T

he Affordable Care Act (ACA) may soon include specific language to protect transgender patients against discrimination in medical care. The Department of Health and Human Services (HHS) is proposing to add “gender identity” to the law’s nondiscrimination provisions. The public comment period ended this week, and now the HHS Office for Civil Rights is drafting a final proposal.

The proposed rule adds specifics to ACA nondiscrimination rules in effect since 2010. It ensures that all consumers have equal access to health care provided by the legislation. Specifically, it puts in place stronger protections for people whose access to health care has been limited. People with disabilities or with limited English proficiency will now have assistance with their communication needs in health care settings, for example.

The proposed rule also strongly prohibits gender identity discrimination, defining it as a form of sex discrimination. This change means that health care providers receiving HHS funding — through Medicaid, Medicare, or state health care marketplaces — cannot withhold or otherwise limit access to treatment on the basis of a patient’s gender, regardless of whether the patient was born with that gender.  

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The new rule could make a difference for many people like Myles Dinnen, 36, of Philadelphia. He recalled his experience with a county health department in Pennsylvania at a time when he didn’t have insurance coverage.

“I went to get a pelvic exam,” said Dinnen, a transgender man. “But the person who saw me was kind of accusatory, like I was doing something wrong by being trans. And yet she was examining a very intimate part of my body.”

After that, Dinnen added, “Mostly I avoided going back there.”

A study published in the May 2015 issue of the journal Health and Social Work showed that over 40 percent of transgender men — those transitioning from female to male — reported verbal harassment, physical assault, or denial of equal treatment in a doctor’s office or hospital. Such experiences often keep them from seeking medical care.

“If the number of trans exclusions falls as a result of this rule change, that would be a huge victory,” said Jaime Grant, director of the Global Trans Research and Advocacy Project. She is also the lead author of “Injustice at Every Turn,” a 2011 report on the results the National Transgender Discrimination Survey.

“In states where gender-affirming procedures are covered, life is a lot better for trans folks,” Grant added. “So it’s worthwhile to have this on the books.”

Under federal guidelines, the HHS is expected to issue a final rule by the end of the year.

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