Respect Equality

LGBTQ+ Equality Caucus asks HHS to bolster protections for transgender health care

“Equal access to health care is a matter of life and death — and strengthening Section 1557 of the Affordable Care Act will save countless lives,” Rep. Pramila Jayapal (D-WA) said Monday.
The view of a Transgender Flag in between two Pride Flags at Christopher Park June 26, 2020 in New York City. (Alexi Rosenfeld/Getty Images)

Story at a glance


  • Members of Congress on Monday voiced their support for proposed changes to a section of the Affordable Care Act that would strengthen protections for transgender people seeking gender-affirming health care.

  • The proposed changes, announced by the Health Department in July, would broaden the definition of sex discrimination to include sexual orientation and gender identity.

  • More than 30 percent of transgender people in a national survey reported experiencing discrimination while accessing health care because of their gender identity.

Reps. Marie Newman (D-Ill.), Pramila Jayapal (D-Wash.) and Jennifer Wexton (D-Va.), co-chairs of the Congressional LGBTQ+ Equality Caucus’ Transgender Equality Task Force, on Monday voiced their support for proposed changes to a section of the Affordable Care Act that would bolster protections for gender-affirming health care.

In a letter sent Monday to Department of Health and Human Services (HHS) Secretary Xavier Becerra, task force members expressed their support for changes to more effectively implement Section 1557 of the Affordable Care Act, which prohibits federally funded health programs from discriminating based on six protected characteristics, including sex.

In July, HHS announced a proposed rule that would broaden the department’s definition of sex discrimination to include sexual orientation and gender identity, consistent with the Supreme Court’s ruling in Bostock v. Clayton County and earlier actions taken by the Biden administration to expand protections for LGBTQ+ Americans.

“We strongly support the explicit clarification that Section 1557 unequivocally prohibits discrimination on the basis of sexual orientation, gender identity, and sex characteristics, including intersex traits,” task force members wrote Monday in the letter, which was also signed by 35 other members of Congress. “These forms of discrimination have run rampant and unchecked in our medical system.”


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In nine states, Medicaid policies explicitly exclude coverage for gender-affirming care, creating a substantial financial barrier to receiving health care major medical associations have said is medically necessary. Medicaid policies in Georgia and West Virginia that excluded coverage for gender-affirming health care were recently overturned for violating the Affordable Care Act.

In a national survey, 33 percent of transgender people reported experiencing discrimination while accessing routine health care because of their gender identity, and 23 percent said they had not sought care when they needed to because they feared they would be discriminated against or mistreated.

A 2021 report from the Center for American Progress found that 88 percent of LGBTQ+ intersex respondents reported discriminatory experiences in health care in the last year, and 65 percent said they postponed or did not seek medical care because of disrespect or discrimination from their providers.

LGBTQ+ youth with intersex traits are more than twice as likely as their non-intersex peers to report that a health care provider has tried to convince them to change their sexual orientation or gender identity, according to research from The Trevor Project.

“Equal access to health care is a matter of life and death — and strengthening Section 1557 of the Affordable Care Act will save countless lives,” Jayapal said Monday in a news release. Both Jayapal and Newman have transgender children.

“This could not be more urgent at a time when extremist Republicans across the country are attacking LGBTQI+ rights, banning lifesaving care for trans youth, and discriminating against trans people by denying public health benefits,” Jayapal said. “We must continue the fight for equitable health care and to protect the lives of our LGBTQI+ friends, family, and neighbors.”