a plan sponsor (or individual in the individual market) the option to cover same-sex spouses under the coverage on the same terms and conditions as opposite sex-spouses,” the guidance states.

Alicia Hartinger, a CMS spokesperson, said the guidance spells out that non-discrimination is the rule for insurers — both on and off the health insurance exchanges — when selling policies.

“CMS recognizes the importance of all Americans and their families having access to quality, affordable coverage,” Hartinger said. “Today’s guidance clarifies that issuers may not choose to treat same-sex spouses differently from opposite-sex spouses. If an issuer offers opposite-sex spouse coverage, it may not choose to deny the same coverage to a same-sex spouse. We will continue to work with states and issuers to help ensure all Americans have an equal opportunity to purchase the new coverage options available to them.”

The guidance says insurers cannot refuse family coverage to married same-sex couples even if they live in — or the insurance is sold in — a non-marriage equality state that doesn’t recognize those unions.

Additionally, the guidance acknowledges insurers may not have realized this prohibition when designing their policies for the 2014 coverage year. Accordingly, while encouraging immediate compliance, CMS says insurers need not begin adhering to this policy until Jan. 1, 2015. The guidance also directs states to begin enforcing the regulations no later than Jan. 1, 2015.

The guidance doesn’t address whether it requires CMS to provide coverage to same-sex couples in domestic partnerships or civil unions. A CMS official said the guidance applies only to marriages, not these other unions.

LGBT advocates praised the new guidance as a step toward ensuring that married same-sex couples have the same access to health insurance as their opposite-sex counterparts.

Rea Carey, executive director of the National Gay & Lesbian Task Force, earlier said her group wanted the Obama administration to make the clarification and upon news of the guidance said it would help same-sex couples “hurting right now” because they were denied health insurance.

“Today’s important HHS announcement will help remove this type of discrimination by requiring the health insurance industry to treat us the same as straight married couples — even if the states where we live do not recognize marriage equality,” Carey said. “While insurers are not required to be in compliance with the new rules until January 2015, we urge the industry to act now — as affordable health care delayed is affordable health care denied.”

There have been reported incidents of married gay couples being unable to receive family coverage in the aftermath of the implementation of the Affordable Care Act. In February, a gay couple — Alfred Cowger and Anthony Wesley of Gates Mills, Ohio — filed a federal lawsuit charging that they were unable to obtain family coverage because their state doesn’t recognize their marriage.

In January, Blue Cross and Blue Shield canceled family insurance policies it sold to same-sex couples under the Affordable Care Act in North Carolina. Following news reports about the cancellations, the insurer changed course and agreed to offer family coverage on the health insurance exchange to same-sex couples.

Kellan Baker, director of the LGBT State Exchanges Project for the Center for American Progress, said the new guidance is important because research shows LGBT families have trouble accessing health insurance.

“Research has shown that same-sex couples, as well as transgender people and other members of the lesbian, gay, bisexual, and transgender, or LGBT, communities, frequently face obstacles to affordable, comprehensive insurance coverage,” Baker said. “My colleagues and I look forward to working with HHS to ensure that this guidance is fully implemented in a timely manner and that similar action is taken to remove other barriers to coverage, such as discriminatory insurance exclusions that target transgender people.”

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District of Columbia

As You Are bar closes temporarily, citing problems with building

Shutdown comes two months after fundraising appeal brought in $170,000

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As You Are is temporarily closed. (Washington Blade file photo by Michael Key)

As You Are, the LGBTQ café and bar located in the Barracks Row section of Capitol Hill near the Eastern Market Metro station, has announced on its Instagram page that problems associated with its building at 500 8th St., S.E., forced it to “temporarily” close on April 8.

“As you may be aware, As You Are’s location in Eastern Market has been closed since April 8, when we began to have concerns about the physical condition of the building,” the Instagram message states. “We worked quickly to alert our landlord, and they have assessed the building with their engineers,” the message says.

“We understand that certain repairs need to be made to ensure the safety of our staff, patrons, and community,” the message concludes.

In one of two more recent videos posted on Instagram on April 17 and 26, As You Are co-owners Jo McDaniel and Rachel Pike said they did not have any update on when they can reopen. “The engineers and contractors have all come into the space, and we’re just waiting on a plan and a timeline from our landlord,” McDaniel said in the video.

Pike mentioned in one of the videos that As You Are has a Venmo app set up, and said they appreciate the support they have been receiving from the community. McDaniel added, “We’re really interested in supporting our team through this, as this is an unexpected loss of income for all of us.”

McDaniel didn’t immediately respond to a request from the Washington Blade for a further update on where things stand with the building repair project and the specific nature of the problems with the building. An earlier message posted on the As You Are website said, “Heavy rain damaged the back wall of our building, and we are closed to assess and repair.”

