Trump Threatens Trans Health Care

The Trump Administration plans to quietly undo a regulation banning healthcare providers and insurers from discriminating against trans patients, according a report in The Hill.

To this day, no federal law explicitly prohibits health care discrimination against LGBTQ people (and while we’re at it, no federal law explicitly prohibits employment or housing discrimination either). And we need one, badly. A 2010 survey found that more than half of LGBTQ people reported experiencing discrimination from their healthcare providers, such as being demeaned or harassed, blamed for their health status, or being straight up denied medically necessary care. Transgender people are especially at risk: in 2015, one in four trans people reported that they faced discrimination from their insurers over the course of a single year, including being denied insurance coverage just because of their gender identity.

Trans people should have clear, statutory protections from discrimination. But even without them, transgender patients have rights stemming from the Affordable Care Act’s nondiscrimination provision, Section 1557.

Section 1557 prohibits any federally-funded health care provider (including insurers, hospitals, and individual doctors) from discriminating against patients on the basis of race, national origin, disability, or sex. As more and more federal courts are recognizing, discriminating against someone on the basis of their gender identity can be sex-stereotyping and thus sex discrimination. In other words, laws banning sex discrimination, courts say, also protect trans people.

The Obama Administration affirmed that principle by issuing regulations clarifying these protections: the regulations explicitly banned anti-trans discrimination in healthcare, as well as many other kinds of anti-queer discrimination and discrimination against people who have had an abortion in the past. Contrary to conservative fear-mongering, these rules don’t require any individual doctor to perform gender-reassignment surgery (duh – no one wants doctors to perform surgeries they’re not trained for). What the Department of Health and Human Services’ (HHS) nondiscrimination rules do require is that doctors don’t deny their patient medically necessary care because they’re trans and that insurers cover trans people’s healthcare equally.

Now, the Trump Administration intends to undo that progress. HHS – run by the notoriously anti-LGBTQ Tom Price – scrubbed info on trans patients’ rights from its website in March. The Administration said in court filings that its “re-considering” the nondiscrimination regulations, and the Hill reports the Administration wants to roll back them back in the near future.

Let’s be clear: health care discrimination is quite literally life-threatening. Just ask Jay Kallio, a trans man whose doctor withheld information about his  “very aggressive” breast cancer, apparently because the doctor had “a real problem with [Jay’s] transgender status.” By rolling back these regulations, the Administration would actively enable such discrimination that could cost transgender people their lives.

Conservatives contend it’s an unfair government overreach to ask healthcare providers to treat trans patients, who are putting their lives in their doctors’ hands, equally. But if you ask me, if you’re a doctor or hospital administrator who has a problem giving a trans man their cancer diagnosis, you should get another job, and you definitely shouldn’t get taxpayer money.

The other common conservative complaint is that nondiscrimination regulations also require insurers to cover transition-related care, like hormones. Republicans (and insurance companies) say that transition-related care is “unnecessary,” when nothing could be further from the truth; despite the problematic pathologization inherent in the “gender dysphoria” diagnosis, both courts and medical experts recognize that treatment is a “serious medical need.” By making it easier for insurers to drop transgender people’s coverage, the Right is sending the explicit message that trans people’s health care is unnecessary, burdensome, and disposable – and their implicit message is that their dignity and survival is too. It’s the same message Trump sent when he banned trans people from the military.

The good news is that, as important as these regulations are for helping healthcare providers understand their obligations, trans people’s rights don’t stem from the regulations, they stem from the statute itself. As long as Section 1557 stays on the books, trans patients have rights. So listen up, insurers – no matter what the Trump Administration does, if you discriminate, trans patients can and will see you in court.


Photo credit: National Center for Transgender Equality

Sejal Singh is a columnist at Feministing, where she writes about educational equity, labor, and reproductive justice. Sejal is a Policy and Advocacy Coordinator for Know Your IX, a national campaign to end gender-based violence in schools, where she has led several state and federal campaigns for student survivors' civil rights. In the past, Sejal led LGBT rights campaigns for the Center for American Progress. Today, she is a student at Harvard Law School and a frequent speaker on LGBTQ rights and civil rights in schools.

Sejal Singh is a law student and columnist at Feministing, writing about educational equity, labor, and reproductive justice.

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