What writing this rule (which replaces the Obama-era rule) does is give protective cover to insurers and providers to be able to either charge LGBTQ but specifically trans people more or deny payment for services, or deny specific services, because there isnāt explicit protection preventing them from doing so, because, per the HHS Office of Civll Rights head,Ā āWeāre going back to the plain meaning of those terms, which is based on biological sex.ā The Obama-era rule was an explicit expansion and explanation that sex was defined as āmale, female, neither, or a combination of male and female.ā All Section 1557 says is that it is illegal to discriminate on the basis of ārace, color, national origin, sex, age or disability in certain health programs and activities.ā So it actually very much allows providers and insurers to discriminate against people, if they donāt consider transgender individuals to be protected under sex discrimination.
Specifically, the new rule involves:
Eliminating the general prohibition on discrimination based on gender identity, as well as specific health insurance coverage protections for transgender individuals;
Adopting blanket abortion and religious freedom exemptions for health care providers;
Eliminating the provision preventing health insurers from varying benefits in ways that discriminate against certain groups, such as people with HIV or LGBTQ people;
Weakening protections that provide access to interpretation and translation services for individuals with limited English proficiency;
Eliminating provisions affirming the right of private individuals to challenge alleged violations of Ā§ 1557 in court and to obtain money damages, as well as requirements for covered entities to provide non-discrimination notices and grievance procedures;
Narrowing the reach of the regulations by only covering specific activities that receive federal funding, but not other operations, of health insurers that are not āprincipally engaged in the business of providing health care,ā and no longer applying the regulations to all HHS-administered programs;
Please note that part of the rule is to make it hard for people to be able to claim that Section 1557 was violated and go to court. Also, considering the Supreme Court has not yet ruled on the transgender rights case(s) before them, I wouldnāt be so quick to rush to theĀ āfederal courts have already said this is a thingā. I mean, Aimee Stephens, the transwoman involved in one of those cases, died last month waiting for the Supreme Court to hear arguments and issue its decision.Ā
The real impact isnāt to outright remove the protections that had been put in place (though it absolutely does do that) - itās to make LGBTQ people afraid of getting medical care, and particularly right now, during the Covid-19 pandemic. Itās to promote more health crises and likely deaths among an already vulnerable and targeted group of people. Itās going to be snapped up by the red states who are more likely to not have those protections as well as moreĀ āfaith-basedā health care providers. Also note that abortion is listed there because we need to get another attack on women.
Due to how much the ACA has caused the health care industry to adjust and shift over the almost ten years that it has been around, and due to the fact that a lot of health care corporationsā actions are governed by which state they operate in or are technically based out of, youāre not going to see an immediate jump toĀ āfuck LGBTQ people and especially trans individuals I hope you dieā but something just as bad, which is the quiet shift to higher costs for services and treatments, the little denials and rejections, and even in states with fairly robust protections, thereās enough bigots and assholes who will do it anyway because they feel empowered to do so, and itāll be ages for any resolution.
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