Earlier this week, the Department of Health and Human Services released the long-awaited set of preliminary guidelines for the development and operation of the health insurance exchanges. The exchanges, part of the reforms introduced by the Affordable Care Act, are intended to connect small businesses and individual consumers with health insurance options.
Gay and transgender people and their families stand to benefit significantly from the exchanges, as they are roughly twice as likely as the general population to be uninsured (largely because discrimination in employment and relationship recognition limits their access to employer-sponsored private coverage). The exchanges, which will utilize subsidies and tax credits to connect customers with coverage offered by private insurers, will help LGBT people access coverage even if they are unemployed, if they work for an employer who does not offer health insurance benefits, or if their employer refuses to offer benefits for same-sex couples. Thus, it is crucial that the design, implementation, and management of these new insurance marketplaces take the needs of LGBT people into account.
The proposed rule includes nondiscrimination protections on the basis of sexual orientation and gender identity. To buttress these protections, federal and state policies around the essential health benefits that private insurers participating in the exchanges will have to offer — guidelines that the Department of Health and Human Services is still developing — should provide similar protections.
This week’s rule is an important step in constructing the architecture of a state-based exchange system that is prepared to serve the needs of all its future consumers, including gay and transgender people and their families. The states should prepare to seize the opportunities offered by the proposed rule to create exchanges that combine flexibility of design with a firm commitment to ensuring that coverage reaches everyone who needs it.