Section 1557 of the Affordable Care Act prohibits health insurance companies, employers, and others from denying consumers coverage or certain benefits based on their sex. Earlier this year, a transgender advocate wrote to Health and Human Services (HHS) Secretary Kathleen Sibelius asking her to issue guidance to clarify how this policy would affect transgender individuals. According to the reply from Leon Rodriguez of HHS’s Office for Civil Rights – a letter that’s being hailed by the LGBT activist community – the rules banning sex-based discrimination apply to transgender people as well.
This means that denying coverage based on transgender identity would be considered discriminatory, explains Michelle Andrews in an article for the Washington Post. “If discrimination is found and an organization doesn’t act voluntarily to resolve the problem, the [HHS Office of Civil Rights] may move to halt federal financial assistance, among other actions,” she writes. It’s a big victory for a group that tends to be medically underserved and has special health care needs, including gender reassignment surgery, hormone treatments, and counseling.
But it doesn’t mean that insurance companies have to cover the surgery or associated treatments, although many insurers do – one survey found that as of 2010, 14% of large employers covered gender reassignment surgery and 32% covered hormones and counseling. Rather, the letter means that being transgender cannot be considered a preexisting condition and used as a basis to deny coverage or deny certain benefits, as some individual market insurers currently do.
The HHS letter is part of a larger movement toward preventing discrimination against transgender people. In April, for example, the Equal Employment Opportunity Commission ruled that the Civil Rights Act of 1964’s ban on sex discrimination applied to transgender people, too.