Today,
The Fenway Institute of Fenway Health released a policy brief outlining
the harm to LGBT people likely to result from a new health care
regulation proposed by the Trump Administration last month. The public
has until August 13, 2019 to offer comment on the proposed regulation,
and the authors of the brief urge health care professionals and
advocates to submit comment urging the Trump Administration to
reconsider the proposal.
On
June 14, 2019, the Trump Administration released a proposed regulation
that would reverse the 2016 final rule implementing the
nondiscrimination provision of the Affordable Care Act (ACA). That
measure, known as the 2016 Section 1557 rule explicitly prohibits gender
identity discrimination, including discrimination against intersex and
non-binary people, in health care facilities and programs receiving
federal funding. The rule also prohibits some forms of sexual
orientation discrimination that take the form of sex stereotyping.
“Initial
news reports about the proposed rule characterized it as
anti-transgender,” said Fenway Institute Health Policy Fellow Katherine
Laurila, author of the brief, titled “New rule proposes removal of LGBT
nondiscrimination provisions from Section 1557 and other health care
regulations.” “But the scope of the proposed regulation extends far
beyond the gender identity and sex stereotyping provisions of the 2016
nondiscrimination provisions of Rule 1557.”
Included
in the Trump Administration proposal are provisions that would revise
several other important health care regulations that explicitly prohibit
both sexual orientation and gender identity. If finalized, the proposed
rule would remove explicit sexual orientation and gender identity
nondiscrimination provisions from:
- Regulations governing the health insurance exchanges, including 34 federally facilitated exchanges and 17 state exchanges;
- Regulations governing Qualified Health Plans;
- Medicaid
regulations, including language that explicitly prohibits sexual
orientation and gender identity discrimination in Medicaid enrollment
and availability of services, and language highlighting the importance
of access and cultural considerations that calls on states to care for
LGBT patients and others in a culturally competent manner;
- Regulations governing the access to services provided by the Program of All-Inclusive Care for the Elderly.
“This
proposed regulation would have far-reaching implications for the LGBT
community, all of them negative,” said Carl Sciortino, Vice President of
Government & Community Relations at Fenway Health. “If this rule is
enacted, the Trump Administration will succeed in reversing much of the
progress made in federal health policy over the past decade.”
Anti-LGBT
discrimination in health care is widespread, correlates with poorer
health and well-being for LGBT people, and makes LGBT people less likely
to access health care. This exacerbates health disparities that LGBT
people experience. Since 2011, the Joint Commission has required sexual
orientation and gender identity nondiscrimination policies in health
care institutions that it accredits. The Joint Commission is a nonprofit
organization that accredits hospitals and other health care
organizations.
Other
anti-LGBT policies enacted by the Trump administration that are harming
the health and access to care of LGBT people include:
- Dismissing
Peace Corps volunteers and Air Force service members who tested
positive for HIV, and refusing to provide pre-exposure prophylaxis for
HIV prevention (PrEP) to at-risk Peace Corps volunteers;
- Placing
transgender inmates of the Federal Bureau of Prisons, especially
transgender women, at much higher risk of rape by incarcerating them
according to their biological sex at birth instead of their gender
identity;
- Prohibiting transgender people from serving in the U.S. military;
- Removing
sexual orientation and gender identity questions from federal surveys
of older adults, people with disabilities, and victims of crime;
- Filing
a brief with the U.S. Supreme Court arguing that gender identity is
outside of the scope of Title VII of the Civil Rights Act of 1964, which
prohibits discrimination based on “race, color, religion, sex and
national origin;”
- Filing
a brief in the Masterpiece Cake Shop case before the U.S. Supreme Court
supporting discrimination against a gay male couple and stating that
there is no compelling federal government interest in prohibiting
anti-gay discrimination;
- Attempting to repeal or weaken the ACA, which has cut the uninsured rate in half for LGBT people.
Other
resources on the Trump Administration’s actions undermining the right
of LGBT people to access health care and other services include:
Since 1971, Fenway Health has
been working to make life healthier for the people in our
neighborhoods, the LGBT community, people living with HIV/AIDS and the
broader population. The Fenway Institute at Fenway Health
is an interdisciplinary center for research, training, education and
policy development focusing on national and international health
issues. Fenway’s Sidney Borum Jr. Health Center cares for youth and
young adults ages 12 to 29, including those who are LGBT or just
figuring things out; homeless; struggling with substance use; or living
with HIV/AIDS. AIDS Action, Fenway’s public health division, works to
reduce the number of HIV infections while supporting those already
infected, and operates a needle exchange that serves as an entry point
to healthcare services for active substance users.
