Many influential players in the health industry have stayed silent since the Trump administration proposed undoing civil rights protections for LGBTQ patients in late May. But these muted responses haven’t gone unnoticed, especially when those who say they support LGBTQ rights, and celebrated Pride Month through social media, don’t speak up.
ThinkProgress reached out to seven insurers and insurance middlemen who either met with HHS’ Office for Civil Rights, the Office of Management, or the Budget’s Office of Information and Regulatory Affairs while officials reviewed the proposed rule for comment, as none have spoken out against it in public statements since it was released two months ago — even if some supported Pride through Twitter.
Insurance companies, however, have lobbied for the elimination of major language access protections in the rule, which indicates they may not only be comfortable with the rollback of these protections as a means for saving money, but were willing to accept anti-LGBTQ aspects of the rule in order to get them, a Center for American Progress analysis shows. (ThinkProgress is an editorially independent news site housed at the Center for American Progress Action Fund.)
The Trump administration is trying to roll back the Affordable Care Act’s Health Care Rights Law by eliminating the ban on sex discrimination, which includes discrimination based on gender identity and sex stereotyping. Under this proposed rule, health providers could refuse to treat transgender patients and insurance companies can refuse to cover services they need or charge them a lot more for it. (The sweeping rule goes beyond undermining protections for LGBTQ individuals; for example, it eliminates protections for all patients who have abortions.)
Many advocacy and provider groups were quick to voice opposition to the proposed rule that changes the Health Care Rights Law, Section 1557 of the ACA. The largest physician group, the American Medical Association (AMA), along with other organizations representing nurses and psychiatrists, immediately wrote the Department of Health and Human Services (HHS), saying it opposed the rule and wants the strongest nondiscrimination protections available for LGBTQ patients.
“We urge you to reconsider,” the May 24 letter reads.
But major insurers and insurance middlemen who can vary benefits in a way that harms LGBTQ patients have yet to comment on the proposed rule, even though some took to Twitter to highlight their support for LGBTQ rights during Pride last month.
Aetna, for example, whose research is often cited in the proposed rule, and which tweeted supportively during Pride Month, hasn’t released any statement.
Happy #PrideMonth! To celebrate, we’re putting Aetna member Albert M. in the spotlight. Since moving to the United States from Spain, he’s found a supportive community and a loving partner, Juan Z., who gave him the strength to come out to his family back home. 🌈 #stonewall50 pic.twitter.com/ZBvcUcSi0d
— Aetna (@Aetna) June 3, 2019
ThinkProgress reached out to Aetna for comment, along with insurance companies and insurance middlemen (pharmacy benefit managers, third parties who negotiate prices between pharmaceutical companies and health plans) who met with Trump officials about the proposed rule but haven’t released any public statement about it. This includes America’s Health Insurance Plans (AHIP), Blue Cross Blue Shield, United Healthcare, CVS Health, Express Scripts, and Pharmaceutical Care Management Association.
Only an AHIP spokesperson immediately responded to say they have until August to comment on the rule. The public has until August 13th to formally submit comments to federal officials, which the Trump administration is required to review — the administration will then release its final rule with an effective date.
“We are still reviewing and if we have a comment we’ll get back to you,” said AHIP communications director Cathryn Donaldson via email.
AHIP is the largest association representing insurers and many companies rely on it to submit formal comments — even those like Oscar Health, who say they’re proud to offer gender-affirming care in all states where they offer plans. In June 2018, for instance, dozens of advocacy groups wrote Oscar Health asking it to eliminate discriminatory exclusions for transgender patients.
“Discrimination based on gender identity runs contrary to Oscar’s values. Gender identity should have no effect on someone’s access to healthcare,” said an Oscar Health spokesperson, in a statement to ThinkProgress.
Like Aetna, Pharmacy benefit manager Express Scripts also showed support of Pride Month by retweeting its Express Scripts Jobs account, which boasted that the Express Scripts and Cigna locations were flying pride flags.
— Express Scripts Jobs (@ExpressRxJobs) June 7, 2019
CVS Caremark, another pharmacy benefit manager, is a subsidiary of CVS Health. In June, CVS Health tweeted about its efforts to keep its own workforce diverse and attached an image of a heart covered with a rainbow flag.
— CVS in the Community (@CVSinAction) June 4, 2019
Insurance companies and pharmacy benefit managers do stand to benefit financially from Trump’s proposed rule, according to a new report by the Center for American Progress’ director of policy, LGBT research and communications project, Sharita Gruberg.
HHS said providers, insurers, and pharmacy benefit managers under Trump’s proposed rule would save $3.6 billion over five years in “unnecessary regulatory costs.” That’s because under the proposed rule, they would no longer need to notify patients of their rights in the top 15 languages spoken in the state they operate in, which is intended to help those with limited English proficiency.
Insurers lobbied to change the Health Care Rights Law, because they wanted to limit language access protections as to relieve administrative burden and costs, Gruberg writes. So, while it hasn’t issued public comments on what the proposed rule means for LGBTQ patients, AHIP has submitted a formal comment to HHS asking it to limit the scope of publications and communications that have to meet a requirement intended to help patients with limited English proficiency.
Meanwhile, advocates have called on the health industry to speak out against the proposed rule.
“In supporting the LGBTQ community, insurers and pharmacy benefit managers should oppose the proposed revision to section 1557 of the Affordable Care Act. Opposing the proposed revision increases access and combats discrimination in health care,” said Benjamin Brooks, the assistant director of policy at Whitman-Walker Health.
“Any entity working toward people living healthily should oppose the revision to the rule,” Brooks said in a statement to ThinkProgress.
National Center for Transgender Equality also encourages anyone who considers themselves an industry leader to condemn this rule because a statement signals to transgender patients who face a public health crisis that they are prioritizing them.
“We’ve seen insurance companies do so. AMITA health care put out a press release days after the regulation was announced, rightfully condemning it and rightfully standing up for their own customer base who are transgender,” said Gillian Branstetter, a spokesperson for the National Center for Transgender Equality.
“It’s really important for the insurance industry to put… generations of stigma behind itself because as the medical world knows and affirms exclusions against transition-related care are not based in good medicine and not based in good science and not based in good business,” she added.
According to the 2015 U.S. Transgender Survey, one third of transgender people surveyed said they had at least one negative experience with a doctor or health care provider that was related to being transgender. Sometimes transgender people had to teach their own provider about appropriate care, were asked unnecessary or invasive questions about being trans that were unrelated to care, or were refused transition-related care.
A 2017 Center for American Progress survey found that 9% of gay, lesbian, bisexual, or queer respondents said that in the year prior to the survey, doctors or health care providers used harsh or abusive language during treatment. Meanwhile, 8% said they were refused treatment because of their actual or perceived sexual orientation.