1. SECTION 1557 AND LGBTQ COMMUNITIES Kellan Baker, MPH, MA February 5, 2016

2. How many provisions of the Affordable Care Act (statute or regulations) deal with discrimination against LGBT people? A. None B. Two C. Four

3. LGBT Nondiscrimination in the Affordable Care Act ACA Section 1557 – Health system nondiscrimination PHSA Section 2702 – Guaranteed issue ACA Section 1302 – Essential Health Benefits ACA Section 1311 – Qualified Health Plans & Marketplaces https://www.americanprogress.org/issues/lgbt/report/2015/04/30/112169/open-doors-for-all/

4. ACA Section 1557 Civil Rights Act Race, color, national origin Rehabilitation Act Disability HIV/AIDS status Age Discrimination Act Title IX Sex Gender identity and sex stereotyping

5. Current Issues

6. Insurance Discrimination Barriers to spousal/family coverage for same-sex couples Barriers to infertility treatment and fertility preservation Transgender exclusions in insurance coverage: o “Procedures or medical care performed in connection with sex reassignment” o “Procedures, services, and supplies related to sex transformation” o “Transsexual surgery, regardless of medical necessity” o “All services related to gender dysphoria or gender identity disorder"

7. I was refused needed health care. Health care professionals used harsh or abusive language. Health care professionals were physically rough or abusive. Health care professionals refused to touch me or used excessive precautions. Source: Lambda Legal “When Health Care Isn’t Caring” study

8. www.americanprogress.org/issues/lgbt/news/2015/07/21/117765/video-their-baby-was-denied-access-to-care-because-they-are-gay/

9. Anti-Transgender Discrimination Source: Lambda Legal “When Health Care Isn’t Caring”

10. Current Applications

11. “I understand that under federal law, discrimination is not permitted on the basis of race, color, national origin, sex, age, sexual orientation, gender identity, or disability. I can file a complaint of discrimination by visiting www.hhs.gov/ocr/office/file.”

13. VOLUNTARY RESOLUTION AGREEMENT Between the U.S. Department of Health and Human Services Office for Civil Rights And The Brooklyn Hospital Center Source: www.hhs.gov/ocr/civilrights/activities/agreements/TBHC/vra.pdf

14. Rumble v. Fairview Hospital

15. Future Applications

16. ACA Section 1557 Proposed Rule Bans discrimination on the basis of sex, including gender identity and sex stereotyping Requires coverage for and provision of medically necessary services for trans people Requires trans people to be treated in accordance with their gender identity in, e.g., hospital room assignments Plans must cover preventive services regardless of gender or gender identity Bans categorical transgender insurance exclusions

18. Source: www.checkitoutguys.ca Removing Trans Exclusions from Medicaid Source: Movement Advancement Project

19. Key Comment Points Do not add a religious exemption Include sexual orientation protections alongside gender identity and sex stereotyping Strong support for provisions related to trans coverage and care Maintain broad application to insurance plans that touch federal financial assistance, including employer plans

21. Thank you! Kellan Baker kbaker@americanprogress.org kellan@out2enroll.org www.out2enroll.org www.americanprogress.org