The Biden rule would strengthen health protections for gay and transgender people

Politics|Biden’s Rule Would Strengthen Health Protections for Gay and Transgender People

The proposed rule would prohibit discrimination based on sexual orientation and gender identity by health care providers who receive federal funds.

WASHINGTON — The Biden administration said Monday that it intends to enshrine anti-discrimination protections for gay and transgender people in the Affordable Care Act, a proposal that would officially reverse a policy adopted by the Department of Health and Human Services. Humans under former President Donald J. Triumph.

Trump’s rule, finalized in 2020, erased Obama-era protections for transgender patients. Last year, the Biden administration took a preliminary step to restore them by announcing that H.H.S. would write a rule that prohibits discrimination on the basis of sexual orientation and gender identity by hospitals and other health care providers that receive federal funds.

That proposed rule was released Monday and is much more expansive than the Obama-era policy. For the first time, it would enforce anti-discrimination protections for patients with Medicare Part B, which covers outpatient medical care.

The new rule comes as some states are banning gender-affirming surgeries, particularly for transgender youth. Xavier Becerra, Biden’s health and human services secretary, told reporters he would “remove the friction” that prevented discrimination protections from being available to all Americans.

“Health care is health care, and if you need access to it, you should not be obstructed from accessing care,” Mr. Becerra said, adding, “That, to me, is the most important principle.”

Section 1557 of the Affordable Care Act prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in certain health programs and activities. But the rule that governs its implementation has been a political ping-pong ball since former President Barack Obama signed the law into law in 2010.

The Obama administration defined “sex” as the inclusion of gender identity. The Trump administration removed that language. The Biden administration’s proposed rule, which will be subject to public comment before it can go into effect, defines “sex” as “sexual orientation and gender identity,” making it clear that sex discrimination includes discrimination based on ” pregnancy or related conditions. , including ‘termination of pregnancy’”.

It is not yet clear how those protections will play out in medical practice. But Roger Severino, who led the Health Department’s Office for Civil Rights during the Trump administration, said the new language would likely cover sex reassignment surgery.

“What it’s really about is insurance coverage,” he said. He voiced his objection to the way the Biden administration defines “sex,” adding: “It is not supported by law. The definition of sex never included gender identity, just as it does not include termination of pregnancy.”

Katie Keith, a health policy expert at the Georgetown University Law Center, predicted that the new rule would become the subject of litigation, as the Obama and Trump rules had. He noted that it also contains broader protections for people with disabilities and clarifies the process for health care providers to raise conscientious or religious objections to providing certain types of care.

“Those who oppose what the Biden administration is doing will try to interpret this as very focused on gender-affirming care and abortion, when in fact there are a lot of provisions there,” she said.

The Human Rights Campaign, an advocacy group, praised the ad.

“Despite policy advances during the Obama and Biden administrations, L.G.B.T.Q.+ people continue to face disproportionate challenges when it comes to accessing health care,” said Joni Madison, interim president of the group, in a statement. “This rule change would help close that gap, and it’s desperately needed at a time when some states are cracking down on access to care.”