Proposed ACA Repeal Puts Health Care for Transgender and Gender Non-Conforming Individuals at Risk

by HRC Staff

Section 1557 of the ACA, a groundbreaking non-discrimination provision has proven transformational for transgender and gender non-conforming people seeking health care.

Post submitted by HRC Law Fellow Bailey Metzger

The passage of the Affordable Care Act (ACA) was a health care milestone for the LGBTQ community. Section 1557 of the ACA, a groundbreaking non-discrimination provision has proven transformational for transgender and gender non-conforming people seeking health care. In May 2016, the Department of Health and Human Services published regulations interpreting Section 1557 as expressly protecting individuals from discrimination on the basis of gender identity and sex stereotyping.

Although the current versions of the House and Senate repeal bills would not roll back the Section 1557 protections, the effects of the these bills would still be devastating for transgender and gender non-conforming individuals.  These individuals disproportionately experience the strain of poverty and a lack of culturally competent resources that has been lessened in part by the ACA, repeal would dismantle a system that provides necessary care for these individuals.

In a 2011 survey, 19 percent of transgender respondents reported lacking health insurance, compared to 17 percent of the general population. Only a few years later, the 2015 follow-up survey indicated that only 14 percent of transgender individuals lacked health insurance, compared to 11 percent of the general population. While the percentage of transgender individuals with insurance is still less than that of the general population, the percentage of insured transgender individuals has noticeably increased. Among those that reported having insurance in the 2015 survey, 13 percent had Medicaid coverage compared to only three percent a few years before. The Medicaid expansion under the ACA has likely contributed to those numbers, as many transgender individuals—particularly those without dependent children—were previously ineligible, regardless of high poverty rates. The ACA Medicaid expansions had also provided lifesaving coverage for  transgender and gender non-conforming individuals living with HIV who did not previously qualify.

Insurance costs for transgender individuals could increase exponentially under the House repeal bill as insurance companies could charge more for individuals with preexisting conditions. This means that transgender individuals with HIV or gender dysphoria would be required to pay much higher rates to obtain coverage. As many insurance providers require that individuals be diagnosed with gender dysphoria before covering transition related care, the high premiums that accompany a gender dysphoria diagnosis would put transgender individuals in an impossible bind.

Finally, revocation of federal funding from Planned Parenthood would have devastating effects for transgender individuals who rely on Planned Parenthood for care. Often, Planned Parenthood is the only provider where  transgender and gender non-conforming individuals can receive culturally competent care and feel safe disclosing their gender identity to a health care provider. The lack of funding for Planned Parenthood would also jeopardize transgender individuals’ ability to obtain transition related care and sexual transmitted disease and HIV screening.

Right now, it is essential that we take action to protect the ACA and ensure that those in our community are able to obtain the medically necessary, life saving care that they deserve. Join HRC as we call on Senators to reject this dangerous attempt to undermine health care access and preserve the incredible gains the LGBTQ community has made under the Affordable Care Act. All you need to do is text “SAVE ACA” to 30644 and we’ll get you connected.