Proposed Roll Back of Transgender Protections Puts Lives at Risk

By Kyle Taylor July 9, 2019

This post is authored by Amy Killelea, Senior Director, Health Systems Integration; Rosy Galván, Director, Health Equity; and Kyle Taylor, Associate Director, Communications

In 2018, the Human Rights Campaign (HRC) released a detailed report that declared anti-transgender violence in America a national epidemic. Since then, the violence hasn’t abated. At least 10 transgender people have been murdered in 2019, in places like Dallas, Texas; Philadelphia, Pennsylvania; Cleveland, Ohio; and Washington, DC. It is hard to know if that statistic captures all of the violence, however, as the victims are often misgendered.

The violence transgender people face is often compounded by the discrimination they face when they interact with the U.S. healthcare system. The National Transgender Discrimination Survey details some of the different ways transgender lives are harmed: 28% of respondents said they were subjected to harassment in medical settings and 2% were victims of violence in doctor’s office. Moreover, 19% reported being refused care due to their transgender or gender non-conforming status, with even higher numbers among people of color in the survey. A growing body of empirical evidence has concluded that the transgender community is disparately impacted by HIV. Moreover, in the U.S., Black transgender women have the highest percentage of new HIV diagnoses due to systemic barriers and discrimination.

Despite the growing awareness of anti-transgender violence and the struggles they endure in trying to access health care, a recent proposal from the Trump Administration would roll back protections for transgender patients. The proposed rule would overhaul Section 1557 of the Affordable Care Act (ACA), which broadly apply non-discrimination protections based on sex (including gender identity and sexual orientation), disability, race, and language access to health plans and programs receiving any federal programs. The proposed changes include eliminating requirements that providers treat individuals in a manner consistent with their gender identity and ending protections that prohibit health plans from denying coverage based on gender identify. The proposed rule would also remove prohibitions on discrimination based on sexual orientation as well as protections that prohibit health plans from designing plans that discriminate against people with disabilities (e.g., placing all HIV drugs on the highest specialty tier).

Removing the explicit protections provided under section 1557 re-establishes barriers to care for the transgender community, which already faces significant challenges in accessing these services. In addition, the refusal to recognize a trans person’s lived experience and gender identity not only leads to the anti-transgender violence we’ve seen across the country, but it can make it much harder for advocates to identify instances of anti-trans violence and share the victims’ stories.

Violence against the transgender community needs to end. While preserving the protections provided under section 1557 is a piece of a much larger, more complicated puzzle, it is an important start to building a more equitable health care system for trans people. NASTAD will submit comments in the Federal Register, and encourages you to do the same. The comment period is open until August 13, 2019.