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Xavier Becerra and Karine Jean-Pierre headline HHS Pride summit

Secretary said ‘Supporting the LGBTQI+ community is a top priority’

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U.S. Department of Health and Human Services Secretary Xavier Becerra at 2023 HHS Pride Summit (Screen capture/YouTube)

The U.S. Department of Health and Human Services held a Pride Summit on Monday that featured appearances by HHS Secretary Xavier Becerra and White House Press Secretary Karine Jean-Pierre.

Each delivering remarks about the administrationā€™s commitment to continuing its work fighting for LGBTQ Americans, they were joined at the event by other top officials from the Biden-Administration and other U.S. federal agencies including Assistant Secretary for Health Admiral Dr. Rachel Levine, White House Deputy National Mpox Coordinator Dr. Demetre Daskalakis, and Harold Phillips, director of the White Houseā€™s Office of National AIDS Policy.

ā€œSupporting the LGBTQI+ community is a top priority for me and HHS,ā€ said Becerra, who noted the agencyā€™s work to facilitate greater access to gender-affirming healthcare and on issues of health equity and access for the LGBTQ community more broadly.

ā€œWe are facing daunting challenges right now ā€“ with some politicians spewing hateful rhetoric and imposing restrictions against the LGBTQI+ community,ā€ the secretary said. However, ā€œthanks to the leadership of President Biden, I am confident we will make it through this moment.ā€

Especially right now, when the United States participates in international fora and urges other countries around the world to unequivocally support womenā€™s rights and ā€œhave protections for the LGBTQI+ community,ā€ the strength of those calls are compromised by Americaā€™s failures to live up to those commitments at home, Becerra said.

Therefore, he said, it is insufficient to merely protect the rights and freedoms currently in place: ā€œWeā€™re here because this game of defense can get tiring. We want offense.ā€

Taking the stage after Becerra, Jean-Pierre began her remarks by telling the audience, ā€œAs the first openly queer person to hold the position of press secretary, I have learned a lot this year.ā€ (She also holds the distinction of being the first Black person ever to serve in the role.)

ā€œOne thing I can say for sure being in my position is that representation matters,ā€ she said. ā€œIt matters at the White House podium. It matters in agencies like HHS. It matters who is sitting at the table making incredibly important policy decisions as we have seen through these last two years of this administration, especially as it relates to our community.ā€

Despite this progress, Jean-Pierre said, ā€œItā€™s been a scary year. A very difficult yearā€ in which ā€œover a dozen states have enacted anti-LGBTQ+ laws that violate our most basic values and freedoms as Americans,ā€ policies that are ā€œcareless,ā€ and ā€œcallous to our kids, our neighbors, and those in our community.ā€

The press secretary listed some of the Biden-Harris administrationā€™s accomplishments in advancing rights and protections for LGBTQ Americans as well as plans to continue that work in the face of major challenges facing the community, including from these harmful policies coming from state legislatures.

For example, she highlighted the White Houseā€™s announcement earlier this month of new actions to better protect LGBTQ youth and the communityā€™s physical safety. She noted these measures come in response to challenges ranging from the homelessness and mental health crises afflicting young LGBTQ people in America to the escalation of bias-motivated acts of violence.

Also in attendance at Mondayā€™s Summit were leaders from LGBTQ advocacy organizations including Human Rights Campaign President Kelley Robinson and National Center for Lesbian Rights Executive Director Imani Rupert-Gordon.

HHS issued a press release following the event in which the agency listed forthcoming actions on a variety of matters concerning health access and equity for the LGBTQ community: a Behavioral Health Care Advisory on Transgender and Gender Diverse Youth, which will serve as a resource for mental health providers; guidance for state child welfare agencies clarifying directives for them to support LGBTQ youth in their care, including by facilitating access to gender affirming medical treatments; advising providers of their right to deny requests for private patient information, including that which concerns these types of clinical care; and notice of proposed rulemaking that will codify legal protections under the Affordable Care Act for trans people in healthcare and health insurance coverage.

Additionally, on Tuesday, HHS debuted its FindSupport.Gov webpage, which features resources to help LGBTQ people find ā€œinclusive and affirming mental health care and support,ā€ including for problems with drugs and alcohol, along with guidance on how to avoid and deal with ā€œharmful approaches like ā€˜conversion therapy.ā€™ā€

This year, HHS kicked off Pride Month with a flag raising ceremony on June 1, which was followed by a string of appearances by Becerra at LGBTQ celebrations across the country, which included events focused on mental health and gender affirming care ā€” as well as the D.C. Pride parade, where the secretary marched with Levine and other HHS appointees and their families.

