Affordable Care Act Targets Discrimination Against Transgender Patients

August 16, 2012 — The federal health reform law (PL 111-148) includes several new protections aimed at curtailing discrimination against transgender patients by health care providers and insurers, The Nation reports.

Obtaining comprehensive health coverage has long been a struggle for transgender individuals. Employment discrimination contributes to high unemployment levels among transgender people, which puts employer-based coverage out of reach for many. Additionally, public health programs like Medicaid currently do not accept low-income adults without children or disabilities in most cases, according to The Nation.

In the individual insurance market, many health plans will deny coverage because they consider a transgender identity to be a pre-existing condition. Health plans that do accept transgender applicants often exclude coverage for "transition-related care," which insurers sometimes interpret to include any treatment that transgender patients receive, such as antibiotics.

Changes Under ACA

But beginning in 2014, insurers will no longer be able to deny coverage for pre-existing conditions. Meanwhile, the health reform law's Medicaid expansion, which extends Medicaid eligibility to all individuals under 133% of the federal poverty level, will help uninsured transgender individuals living in participating states to obtain coverage.

The federal health reform law will also help transgender individuals who have been refused medical care by bringing the Title VII federal nondiscrimination protections to the health care industry.

A survey by the National Transgender Discrimination Survey found that 25% of transgender individuals have been verbally harassed at a physician's office or hospital, and 2% have been physically assaulted while seeking treatment. To address these incidents, the federal health reform law is providing funding for LGBT cultural competency training that aims to teach health care workers how to provide respectful care.

The law is also providing funding to LGBT-friendly community health centers and in 2013 HHS will be required to include sexual orientation and gender identity in its national data collection efforts to better assess the resources transgender patients need (Carroll, The Nation, 8/14).