全球智库信息集成服务系统

These categorical exclusions are based on the false premise that the health care services that transgender people need are not medically necessary and are never needed by nontransgender people. In fact, however, the health care services denied to transgender people under these exclusions are frequently needed by nontransgender people as well:

The Affordable Care Act prohibits insurance discrimination against transgender people

The Affordable Care Act takes important steps toward eliminating insurance discrimination against populations that historically have been excluded from coverage, including transgender people. In particular, federal regulations implementing the law’s essential health-benefits concept will improve the comprehensiveness of benefits offered under health insurance plans.

As defined in Section 1302 of the law, the essential health benefits standard applies to all nongrandfathered plans sold in the individual- and small-group markets in every state. It is estimated that 68 million people will purchase coverage based on the essential health-benefits standard. These plans must offer coverage across 10 categories of care including prescription drugs, ambulatory care, and mental-health treatment.

Importantly, regulations implementing the essential health benefits prohibit the use of benefit designs and coverage determination techniques that discriminate against discrete classes of people by reducing the availability of any benefit in a manner that is not based on current clinical standards. The rules include explicit prohibitions on the use of benefit designs that discriminate on the basis of characteristics such as disability, health condition, or gender identity. This includes exclusions targeting transgender people since, as the American Medical Association noted, “the denial of … otherwise covered benefits for patients suffering from gender identity disorder [the medical diagnosis associated with a transgender identity] represents discrimination based solely on a patient’s gender identity.”

State regulators are primarily charged with enforcing these antidiscrimination protections, but federal officials will be monitoring compliance where states are not substantially enforcing them and for plans sold through federally facilitated marketplaces.

States are taking action to prevent discrimination against transgender people in insurance

California was the first state in the nation to specifically prohibit insurance discrimination against transgender people.* In 2012 the California Department of Insurance, or CDI, issued regulations implementing the state’s Insurance Gender Nondiscrimination Act that prohibited plans from “Denying or limiting coverage, or denying a claim, for … health care services related to gender transition if coverage is available for those services under the policy when the services are not related to gender transition, including but not limited to hormone therapy, hysterectomy, mastectomy, and vocal training.” The CDI regulations further clarify that plans may not exclude, deny, or limit coverage for “health care services that are ordinarily or exclusively available to individuals of one sex when the limitation is only due to the fact that the insured is enrolled as belonging to the other sex or has undergone, or is in the process of undergoing, gender transition.”

In the first few months of 2013, insurance regulators in Colorado, Oregon, Vermont, and the District of Columbia, as well as the CDI’s sister agency, the California Department of Managed Health Care, have all issued bulletins clarifying that their state laws prohibit insurance discrimination against transgender people.

These bulletins clarify that categorical insurance exclusions that discriminate against transgender people violate gender-identity nondiscrimination protections. They accordingly require carriers to eliminate plan language that excludes transgender consumers from coverage for medically necessary services. The elimination of transgender exclusions is a key step in ensuring that transgender people have equal access to the health care services they need.

主题