Susan's Place Transgender Resources

Obamacare Prohibits Providers From Denying Health Care to Trans People


http://www.advocate.com/transgender/2016/5/13/obamacare-prohibits-providers-denying-health-care-trans-people

The Advocate.com
By Yezmin Villarreal
May 13 2016 9:17 PM EDT

Only a day after the federal Department of Education announced that Title IX protects transgender students, the U.S. Department of Health and Human Services announced Friday that health providers must provide transgender people with transition-affirmative health care.

The Nondiscrimination in Health Programs and Activities rule puts Section 1557 of the Affordable Care Act into effect. Section 1557 is "the first federal civil rights law to broadly prohibit discrimination on the basis of sex in federally funded health programs," says an HHS press release. Other laws enforced by the HHS Office of Civil Rights "broadly barred discrimination based only on race, color, national origin, disability, or age," the release notes.
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This ruling has long been awaited  and has several far reaching implications. Insurance companies in the Obamacare marketplace now must cover some transition services, i.e. HRT, counseling and GCS. No provider (hospital or physician) or insurance company who receives federal dollars can deny access to treatment. However,, what is still unclear is whether or not hospitals who receive federal dollars, whose employees are covered by health insurance by companies who also compete in the Obamacare Marketplace are required to cover their own employees for gender dysphoria care. Intuitively one would think yes, but not being a lawyer, I don't see any provisions clearly spelling that out. As a hospital employee whose current insurance prohibits transition related care, you could well say that I have a vested interest in these provisions. Interesting how this news was dropped the day after the school letters going out and how little coverage of these changes I've seen. 

Definitely good news and a major step.  This might actually make Obamacare more attractive for me than skipping insurance next year. 

It is great news. Here in Oregon the population is over $3Million and about 1.4 million are on the federal expanded medicare/medicaid. I was a bit surprised at that, but the state has for a long time, offered free health care for children if a family's income did not meet certain levels.

Now plans that are on the exchange at all even subsidized will have to provide these services. It will absolutely save lives.

Quote from: RobynD on May 16, 2016, 11:24:36 AM
It is great news. Here in Oregon the population is over $3Million and about 1.4 million are on the federal expanded medicare/medicaid. I was a bit surprised at that, but the state has for a long time, offered free health care for children if a family's income did not meet certain levels.

Now plans that are on the exchange at all even subsidized will have to provide these services. It will absolutely save lives.

The chair of our Lower Columbia Gender Alliance was part of the panel BRO created for the recent leadership conference in Eugene, Oregon.  She noted the acute absence and/or limited access to transgender related care in our rural areas.  Totally agree with you, this will save lives. 

I know we need to push for more but there is no doubt that the Obama administration features the first real and tangible recognition and support for transgender people at the federal government level in my lifetime.  Progress!

Sooo.... Tricare?  If they go along with this, that would open the door for the military.

Given my experience with my insurance company here in California I expect that the insurance companies will fight this tooth and nail. It might not be with a flat denial, but they can make it effectively impossible by requiring endless paperwork, endless internal approvals, and by causing endless delays. In California it has been the law that they have to cover us and yet I still had to file a complaint with the state insurance board to get my insurance to cover some of my therapy. Once the state board got onto them their tune changed pretty quickly.

From what I have read this kind of treatment of trans customers by insurance companies is not unusual.

If you can get your insurance company pay for your surgery I think that it would happen only be after a long, protracted, nasty fight. I hope that i'm wrong but knowing how slimy insurance companies are I would not be surprised if they fight this with underhanded tricks.

The AMA has accepted the fact that treating us is valid medical procedure. I'm sure the legal necessities become clear as this directive indicates. Proper treatment for many trans cases is minimal compared to many other courses of treatment for many medical maladies. I am hopeful that this will all fall under the medical necessity umbrella (and therefore covered by insurance) within the next few years. This political election could not be more important for our cause. For us, we should not worry whether we are liberal or conservative. Rather, we should be concerned over which administration will support us. I'm really tired of political debate focussing on issues that should be standard civil rights.

Humana which covers military families and retirees isn't covering anything.  I wonder if this directive will change that or if they will be excepted?


Sapere Aude

This article gives a good overview (http://transgenderlawcenter.org/archives/12908) of the new rule. It's going to be very hard for insurance companies, or state-run programs like Medicaid, to fight or get around it. That said, although the general anti-discrimination provisions of the rule will be in effect as of July 18, 2016, insurance companies will have considerably longer to comply: "If a covered health plan currently has exclusions, it has until the first day of the first plan year beginning January 1, 2017 to remove the exclusion."

There will no doubt be lawsuits challenging the rule from some of the, er, less progressive states like NC and Wisconsin. It's also possible that Congress may try to interfere by way of the legislative process.

This is a huge step in the right direction, but it ain't over. We need to keep fighting, and we ALL need to vote in November for candidates who support this!