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Trump Administration Takes Aim at Transgender Healthcare

Proposed Rule Would Worsen Stark Disparities

People protest U.S. President Donald Trump's announcement that he plans to reinstate a ban on transgender individuals from serving in any capacity in the U.S. military, in Times Square, in New York City, New York, U.S., July 26, 2017. © 2017 Reuters

On Friday, the Trump Administration released a proposed rule that would roll back nondiscrimination protections for transgender people under the Affordable Care Act (ACA). The rule would have devastating effects on transgender people, who already face stark barriers in accessing care.

The rollback is particularly dangerous because it comes at a time when other coverage for transgender people is being eliminated. Under the transgender military ban, for example, the Department of Defense will no longer cover transgender-related healthcare for servicemembers.

Protections at the state level are also limited. Only fourteen US states prohibit health insurance discrimination based on gender identity; ten expressly exclude transgender related care under state Medicaid policies. Most recently, Iowa’s legislature amended the Iowa Civil Rights Act to expressly remove healthcare nondiscrimination protections in late April, rushing the provision through without public hearing and leaving low-income transgender Iowans without much-needed care.

A report released by Human Rights Watch last year documented that lesbian, gay, bisexual, and transgender (LGBT) people in the United States, and especially transgender people, often face difficulty finding and accessing healthcare providers, face discrimination and refusals of service in medical settings, and often forego care out of fear that they will face mistreatment. Another documented the difficulty transgender women in Florida experience accessing HIV treatment and care. This latest rule will almost certainly worsen the persistent health disparities transgender people face.

In 2016, the US Department of Health and Human Services (HHS) interpreted the ACA’s prohibition of discrimination based on sex to include discrimination based on gender identity. The proposed rule from the Trump Administration would reverse this, so that HHS would no longer interpret or enforce the rule to protect transgender people.

Human Rights Watch has joined the Protect Trans Health Coalition, which will be organizing actions in the coming weeks to push back against the proposed rule.

In the meantime, the Trump Administration’s shameful record on transgender rights underscores the importance of the Equality Act, an omnibus nondiscrimination bill that would protect LGBT people from discrimination across a range of domains. The House passed the bill last week, but Senate Majority Leader McConnell has not committed to bringing it to a vote. The rollback of basic nondiscrimination protections illustrates why clear protections are needed – and why Congress should do its job and enact those protections into law.

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