The message added, “Regular updates and ways to support can be found on our Instagram page @asyouaredc.”

The April 8 shutdown came a little over two months after As You Are issued a GoFundMe appeal on Feb. 5 seeking emergency financial support to prevent it from closing in February due to a $150,000 debt. In a display of strong community support, its $150,000 fundraising goal was reached in less than a week. By the following week, the GoFundMe appeal had pulled in more than $170,000 from more than 3,000 individual donations.

Many of the donors left messages on the GoFundMe page for As You Are expressing their strong support for the bar and café, saying it served as a uniquely supportive space for all members of the LGBTQ community.

In the GoFundMe message, McDaniel and Pike said their goal in opening their business in March 2022 was to offer community center type programming beyond just a bar and café.

“AYA is a café, bar and dance floor that hosts diverse programming nearly every night of the week, including social sport leagues, Queer youth socials, weekly karaoke, book clubs, open mics, Queer author events, dance parties, and much more,” the two said in their message. 

The building’s owner and the As You Are landlord, Rueben Bajaj, who is the principal operator of the Bethesda, Md., based real estate firm White Star Investments, couldn’t immediately be reached for comment. The Washington Post reported that he contributed $500 to the As You Are GoFundMe appeal, saying, “I personally want to see As You Are succeed.”

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World

New World Bank US executive director: LGBTQ rights are human rights

Felice Gorordo assumed role last year

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Acting U.S. World Bank Executive Director L. Felice Gorordo (Photo courtesy of Gorordo)

Acting U.S. World Bank Executive Director L. Felice Gorordo recently told the Washington Blade that he is committed to the advancement of LGBTQ and intersex rights within the multilateral organization.

“LGBTQI+ rights are human rights and human rights are LGBTQI+ rights. Period. Hard stop,” he said during an exclusive interview at his D.C. office on March 27. “I see it, personally, from a human rights promotion lens.”

Gorordo, a Cuban American who was born in Miami, graduated from Georgetown University in 2005.

He co-founded Roots of Hope, an organization that seeks to empower young Cubans on the island through entrepreneurship and increased access to technology. 

Gorordo served in various roles in both the Obama and George W. Bush administrations, and served as advisor to then-Vice President Joe Biden’s cancer initiative after his mother died from pancreatic cancer.

He has also been the CEO of three-venture backed technology companies, an investor and advisor at two venture capital funds with focuses on global healthcare and infrastructure, and has sat on the boards of several for- and non-profit organizations. Gorordo was most recently the CEO of eMerge Americas and executive director of the Technology Foundation of the Americas before the U.S. Senate confirmed him in May 2023.

He has been the World Bank’s acting U.S. executive director since Adriana Kugler joined the Federal Reserve Board.

Gorordo, 41, throughout the interview referenced the Biden-Harris administration’s 2021 memo that committed the U.S. to promoting LGBTQ and intersex rights abroad as part of U.S. foreign policy.

“It starts off with us at the bank trying to build demand for the issues related to LGBTQI+ rights and people,” he said. “It’s about protecting LGBTQI+ rights in and outside of World Bank operations and projects and supporting LGBTQI+ people and rights inside and outside of our projects through inclusion. It’s using our voice and vote at every chance that we get to advance LGBTQI+ people.”

Gorordo pointed out his office reviews roughly 700 projects a year for the World Bank, and they have an average of $90-$100 billion in financial commitments. He said there is a “pretty extensive review process for due diligence” with criteria that include environmental and social frameworks and bank safeguards (that currently do not explicitly include sexual orientation or gender identity.)

“We take a critical lens at each one that it lives up to the values that we want to promote, and that includes looking at it through the lens of LGBTQI+ rights,” said Gorordo.

One LGBTQ-inclusive project is the World Bank International Finance Corporation’s $275 million loan to Banco Davivienda in Colombia, which provides funding for advisory services to LGBTQ and intersex people and for the design of LGBTQ and intersex banking products. The board in 2023 greenlighted $200 million for the Program for Universal Primary Healthcare Coverage and Resilience which, among other things, seeks to improve the quality of healthcare that LGBTQ and intersex people receive in Chile.

The World Bank’s EQOSOGI Project has already collected LGBTQ- and intersex-specific data on legal gaps as well as practices that impact LGBTQ and intersex people in 16 countries, and it plans to expand its work to other nations in 2024. The World Bank is also expanding its research on the economic costs of discrimination based on sexual orientation and gender identity. 

The first studies focused on Serbia and North Macedonia, and found both countries’ annual gross domestic product would increase by .6 percent if LGBTQ and intersex people faced less discrimination in the workplace. A study that will focus on Brazil will be released later this year.

“There’s always more we can do,” Gorordo told the Blade. “What we believe we need to do, again, using our convening power and our voice and our vote is to help build because in the end we are still a demand-driven organization.” 

