The LGBTQ community is facing two contradictory decisions.
On one hand, the Supreme Court ruled on June 15 that employers cannot discriminate against workers based on sexual orientation or transgender status. On the other, the Trump administration is rolling back protections that made it illegal for health care providers and insurers to discriminate against LGBTQ people, effective in mid-August.
The contradiction is in the details, said Caitlin Donovan, spokeswoman for the National Patient Advocate Foundation, a nonprofit promoting access to health care. The Supreme Court’s ruling has to do with Title VII of the Civil Rights Act of 1964, which prohibits descrimination based on sex. The Supreme Court ruled that the act includes protections for sexual orientation and transgender status. In contrast, the Trump administration’s rollbacks say the Affordable Care Act’s protections against sexual discrimination only apply to biological sex.
How this affects LGBTQ access to health care
Before the Supreme Court ruling, many LGBTQ workers were insured through their companies. That made it risky to seek care that might “out” them to their employers, like getting access to anti-HIV drugs or seeking gender confirmation surgery, said Donovan.
The ruling means workers can now access the care they need without fear of being fired, she said. However, due to the rollback by the Trump Administration, you may be protected against being fired for being LGBTQ, but a health care provider or insurer may deny you coverage, she added.
Health insurance companies have said they would seek to eliminate barriers to health care for the LGBTQ community in spite of the administration’s move. America’s Health Insurance Plans, an industry group representing health insurers, released a statement that said its members “disagree with any attempt to remove protections in federal law that prohibit discrimination based on gender identity, sex stereotyping, and pregnancy status.”
How will this affect transgender health care and insurance?
Transgender people already faced problems when it comes to accessing health coverage, said Daniel Bruner, senior director of policy at Whitman-Walker Health, a community health care provider specializing in the LGBTQ community in Washington, D.C. The Trump administration rollback means access to certain services may continue to be difficult.
For example, Bruner said, a transgender man may have trouble getting screened for ovarian cancer, while a transgender woman may face the same issues trying to get care for prostate cancer. Some insurance providers also deny coverage for gender affirming surgeries or hormone therapy, he said.
How to find coverage
You shouldn’t be afraid to apply for health insurance or seek health care if you need it, said Donovan. If you’re looking for health care, she suggests researching providers in your area that are LGBTQ friendly. GLMA, an association of queer-friendly health professionals, has a directory of LGBTQ-friendly providers on its website. Local LGBTQ organizations or word of mouth may also point you in the right direction.
Finding LGBTQ-friendly health insurance may be more complicated. Finding an affordable plan can be difficult on its own (we have a step-by-step guide). But you should also know whether the plans you're considering cover the providers you need and if they cover your specific family situation. For example, how does the plan cover children of same-sex parents? The organization Forward Together has a comprehensive list of questions for LGBTQ people to consider when picking a health plan.
If you feel you’ve been denied health coverage or insurance illegally, look for local LGBTQ advocacy groups or legal services. For example, Whitman-Walker provides LGBTQ health and legal services, including HIV/AIDS consultations and counsel in the Washington, D.C. area. Human Rights Campaign can direct you to local clinics, sexual assault recourses and a PreP resource center. Lambda Legal, part of a coalition of groups challenging the Trump rollback in court, also provides legal assistance to LGBTQ people who have faced discrimination in the area of health care. In addition, you can file a complaint with your state insurance department.
"There are a lot of legal services and national organizations who operate all over the country, so you should certainly not take no for an answer," said Bruner.
Image: Inti St Clair (Getty)