Modern Healthcare
HHS targets discrimination based on sex, gender identity
By Virgil Dickson
September 3, 2015
HHS proposed on
Thursday to ban discrimination against transgender people throughout the
healthcare system, carrying out anti-bias provisions in the Affordable
Care Act.
The proposed
rule (PDF) would apply to any provider or program that accepts federal
dollars.
Most doctors would be covered, as would Medicaid and Medicare.
Insurers that offer plans through HealthCare.gov would have to comply with the
requirements in their plans off the health insurance exchange as
well.
The rule does not explicitly require insurers to cover gender
transition treatment like surgery. But insurers could face questions if they
deny medically necessary services related to gender transition by a man who
identifies as a woman, or a woman who identifies as a man.
The rule
largely supports existing polices and law but clarifies that the protections
will block discrimination based on sex, which the agency says includes gender
identity.
For example, transgender people can now enter bathrooms or
hospital wards consistent with the gender that they identify
with.
Previously, civil rights laws enforced by HHS' Office for Civil
Rights (OCR) barred discrimination based only on race, color, national origin,
disability or age.
Overall, the rule is expected to cost the healthcare
industry as well as state and federal agencies $558 million in training and
administrative costs over its first few years of implementation, the agency
estimates.
gWe anticipate that a large number of providers may need to
develop or revise policies or procedures to incorporate this prohibition,h
according to the rule. gWe further assume that one-third of health insurance
issuers will need to develop or modify policies and procedures.h
The
agency says that despite numerous anti-discriminatory policies and laws on the
books, this rule was needed.
HHS' OCR receives 3,000 complaints a
year.
gThere continues to be a series of problems with discrimination in
the healthcare arena,h Jocelyn Samuels, director of the OCR, said Thursday
during a press call with reporters.
gThis proposed rule is an important
step to strengthen protections for people who have often been subject to
discrimination in our healthcare system," HHS Secretary Sylvia Burwell said in a
statement.
When it comes to enforcing anti-discrimination policies, the
first approach HHS will take is to always have the health entity voluntarily
address the issue, Samuels said.
If non-compliance cannot be corrected by
informal means, the ACA empowers HHS to suspend, terminate or refuse to grant or
continue federal financial assistance to that entity, and depending on the
nature of the case, it compels it to contact the Justice Department with a
recommendation to enforce the law.
Response to the proposed rule has been
positive. g(The rule) will help finally make the promise of the Affordable Care
Act real for transgender people—that they can find affordable health insurance
that covers the essential care they need and doesn't exclude care simply because
of who they are,h Mara Keisling, executive director of National Center for
Transgender Equality, said in a statement.
The proposed rule is open for
public comment through Nov. 6.