Health insurance discrimination against gender-variant people is supposed to be a thing of the past under president Obama’s health law.
The same goes for discrimination against women, gays, lesbians and people who are bisexual and questioning.
“The Affordable Care Act is the first enactment dealing with sex discrimination and health care,” Regional Director of the U.S. Department of Health of Human Services Herb Schultz, told a Tucson audience last week. “It’s historic.”
Schultz explained to the audience how the Affordable Care Act’s nondiscrimination provisions make it illegal for insurance companies who offer coverage through the marketplace to discriminate based on sexual orientation or gender identity.
The law’s prohibition on discrimination against people who have pre-existing conditions and the removal of annual or lifetime caps on services greatly improves healthcare for everyone, but in particular for the LGBTQ (lesbian, gay, bisexual, transgender and questioning) community, he said.
“Most people are being treated for more than one condition. I have HIV, I go to a therapist every Sunday,” Schultz said. “These provisions mean that anybody who has any type of chronic health condition can no longer bust that cap and be rendered uninsured because of that.”
Schultz and Dr. Kevin Maxey, co-founder of the Southern Arizona Gender Alliance, answered questions from the audience about what services will be covered under the new law.
“If my driver’s license says I’m a man, but I have a cervix, will my insurance cover a pap smear?” one audience member asked.
Schultz clarified that basic preventive services are now considered essential in anyone who has the appropriate anatomy. For an insurance provider to deny something like a pap smear now constitutes a civil rights violation.
Other questions were raised about if transitional services, such as hormone treatments or surgeries, would be covered.
“With a diagnosis of gender dysphoria, services such as hormone treatments are legitimate and medically necessary,” Maxey said. “Transitional and cosmetic procedures can also present as medically necessary.”
Maxey provides annual lectures about transgender health priorities for the University of Arizona College of Medicine. Currently working as a physician with the Pima County Health Department, Maxey transitioned from female to male in the late 1980s while working as an emergency room physician.
As there isn’t yet a clear definition for what constitutes medically necessary, Schultz conceded that access to hormone and surgical procedures might not be immediately approved by all providers. But with the nondiscrimination provision and complaint system in place, he believes that positive changes in access and treatment are still to come.
Based in San Francisco, Schultz provided his cellphone number to the audience, offering to help with anyone who contacted him with discrimination claims.
“I’ll personally walk them downstairs to the office of Civil Rights,” he said.
Schultz and Tucson Congressman Raúl Grijalva have held six forums within Grijalva’s district in Arizona, targeting vulnerable populations who have faced barriers to quality health care.
“This is the most profound social health-care initiative that this country has ever had,” Grijalva said. “These underserved communities must, and can now be reached.”
The Tucson forum coincided with Transgender Awareness week, an annual citywide event put on by the University of Arizona’s LGBTQ Resource Center and Wingspan’s Southern Arizona Gender Alliance.
“This week is an opportunity to educate the community and health-care providers about who we are,” UA employee Michael Woodward said. “We’re not that different and we need health care just like everyone else.”
Woodward transitioned from female to male 15 years ago and is a Graduate Assistant for Ally Development in the UA’s Office of LGBTQ Affairs.