How Obamacare Is Helping Protect Trans People’s Right To Health Care

CREDIT: AP PHOTO/CHARLES DHARAPAK
CREDIT: AP PHOTO/CHARLES DHARAPAK

Thanks to a provision of the Affordable Care Act (ACA) that protects transgender patients, a trans woman was able to take her medical provider to task and come out on top — winning her case against a New York-based hospital and compelling it to improve its nondiscrimination policies, per an agreement reached with the Office of Civil Rights (OCR) this week.

The patient, whose name wasn’t released, alleged that administrators at the Brooklyn Hospital Center violated policy when they assigned her to a double occupancy patient room with a man, although she identified as female. In the case, litigators cited Section 1557 of the ACA, which prohibits sex discrimination, as just cause for the complaint.

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As part of the settlement agreement, the Brooklyn Hospital Center can’t deny equal services, accommodations, or other opportunities to any patient because of their sex, gender identify, gender expression, and nonconformity with gender stereotypes. Staff members also have to undergo training where they’ll discuss Section 1557 and learn proper trans terminology. Brooklyn Hospital Center will update its nondiscrimination policy within 90 days so that it’s inclusive of trans patients.

“Through the Affordable Care Act, for the first time, individuals are protected from discrimination on the basis of sex, which includes gender identity, in health programs,” Jocelyn Samuels, director of OCR, wrote in a statement. “We are pleased that we were able to come to a voluntary agreement with the Brooklyn Hospital Center to ensure that all patients have full and equal access to health care services, regardless of their sex or gender identity.”

Under the ACA, trans people have protections against discriminatory policies, privacy of identifiable healthcare information, and autonomy in choosing their own visitors and medical decision makers, regardless of their relationship to the patient. The ACA also raises the standards for patient protection by outlawing unfair insurance practices — including the exclusion of trans people via its preexisting conditions provision, the denial of services, and the cancellation of plans in the cases of gender transition.

Most importantly, the ACA allows trans people to file a discrimination complaint when they believe they have encountered unethical behavior in medical settings.

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The case out of Brooklyn follows other efforts around the country to address administrators’ missteps and put Section 1557 to use. Earlier this year, a U.S. District Court judge ruled that a trans man had plausible cause to believe he experienced gender-based discrimination in a St. Paul, MN emergency room. In 2013, hospital administrators made him wait more than four hours for care and later asked a barrage of questions about his sex life. Last month, a trans woman alleged that Medstar Georgetown University Hospital discriminated against her by denying a breast implant surgery because of her gender.

“We are surprised and disappointed to learn of Georgetown’s statement and its implications for access to much-needed surgery services for the metro D.C. transgender community,” Shawn Jain, director of communications for Whitman-Walker Health, told the Washington Blade at the time, saying that the LGBT community health center often refers its clients to qualified specialists at Georgetown. “Based on our reading of Georgetown’s statement, we believe this will present some very real and tangible access to care issues for our transgender patients.”

Long before the ACA’s passage, trans people — particularly those who have undergone female-to-male gender reassignment surgery — have reported discrimination in hospitals and clinics. A study released in March found that nearly 42 percent of female-to-male trans patients recounted instances of verbal harassment, denial of equal treatment, and physical assault. A small number of respondents said they never accessed care at a doctor’s office or the hospital — perhaps out of fear of bias.

The authors of the study said improving health care for trans people requires tangible changes, including the addition of options on medical forms that go beyond binary gender designations. The report also highlighted the importance of continuous medical training that addresses the intricacies of the trans patients’ care. Although LGBT patients’ medical needs mirror those of their heterosexual and cisgender counterparts, they abuse tobacco, alcohol, and other substances at higher aggregate rates. They also stand a greater risk of mental illness, cancer, and some sexually transmitted diseases.

For medical providers, confronting the root causes of such disparities would require growing comfortable with LBGT-related policy and social matters. Previous research, however, has found that most medical schools spend an average of just five hours on LGBT issues, most of which take place during non-patient care years. This ultimately surfaces in the doctor’s office, where the topic matter scares a significant number of physicians, as found in a 2011 study.

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“People are uncomfortable with things, and until people get to know people who are gay, lesbian and transgender, they are going to feel uncomfortable,” Dr. Harvey Makadon, the director of the National LGBT Health Education Center at the Fenway Institute in Boston, told reporters in March. “And how that manifests itself can affect someone’s comfort level in terms of coming for care. And so we need to work on those issues if we are going to really make a difference.”