Proposed ACA Repeal Puts Health Care for Transgender and Gender Non-Conforming Individuals at Risk
Source: Human Rights Campaign
By HRC staff June 22, 2017
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.
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