MAY 11 2015 8:27 PM ET
Following a celebrated March decision from a federal courtaffirming that the Affordable Care Act (also known as "Obamacare") prohibits discrimination against trans patients, the Department of Health and Human Services announced Monday that insurers are no longer allowed to deny patients, or require copayments or other charges, for preventive care based on their gender identity or birth gender, reports the New York Times.
HHS issued new guidelines, in part, after facing an increasing number of trans patients claiming discrimination from doctors and insurers who denied "sex-specific recommended preventive services," including screenings, tests, and other treatments for various medical issues, based on the fact that the gender listed on a patient's medical records differs from either their authentic gender identity or the treatment's intended gender group, according to the National Journal.
Breast cancer screenings, for instance, are just as necessary for cisgender (nontrans) and transgender women over age 50, but can often be denied coverage by insurers if a woman's birth gender is listed as "male," notes the Journal. Alternatively, for example, certain trans men are unique among men for potentially needing cervical cancer screenings, but could be denied coverage if they had previously updated their medical records to reflect their authentic male gender.
The HHS guidelines also address other forms of sex-based discrimination, requiring insurers to cover all forms of female contraception and genetic testing for people with certain histories of breast or ovarian cancers.
Such previous holes in coverage, compounded by a poverty rate among trans populations that averages four to six times that of the cisgender population, have amplified health disparities faced by trans patients. With HHS's Monday announcement, insurers will now be required to cover any preventive treatment recommended by a patient's healthcare provider.
While the decision is a much-needed affirmation to trans advocates that preventive care should be based on body parts rather than gender identity, the federal government has yet to demand that insurers cover all medically necessary transition-related care, including talk therapy, hormone therapy, and gender-affirming surgeries. Thus far, only New York, California, Colorado, Connecticut, the District of Columbia, Massachusetts, Oregon, Washington, and Vermonthave eliminated statewide barriers to trans-inclusive health insurance.
Obamacare has, however, made it illegal since 2013 for insurance companies to deny coverage to anyone for a "pre-existing condition," including "gender dysphoria" — a clinical diagnosis received by many trans people.
Today, less than a year after the DC Department of Insurance, Securities, and Banking (DISB) issued a bulletin clarifying the meaning of gender identity nondiscrimination in insurance, Mayor Vincent Gray announced additional standards for health coverage that will improve health care access for transgender people in the District of Columbia.
Following today’s announcement, the District will have the most comprehensive policy in the nation when it comes to providing transgender people with the health care that they need to live healthy and authentic lives — including coverage for transition-related care. The policy applies to nearly all public and private plans throughout D.C., including:
- Individual, small group, and large group private market plans. This includes all plans sold through the DC Health Link, which is the Marketplace established for the district under the Affordable Care Act. The only exception is self-insured employer plans, which are regulated by ERISA.
- D.C. Medicaid. Medicaid coverage is particularly important for transgender residents in the District because, as Dr. Linda Elam remarked at the Mayor’s press conference, D.C.’s Medicaid program insures nearly one third of the District’s residents.
- D.C. government employee plans . The District now joins the many employers — both government and private — who offer comprehensive coverage to transgender employees.
With today’s announcement, DC joins the increasing number of states, municipalities, and employers who recognize that equal access to health coverage is supported by medical science, improves the health of transgender people, and does not significantly increase costs.
In fact, the District’s policy may serve as a model for other states recognizing the importance of equal access to health coverage for transgender people. The standards articulated in the announcement today expressly tie the coverage that must be provided to transgender people to standards of care established by medical experts in the World Professional Association for Transgender Health (WPATH). By adopting the WPATH standards as the guidelines for medical necessity, DC policymakers have taken the important step of recognizing that the determination of what care transgender people need is best made by patients in consultation with their medical providers, rather than by insurance companies.
This groundbreaking policy is the direct result of partnership between Mayor Gray’s administration and advocates with the National Center for Transgender Equality, the Center for American Progress, and transgender residents of the District. It also follows years of work from local advocacy organizations, including the DC Trans Coalition, Casa Ruby, Gay and Lesbian Activists Alliance, Whitman Walker Health, and the Gertrude Stein Democratic Club.
Andrew Cray is a Policy Analyst for the LGBT Research and Communications Project at the Center for American Progress