The Trump administration has proposed a rule that would allow insurers and health care providers to discriminate against transgender patients, making it even more difficult for transgender people to find accessible, inclusive healthcare in the United States.
The Department of Health and Human Services (HHS) should reject the proposed rule, which would narrow how the department defines sex discrimination.
During the Obama administration, HHS clarified that discrimination based on gender identity, sex stereotypes, pregnancy, and termination of pregnancy are forms of sex discrimination, and are prohibited under the Affordable Care Act. That meant insurers couldn’t refuse to insure someone, raise their rates, or deny them coverage for certain forms of health care simply because they’re transgender, and providers couldn’t turn away or mistreat transgender patients.
A federal judge in Texas put some of these protections on hold in 2016 in response to a court challenge, and the Trump administration has declined to defend them in court. It now plans to claw them back altogether – at the expense of LGBT and pregnant patients.
Human Rights Watch has documented the difficulties transgender people in the US face when seeking health care providers who offer the services they need without discriminating or making them feel unwelcome. People described struggling to obtain insurance for basic health care needs, traveling hours to find welcoming providers, and being mocked or humiliated by medical personnel or refused service outright. The proposed rule would make it even harder to change this harmful status quo.
Without federal protections, individuals have to look to states for protection – and the landscape is bleak. Only 14 states and the District of Columbia expressly prohibit private insurers from discriminating on the basis of gender identity, while only 20 states and the District of Columbia ban them from offering plans that categorically deny coverage for transition-related care. The impact of the federal rollback will be swiftly felt in places such as Iowa, where lawmakers recently overrode a court decision prohibiting health care discrimination by expressly excluding transition-related care from the state’s Medicaid policy.
Eliminating existing protections would put transgender people and pregnant people at risk. The Trump administration should keep these vital safeguards in place, instead of bending over backwards to stop the federal government from fighting discrimination.
