HHS takes steps toward protecting transgender people under health-care law

In a recent letter hailed by advocates in the lesbian, gay, bisexual and transgender (LGBT) community, the Department of Health and Human Services clarified that provisions in the Affordable Care Act prohibiting sex discrimination in health insurance apply to transgender people.

With HHS declaring that it would be discriminatory for employers, insurers and others to deny health insurance coverage or benefits based on “gender identity or failure to conform to stereotypical notions of masculinity or femininity,” advocates hope that transgender people — those who identify with a sex other than the one they were born as — will take another step toward achieving equality in health care.

“This is a population that’s very underserved and in need of a lot of health care,” says M. Dru Lavasseur, a transgender rights attorney at Lambda Legal, an advocacy group based in New York. “This HHS letter sends a message that we need to address its problems.”

The HHS letter, issued by the department’s Office of Civil Rights, adds to recent court decisions and a ruling by the Equal Employment Opportunity Commission in April that the Civil Rights Act’s prohibition against sex discrimination applies to transgender people. The letter says the civil rights office is now accepting and investigating complaints of sex discrimination under the health- care law. If discrimination is found and an organization doesn’t act voluntarily to resolve the problem, the office may move to halt federal financial assistance, among other actions.

The letter does not mean that insurers have to cover surgery related to gender transition, according to a statement posted online by HHS, which plans to issue further guidance on the subject.

Many major professional medical organizations, including the American Medical Association and the American Psychiatric Association, support treatment for gender identity disorder.

Although they are not required to do so, a growing number of employers provide health benefits that address the needs of transgender individuals. In addition to surgery to reconstruct the genitals, reduce or augment the chest or contour the face, transgender patients may need hormone therapy, mental health counseling and short-term leave, among other things.

For the past decade, the Human Rights Campaign, a Washington-based LGBT advocacy organization, has published an annual corporate equality index that scores large companies, including the Fortune 1000 companies and the country’s 200 top-grossing law firms on how equitably they treat their LGBT employees.

In 2012, the requirements to receive top marks got tougher. Companies have to provide equal health care for transgender employees, without any exclusions for medically necessary care, and the survey for the first time required coverage of gender reassignment surgery. Even with that stringent standard, the number of companies getting a perfect score for transgender-inclusive benefits grew from 85 in 2011 to 207 in 2012.

Getting a perfect score is important not only for the benefits it provides transgender employees but also because it sends a message to job applicants about the workplace environment.