How Does the House Health Care Bill Impact LGBT People?
July 16, 2009
On Wednesday, the House of Representatives introduced its version of health reform legislation, America’s Affordable Health Choices Act (AAHCA). Today, three House committees – Energy and Commerce, Education and Labor, and Ways and Means – begin their markups of the bill, which are expected to extend into next week. HRC has been lobbying for the inclusion of a number of provisions critical to the health of the LGBT community and people with HIV and AIDS, and we are pleased to see that this bill contains a number of them. Unfortunately, it also misses the mark in a few areas. HRC will continue to push the committees and Members of Congress to protect the positive provisions and address the deficiencies as the bill moves forward. Of couse we'll continue to provide updates throughout the process here at HRC Back Story. Here’s a brief of summary of the good, and the not-so-good, in the House bill: Data Collection and Health Disparities AAHCA creates a new Assistant Secretary for Health Information at the Department of Health and Human Services and charges him or her with ensuring critical health data is properly collected – including, for the first time, data on sexual orientation and gender identity. Collecting this data would be a critical first step in our government taking a serious interest in the health needs of LGBT people. Unfortunately, LGBT people are not included in the bill’s provisions that focus on populations with significant health disparities. Early Treatment for HIV AAHCA includes a version of the Early Treatment for HIV Act, legislation that has been part of HRC’s agenda for many years. This provision allows states to cover early treatment of HIV under their Medicaid programs; currently, a Medicaid beneficiary must develop full blown AIDS in order to get coverage. Early treatment is a win-win – it helps reduce infections, improves quality of life for people with HIV, and reduces costs in the course of treatment. In this bill, the early treatment option terminates after three years, when many of the legislation’s other reforms to health care go into effect. Nondiscrimination AAHCA includes an important civil rights provision, prohibiting consideration of “personal characteristics extraneous to the provision of high quality health care,” language which we believe will help protect LGBT people in accessing health care. Under current federal law, and most states' laws, there are no protections against discrimination in health care based on sexual orientation and gender identity. As a result, lesbian, gay, bisexual and transgender people encounter numerous problems in accessing health care, including: physicians and other health care providers refusing to treat LGBT patients; physicians or other health care providers providing dilatory or inadequate care to LGBT patients because of bias, or dealing with those patients in a harassing, discriminatory or disrespectful manner; and hospitals and medical staff refusing to recognize the lawful health care decision-making authority of and/or to permit visitation by a domestic partner or non-biological parent of the same sex. Families AAHCA for the most part refers to “family” and “family coverage” in a way that does not exclude same-sex couples and their children – a very positive step. Unfortunately, there are still parts of the bill that frame programs, taxes, and benefits around the term “spouse,” which, under the Defense of Marriage Act, can only refer to a husband or wife in a different-sex marriage. Special thanks to HRC Senior Counsel Brian Moulton for his continuing work on this important issue.