ā€œI have crossed the country,ā€ Becerra said during his remarks on Monday. ā€œI have met with trans teens to find out how we can serve them better. We have met with folks who have been attacked during Pride months. We have met with those who are seeing their children denied the gender affirming care that they need. And we know that those are our families. Those are our kids. Those are our teems in school. And so weā€™re gonna do everything we can.ā€

ā€œWhen we raised the flag earlier this month, it was interesting that in such a short order of time, I was no longer able to say we are the first and only agency who has claimed that flag at the very top of this building,ā€ he said. ā€œIt was great to see that we were joined by essentially the U.S. Federal Government, the Biden administration.ā€

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Federal Government

US Census Bureau testing survey on LGBTQ households

Agency proposing questions about sexual orientation and gender identity

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The U.S. Census Bureau headquarters in Suitland, Md. (Photo courtesy of the U.S. Census Bureau)

The U.S. Census BureauĀ is seeking public comment on a proposed test of sexual orientation and gender identity questions on the American Community Survey. The test would begin this summer and continue into next year.

The Census Bureau published the request as a Federal Register notice. In its press release the agency noted that the ACS is an ongoing survey that collects detailed housing and socioeconomic data. It allows the Census Bureau to provide timely and relevant housing and socioeconomic statistics, even for low levels of geography.

As part of the process for adding new questions to the ACS, the Census Bureau tests potential questions to evaluate the quality of the data collected.

The Census Bureau proposes testing questions about sexual orientation and gender identity to meet the needs of other federal agencies that have expressed interest in or have identified legal uses for the information, such as enforcing civil rights and equal employment measures.

The test would follow the protocols of the actual ACS ā€” with one person asked to respond to the survey on behalf of the entire household. These particular questions are asked about people 15 years of age or older. Households are invited to respond to the survey online, by paper questionnaire or by phone.

TheĀ current Federal Register noticeĀ gives the public a final opportunity to provide feedback before the Census Bureau submits its recommendations to the Office of Management and Budget for approval. The public may provide feedback through May 30Ā online.

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Federal Government

Republican state AGs challenge Biden administration’s revised Title IX policies

New rules protect LGBTQ students from discrimination

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U.S. Secretary of Education Miguel Cardona (Screen capture: AP/YouTube)

Four Republicans state attorneys general have sued the Biden-Harris administration over the U.S. Department of Education’s new Title IX policies that were finalized April 19 and carry anti-discrimination protections for LGBTQ students in public schools.

The lawsuit filed on Tuesday, which is led by the attorneys general of Kentucky and Tennessee, follows a pair of legal challenges from nine Republican states on Monday ā€” all contesting the administration’s interpretation that sex-based discrimination under the statute also covers that which is based on the victim’s sexual orientation or gender identity.

The administration also rolled back Trump-era rules governing how schools must respond to allegations of sexual harassment and sexual assault, which were widely perceived as biased in favor of the interests of those who are accused.

ā€œThe U.S. Department of Education has no authority to let boys into girlsā€™ locker rooms,ā€Ā Tennessee Attorney General Jonathan Skrmetti said in a statement. ā€œIn the decades since its adoption, Title IX has been universally understood to protect the privacy and safety of women in private spaces like locker rooms and bathrooms.”

“Florida is suing the Biden administration over its unlawful Title IX changes,” Florida Gov. Ron DeSantis wrote on social media. “Biden is abusing his constitutional authority to push an ideological agenda that harms women and girls and conflicts with the truth.”

After announcing the finalization of the department’s new rules, Education Secretary Miguel Cardona told reporters, ā€œThese regulations make it crystal clear that everyone can access schools that are safe, welcoming and that respect their rights.”

The new rule does not provide guidance on whether schools must allow transgender students to play on sports teams corresponding with their gender identity to comply with Title IX, a question that is addressed in a separate rule proposed by the agency in April.

LGBTQ and civil rights advocacy groups praised the changes. Lambda Legal issued a statement arguing the new rule ā€œprotects LGBTQ+ students from discrimination and other abuse,ā€Ā adding that it “appropriately underscores that Title IXā€™s civil rights protections clearly cover LGBTQ+ students, as well as survivors and pregnant and parenting students across race and gender identity.”

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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 stateā€™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 ā€œapply to everyone, not just transgender people.ā€ 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 ā€œapplying to straight, gay, lesbian, and bisexual people equally,ā€ 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, ā€œgender 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.ā€ 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 ā€œXX chromosomesā€ and ā€œXY chromosomesā€ to get around sex discrimination policies:

The 4th Circuit majority rebuts the stateā€™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 Actā€™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.Ā Twenty-one Republican statesĀ filed an amicus brief in favor of denying trans people anti-discrimination protections in healthcare, and 17 Democratic statesĀ 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 Circuitā€™s jurisdiction, West Virginia and North CarolinaĀ already have gender-affirming care bans for trans youth in place, andĀ 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 Carolinaā€™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, theĀ Supreme Court recently narrowedĀ 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, ā€œThe courtā€™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 ā€¦ 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.ā€ 

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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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