HHS Proposes Rule Endorsing Nondiscriminatory Gender Equity
By - The Affordable Care Act’s (ACA’s) handling of civil rights matters is under fresh review. The Department of Health and Human Services (HHS), seeking to advance health equity under the ACA, issued a proposed rule last week – Nondiscrimination in Health Programs and Activities – advocating for diminished inequality for those populations most vulnerable to discrimination. The proposed rule embraces a variety of new protections regarding matters of gender, gender identity, gender transitions, language barriers, and disabilities.
“This proposed rule is an important step to strengthen protections for people who have often been subject to discrimination in our health care system,” states Sylvia M. Burwell, HHS Secretary. “This is another example of this Administration’s commitment to giving every American access to the health care they deserve,” she says.
Although HHS’s Office for Civil Rights (OCR) once only banned discrimination associated with race, color, national origin, disability, or age, this extension of civil rights refines Section 1557 of the ACA regarding discrimination definitions within the healthcare space. HHS confirms the proposed rule means individuals can actively pursue legal remedies for discrimination under Section 1557.
“The proposed rule makes clear HHS’s commitment, as a matter of policy, to preventing discrimination based on sexual orientation, and requests comment on how a final rule can incorporate the most robust set of protections against discrimination that are supported by the courts on an ongoing basis,” confirms HHS, additionally noting future commentary will be accepted to determine other possible exemptions to Section 1557, such as those involving religion.
The proposed rule’s new protections include the following:
- Women must be treated equally with men in the health care they receive. Other provisions of the ACA bar certain types of sex discrimination in insurance, for example by prohibiting women from being charged more than men for coverage. Under Section 1557, women are protected from discrimination not only in the health coverage they obtain but in the health services they seek from providers.
- Individuals may not be subject to discrimination based on gender identity. For example, some insurance policies have historically contained categorical exclusions on coverage of all care related to gender transition. Those categorical exclusions are prohibited under the proposed rule. Individuals must also be treated consistent with their gender identity, including in access to facilities.
- The rule bolsters language assistance for people with limited English proficiency, so that individuals are able to communicate more effectively with their health care providers to, for example, describe their symptoms and understand the treatment they have been prescribed. The proposed rule provides clear guidance on the requirements of the law with regard to provision of language services, such as oral interpreters and written translations.
- For individuals with disabilities, the rule contains requirements for the provision of auxiliary aids and services, including alternative formats and sign language interpreters, and the accessibility of programs offered through electronic and information technology.
Digging a tad deeper into merely one of the above demographics, a report last year from HealthITAnalytics.com noted that focusing on the specific health needs of those patients openly identifying as gay, lesbian, or bisexual helps amplify care and efficiently manage population health. Straight adults were nearly 10% more likely to report having a regular healthcare provider than those individuals openly identifying as bisexual. Twice as many bisexual patients in comparison with straight patients confirmed expenses kept them from receiving needed medical care, although few differences in insurance coverage rates existed. Perhaps these and other such gaps can become fused as HHS’s implied mission of bringing quality healthcare to all from a humanist consideration will perhaps soon be openly adopted.
