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Back in May 2016, the U.S. Department of Health and Human Services Office for Civil Rights (HHS OCR) made history by issuing a new rule which codifies nondiscrimination protections for lesbian, gay, bisexual, and transgender (LGBT) people in health facilities, programs, and activities receiving federal funding nationwide. Affordable Care Act Section 1557 forbids the prejudice against LGBT individuals in health insurance coverage and health care.

Despite the public acceptance of LGBT individuals over the past decade or so, these people and their families still face bigotry when seeking health coverage and care. These discriminatory experiences with the health industry have significant negative repercussions for the health and well-being of LGBT people and worsen the serious health issues plaguing the LGBT community.

“LGBT Americans face numerous barriers to health – from providers who just don’t understand their unique health needs, to difficulty getting health insurance because they can’t get coverage through a partner or a spouse,” noted former Secretary of Health and Human Services Kathleen Sebelius in an HHS OCR opinion letter in 2012. “And unfortunately way too many LGBT individuals face discrimination and bigotry in the health care system.”

The key provisions of the Affordable Car Act Section 1557 final ruling in relation to LGBT people include:

  • Protects transgender individuals on the basis of gender identity
  • Protects lesbian, gay, and bisexual individuals on the basis of sex stereotypes
  • No new religious exemption

Section 1557 prohibits any health facility or program which obtains federal funds from discriminating on the basis of race, color, national origin, age, disability, or sex. Cover entities under this ruling include any hospital and most health care providers that take part in Medicare or Medicaid, community health centers and other programs backed by the HHS, student health plans, state Basic Health Programs, state Children’s Health Insurance Programs (CHIP), Meaningful Use of Electronic Health Records payment recipients, health insurance plans which take part in insurance marketplaces in every state, as well as other programs.

The following are the definitions of the terms based on the “discrimination on the basis of sex”:

  • Gender identity – defined as a person’s internal sense of gender, such as male, female, neither, or a combination of both male and female, and which may be different from a person’s sex determined at birth. “Gender expression” is how a person expresses their gender identity and may or may not adhere to social stereotypes related to a specific gender.
  • Sex stereotypes – defined as the stereotypical notions of masculinity or femininity, such as how people represent or communicate their gender to others in regards to behavior, mannerisms, body characteristics, voice, fashion, hairstyles, or activities. These stereo types can include the expectation which individuals will identify with only one gender on a consistent basis, and that they will act in correlation with the gender-related expressions corresponding with that particular gender.

Whether the discrimination is coming from the design of the coverage or third-party administrators, HHS OCR now has the responsibility of enforcing these new LGBT protections. On the administrative side, an important aspect of enforcement will include adequate data collection on the demographic of individuals who file the complaints – regarding gender identity and sexual orientation – in order to keep track of trends and determine patterns in discrimination complaints. They must also cooperate with other entities, such as the Health Services and Resources Administration, to make sure theses rulings are executed properly.

For more information, contact Insurance Specialists, Inc. today!