LGBT Protections under the Affordable Care Act

The Patient Protection and Affordable Care Act (ACA), more commonly known as Triage Cancer Blog LGBT CancerObamacare, passed in 2010, but continues to evolve through rules issued by agencies such as the U.S. Department of Health and Human Services (HHS).

On May 13, 2016, the HHS Office for Civil Rights released a final rule that provides nationwide, nondiscrimination protections for members of the lesbian, gay, bisexual, and transgender community (LGBT), throughout federally-funded health care facilities, programs, and activities. Under the final rule, Section 1557 of the ACA extends protection against discrimination against LGBT people throughout the healthcare system. Previously, Section 1557 of ACA did not explicitly prohibit discrimination based on gender identity and sexual orientation.

Two key provisions clarified the protections for the LGBT community:

  1. Explicit protections for transgender individuals on the basis of gender identity.
    2. Explicit protections for lesbian, gay, and bisexual (LGB) individuals on the basis of sex stereotypes.

Provision One: Protections on the Basis of Gender Identity

Transgender people encompass approximately 0.3 percent of the United States population, or slightly under one million Americans in 2016. Transgender individuals’ gender identity, or their internal knowledge of their own gender, is different from the sex assigned to them at birth. Within the healthcare system, discrimination of transgender individuals on the basis of gender identity is massive, nearly 6,400 transgender and gender-nonconforming individuals reported discrimination, including being denied care, according to a 2011 study.

A health care provider now must provide medically necessary health care services to transgender individuals, as long as they are within the scope of the provider’s practice. Sex-specific services must be provided through Medicaid and private plans nationwide. Specifically, this applies to transgender men receiving cervical Pap tests and transgender women receiving prostate exams.

Provision Two: Protections on the Basis of Sex Stereotypes

The final rule does not define “sex” in Section 1557 to include sexual orientation; however, the rule expands the protections to LGB individuals to address the higher rates of discrimination in the health care setting. Health care providers are prohibited from discriminating against patients because of their sexual identity.

The rule also notes that protections against discrimination will continue to expand through the legal system. Currently, Equal Employment Opportunity Commission v. Scott Medical Health Center and Equal Employment Opportunity Commission v. Pallet Companies d/b/a IFCO Systems NA, Inc. are two of the federal circuit court cases fighting to expand the sex discrimination provision under Title VII of the Civil Rights Act to include sexual orientation discrimination.

In order to enforce the rule, HHS will take collect adequate demographic data on individuals filling complaints, to identify patterns in complaints of discrimination. HHS OCR will also need to work with other operating departments throughout HHS to maintain the enforcement of these protections. The goal of this final rule regarding Section 1557, is to continue the expansion of protections and provide healthcare services to more and more Americas under the Affordable Care Act.

For more information regarding LGBT+ healthcare, visit www.cdc.gov/lgbthealth.

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