“We need to use our research and the data, in my opinion, our opinion, to help generate the demand for LGBTQI rights to be enshrined in our safeguards, in our strategies and in every single one of our products and the data speaks for itself,” he added.

Gorordo also noted the bank in the coming months will release a new gender strategy that recognizes gender as nonbinary.

“That’s a big step,” he said.

Gorordo described World Bank President Ajay Banga as “a champion of the rights of all, including LGBTQI+ people.” Gorordo, however, acknowledged there has been “some pushback from certain constituencies that have different views and opinions than ours” on the new gender strategy and support for LGBTQ and intersex rights.

“I see it as my responsibility to not just advocate for it in the board room or with management, but also using my office and chair to meet with other chairs bilaterally, to make the case for it, to try and bring folks along with us,” he added.

Uganda’s Anti-Homosexuality Act ‘needs to be struck down and repealed’

The World Bank last August suspended new loans to Uganda in response to the country’s Anti-Homosexuality Act that President Yoweri Museveni signed.

Uganda’s Constitutional Court earlier this month refused to nullify the law. A group of Ugandan LGBTQ activists have appealed the ruling.

“The law needs to be struck down and repealed. Hard stop,” said Gorordo. “We continue to advocate for that.”

Then-World Bank President Jim Yong Kim in 2014 postponed a $90 million loan to the Ugandan government in response to Museveni’s decision to sign a nearly identical version of the Anti-Homosexuality Act, known as the “Kill the Gays” law that imposed a life sentence upon anyone found guilty of repeated same-sex sexual acts. 

Uganda’s Constitutional Court later struck down the law on a technicality, but Kim’s decision to postpone the loan without first consulting the World Bank’s board sparked widespread criticism among board members. Advocacy groups had asked the World Bank not to fund future projects in Uganda, but they did not ask for the cancellation of existing loans.

The World Bank earlier this year organized a seminar with the Human Rights Promotion Forum of Uganda that upwards of 50 people attended virtually and in person.

“One of the things that I think is incredibly critical is hearing directly from those we seek to serve and who are being impacted by these discriminatory laws,” said Gorordo.

Gorordo said the World Bank in lieu of the law’s repeal has “been doing a review of mitigation efforts” that includes “a three-month trial period once there is an agreement of what those mitigation efforts would be, to see if they are fit for purpose.” 

“At the crux of it includes the protection as well as the equal access of benefits for LGBTQ communities in Uganda. If it is not fit for purpose, then we have to go back to the drawing board., So we will continue to push for the strictest mitigation measures that can be put into place, a very critical review through that process … and ensuring that we are able to guarantee equal access and protection for the LGBTQ community.”

Ghanaian President Nana Akufo-Addo has delayed a decision on whether he will sign a bill that would further criminalize LGBTQ people in his country. Lawmakers in Kenya and Tanzania have proposed similar measures.

“One of the reasons why we’ve taken such a critical view of the Uganda case is this is potentially one of many of these types of cases that we’ll have to deal with,” said Gorordo. “What we do in Uganda could have a ripple effect in other countries and we need to ensure that we are setting the right precedents for how we react in these cases.”

Gorordo further noted consensual same-sex sexual relations remain criminalized in upwards of 60 countries around the world.

“The discrimination that’s against LGBTQI+ people is unacceptable across the board,” he said. “We will use all the tools in the U.S. government’s toolbox to be able to make it known our objection and to try and stop discrimination and protect the rights of LGBTQ+ people every chance we get.”

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Federal Government

4th Circuit rules gender identity is a protected characteristic

Ruling a response to N.C., W.Va. legal challenges

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Lewis F. Powell Jr. Courthouse in Richmond, Va. (Photo courtesy of the U.S. Courts/GSA)

BY ERIN REED | The 4th U.S. Circuit Court of Appeals ruled Monday that transgender people are a protected class and that Medicaid bans on trans care are unconstitutional.

Furthermore, the court ruled that discriminating based on a diagnosis of gender dysphoria is discrimination based on gender identity and sex. The ruling is in response to lower court challenges against state laws and policies in North Carolina and West Virginia that prevent trans people on state plans or Medicaid from obtaining coverage for gender-affirming care; those lower courts found such exclusions unconstitutional.

In issuing the final ruling, the 4th Circuit declared that trans exclusions were “obviously discriminatory” and were “in violation of the equal protection clause” of the Constitution, upholding lower court rulings that barred the discriminatory exclusions.

The 4th Circuit ruling focused on two cases in states within its jurisdiction: North Carolina and West Virginia. In North Carolina, trans state employees who rely on the State Health Plan were unable to use it to obtain gender-affirming care for gender dysphoria diagnoses.

In West Virginia, a similar exclusion applied to those on the state’s Medicaid plan for surgeries related to a diagnosis of gender dysphoria. Both exclusions were overturned by lower courts, and both states appealed to the 4th Circuit.

