Following a celebrated March decision from a federal court affirming that the Affordable Care Act (also known as "Obamacare") prohibits discrimination against trans patients, the Department of Health and Human Services announced Monday that insurers are no longer allowed to deny patients, or require copayments or other charges, for preventive care based on their gender identity or birth gender, reports the New York Times.
HHS issued new guidelines, in part, after facing an increasing number of trans patients claiming discrimination from doctors and insurers who denied "sex-specific recommended preventive services," including screenings, tests, and other treatments for various medical issues, based on the fact that the gender listed on a patient's medical records differs from either their authentic gender identity or the treatment's intended gender group, according to the National Journal.
Breast cancer screenings, for instance, are just as necessary for cisgender (nontrans) and transgender women over age 50, but can often be denied coverage by insurers if a woman's birth gender is listed as "male," notes the Journal. Alternatively, for example, certain trans men are unique among men for potentially needing cervical cancer screenings, but could be denied coverage if they had previously updated their medical records to reflect their authentic male gender.
The HHS guidelines also address other forms of sex-based discrimination, requiring insurers to cover all forms of female contraception and genetic testing for people with certain histories of breast or ovarian cancers.
Such previous holes in coverage, compounded by a poverty rate among trans populations that averages four to six times that of the cisgender population, have amplified health disparities faced by trans patients. With HHS's Monday announcement, insurers will now be required to cover any preventive treatment recommended by a patient's healthcare provider.
While the decision is a much-needed affirmation to trans advocates that preventive care should be based on body parts rather than gender identity, the federal government has yet to demand that insurers cover all medically necessary transition-related care, including talk therapy, hormone therapy, and gender-affirming surgeries. Thus far, only New York, California, Colorado, Connecticut, the District of Columbia, Massachusetts, Oregon, Washington, and Vermont have eliminated statewide barriers to trans-inclusive health insurance.
Obamacare has, however, made it illegal since 2013 for insurance companies to deny coverage to anyone for a "pre-existing condition," including "gender dysphoria" — a clinical diagnosis received by many trans people.