Just hours after sending out clear guidelines against anti-transgender discrimination in schools, the Obama administration published another rule protecting trans people — this time in health care.
The US Department of Health and Human Services finalized the regulations for Section 1557 of Obamacare, which bans sex discrimination in health services and insurance. HHS says that bans on sex discrimination protect trans people, because discrimination based on gender identity is, fundamentally, discrimination over what people of certain sexes should be like. So it included trans people in its Section 1557 protections:
A covered entity shall provide individuals equal access to its health programs or activities without discrimination on the basis of sex; and a covered entity shall treat individuals consistent with their gender identity, except that a covered entity may not deny or limit health services that are ordinarily or exclusively available to individuals of one sex, to a transgender individual based on the fact that the individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available.
As Zack Ford reported for ThinkProgress, the rule also prevents insurers from excluding procedures related to transitioning:
A covered entity shall not, in providing or administering health-related insurance or other health-related coverage… Have or implement a categorical coverage exclusion or limitation for all health services related to gender transition; or otherwise deny or limit coverage, deny or limit coverage of a claim, or impose additional cost sharing or other limitations or restrictions on coverage, for specific health services related to gender transition if such denial, limitation, or restriction results in discrimination against a transgender individual.
The rule does not, however, explicitly ban discrimination based on sexual orientation. But HHS said it encourages gay, lesbian, or bisexual patients to report any discrimination they face, and the feds "will evaluate complaints that allege sex discrimination related to an individual's sexual orientation to determine if they involve the sorts of stereotyping that can be addressed under 1557."
Trans people face a lot of discrimination in health care
Although the lack of protections for sexual orientation disappointed LGBTQ advocates, they were quick to praise the provisions for trans people. There's good reason for that: Trans people face a lot of discrimination in medical settings.
In a 2010 national survey published by various LGBTQ groups, 19 percent of trans and gender nonconforming people said they were refused care because of their gender identity or expression, 28 percent said they were subjected to harassment in medical settings, and 2 percent said they were victims of violence in such settings. This led to delays in care for many people: 28 percent said they postponed medical care when they were sick or injured due to discrimination.
Previously, a patchwork of state laws had protected trans patients in a few states. But with this newly finalized rule, trans people will be protected in all 50 states.