Attorneys for the states had argued that the policies were not discriminatory because the exclusions for gender affirming care “apply to everyone, not just transgender people.” The majority of the court, however, struck down such a claim, pointing to several other cases where such arguments break down, such as same-sex marriage bans “applying to straight, gay, lesbian, and bisexual people equally,” even though straight people would be entirely unaffected by such bans.

Other cases cited included literacy tests, a tax on wearing kippot for Jewish people, and interracial marriage in Loving v. Virginia.

See this portion of the court analysis here:

4th Circuit rules against legal argument that trans treatment bans do not discriminate against trans people because ‘they apply to everyone.’

Of particular note in the majority opinion was a section on Geduldig v. Aiello that seemed laser-targeted toward an eventual U.S. Supreme Court decision on discriminatory policies targeting trans people. Geduldig v. Aiello, a 1974 ruling, determined that pregnancy discrimination is not inherently sex discrimination because it does not “classify on sex,” but rather, on pregnancy status.

Using similar arguments, the states claimed that gender affirming care exclusions did not classify or discriminate based on trans status or sex, but rather, on a diagnosis of gender dysphoria and treatments to alleviate that dysphoria.

The majority was unconvinced, ruling, “gender dysphoria is so intimately related to transgender status as to be virtually indistinguishable from it. The excluded treatments aim at addressing incongruity between sex assigned at birth and gender identity, the very heart of transgender status.” In doing so, the majority cited several cases, many from after Geduldig was decided.

Notably, Geduldig was cited in both the 6th and 11th Circuit decisions upholding gender affirming care bans in a handful of states.

The court also pointed to the potentially ridiculous conclusions that strict readings of what counts as proxy discrimination could lead to, such as if legislators attempted to use “XX chromosomes” and “XY chromosomes” to get around sex discrimination policies:

The 4th Circuit majority rebuts the state’s proxy discrimination argument.

Importantly, the court also rebutted recent arguments that Bostock applies only to “limited Title VII claims involving employers who fired” LGBTQ employees, and not to Title IX, which the Affordable Care Act’s anti-discrimination mandate references. The majority stated that this is not the case, and that there is “nothing in Bostock to suggest the holding was that narrow.”

Ultimately, the court ruled that the exclusions on trans care violate the Equal Protection Clause of the Constitution. The court also ruled that the West Virginia Medicaid Program violates the Medicaid Act and the anti-discrimination provisions of the Affordable Care Act.

Additionally, the court upheld the dismissal of anti-trans expert testimony for lacking relevant expertise. West Virginia and North Carolina must end trans care exclusions in line with earlier district court decisions.

The decision will likely have nationwide impacts on court cases in other districts. The case had become a major battleground for trans rights, with dozens of states filing amicus briefs in favor or against the protection of the equal process rights of trans people. Twenty-one Republican states filed an amicus brief in favor of denying trans people anti-discrimination protections in healthcare, and 17 Democratic states joined an amicus brief in support of the healthcare rights of trans individuals.

Many Republican states are defending anti-trans laws that discriminate against trans people by banning or limiting gender-affirming care. These laws could come under threat if the legal rationale used in this decision is adopted by other circuits. In the 4th Circuit’s jurisdiction, West Virginia and North Carolina already have gender-affirming care bans for trans youth in place, and South Carolina may consider a similar bill this week.

The decision could potentially be used as precedent to challenge all of those laws in the near future and to deter South Carolina’s bill from passing into law.

The decision is the latest in a web of legal battles concerning trans people. Earlier this month, the 4th Circuit also reversed a sports ban in West Virginia, ruling that Title IX protects trans student athletes. However, the Supreme Court recently narrowed a victory for trans healthcare from the 9th U.S. Circuit Court of Appeals and allowed Idaho to continue enforcing its ban on gender-affirming care for everyone except the two plaintiffs in the case.

Importantly, that decision was not about the constitutionality of gender-affirming care, but the limits of temporary injunctions in the early stages of a constitutional challenge to discriminatory state laws. It is likely that the Supreme Court will ultimately hear cases on this topic in the near future.

Celebrating the victory, Lambda Legal Counsel and Health Care Strategist Omar Gonzalez-Pagan said in a posted statement, “The court’s decision sends a clear message that gender-affirming care is critical medical care for transgender people and that denying it is harmful and unlawful … We hope this decision makes it clear to policy makers across the country that health care decisions belong to patients, their families, and their doctors, not to politicians.” 

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Erin Reed is a transgender woman (she/her pronouns) and researcher who tracks anti-LGBTQ+ legislation around the world and helps people become better advocates for their queer family, friends, colleagues, and community. Reed also is a social media consultant and public speaker.

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The preceding article was first published at Erin In The Morning and is republished with permission.

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