When President Obama signed the Affordable Care Act (ACA) back in 2010, it became the first federal civil rights law to ban discrimination in healthcare settings based on a person’s gender.

However, the part of the “Obamacare” law that offers those protections isn’t very specific. This has led to some insurers, physicians, and hospitals denying coverage and care to transgender clients.

Situations like that may be a thing of a past, though, if the administration implements a rule change submitted by the Department of Health and Human Services (HHS) in early September.

This proposed rule adds some much-needed “meat to the bone” of a two-paragraph portion of the ACA. Those 60 or so words prohibit discrimination based on race, color, national origin, sex, age, or disability in certain healthcare settings.

Or, as HHS Secretary Sylvia Burwell said in a related press release, the rule “strengthen(s) protections for people who have often been subject to discrimination in our health care system.”

How the Rule Works

It does that — or will do it, once a final rule is issued — by protecting transgender people who:

  • Buy coverage through the federal health insurance marketplace or state exchanges,
  • Are patients of physicians, hospitals, or other care providers that HHS funds, or
  • Use any health program HHS administers

This rule doesn’t cover all providers or programs, however. Certain health plans are exempt. (Basically, ones sold by insurers that don’t offer marketplace plans or receive federal funds.) Also, it doesn’t include non-HHS programs like veterans’ and military health care.

Still, many applauded its introduction. That includes the Transgender Law Center’s Anand Kalra. “[This] is necessary to ensure that transgender people can expect the same quality of care as non-transgender people,” says the California-based org’s health program manager.

Many Important Protections

Some of the specific protections this rule offers transgender Americans:

  • Care providers and insurance companies can’t deny aid or coverage to someone because of their gender or gender identity
  • Those same entities must treat customers and patients consistent with their gender identity
  • Hospitals, physicians, and insurers can’t withhold or limit care to someone because they’re of the opposite gender
  • An example: they can’t refuse to treat a transgender man for ovarian cancer or give a transgender woman a prostate exam
  • Insurers are no longer allowed to decline coverage tied to gender transition across the board

If you’re transgender and you’re shopping for health insurance, let QuoteWizard help. We’ll put you in touch with multiple companies so you can compare quotes and get the best rates.

Why It is Needed

Why is this rule needed? For starters, a shocking number of insurance plans – 96 in 12 states, according to a recent National Women’s Law Center report – don’t meet the ACA’s non-discrimination standards.  

And then there are the following stats, gathered by the National Center for Transgender Equality (NCTE) and the National LGBTQ Task Force:

  • 28 percent of transgender people say they’ve been harassed at a doctor’s office or hospital
  • 28 percent have postponed medical care because they worry their provider will discriminate against them
  • 41 percent say they’ve attempted suicide

All of which explains why NCTE’s director, Mara Keisling, said earlier this year that the rule has "the potential to be life-saving for transgender people.”

Specifically, she said it will help “make the promise of the Affordable Care Act real for transgender people.” In other words, it’ll show “they can find affordable health insurance that covers the essential care they need and doesn’t exclude care simply because of who they are.”

Keisling also said she hopes the rule will “alleviate stress-related health conditions that all people have when they aren’t getting the care they need.”

Adds Kalra: “this rule provides relief. Knowing that life-saving care is covered removes a large amount of stress from the experience of seeking health care. Also, “improving access to care and quality of care improves short- and long-term health outcomes for transgender individuals.”

Still More to Be Done

Although Kalra acknowledges the rule “goes a long way,” he also says that more needs to be done. A case in point: “many transgender people continue to receive denials of coverage, or receive verbal information from customer service representatives that their treatments are not covered under their plan.”

As for what should be done to address those and other lingering issues, Kalra suggests “staff need adequate training. Payment processes need to be updated to prevent automatic denials. And provider networks need to be expanded to ensure network adequacy.”

The good news here is insurers that want to improve in this area have a lot of options. One of them, according to Kalra: “Medicare has billing code modifiers to account for mismatches between the gender marker on file and a gender-specific procedure.”

Another involves making use of resources close at hand. So many people in the industry have worked for years “to build and maintain system and human solutions to remaining issues” in this area, Kalra says.

On the flip side, if you’re a consumer and you need help finding a health insurance policy that covers the care you need, shop around. Talk with a number of companies and compare quotes. That will ensure you get the best rates.