Proposed Rule Would Hurt Transgender Patients, Women, Say Groups

June 03, 2019 01:28 pm Scott Wilson – The AAFP and five other physician groups said a rule proposed by HHS could impede access to care by stigmatizing transgender people and allowing discrimination against women seeking necessary reproductive health care.

HHS said in a May 24 press release that its proposed revision of Section 1557 of the Patient Protection and Affordable Care Act would eliminate "unneeded paperwork burdens," and added that the updated regulation would allow for "continued robust enforcement" of laws protecting civil rights.

The Academy, voicing its objection to the change as part of the Group of Six -- which also includes the American Academy of Pediatrics, the American College of Obstetricians and Gynecologists, the American College of Physicians, the American Osteopathic Association, and the American Psychiatric Association -- disputed that characterization.

The proposal would roll back vital safeguards against gender discrimination and weaken critical protections for all U.S. patients, "including those who are transgender, those with limited English proficiency, those with disabilities and those who are seeking access to reproductive health care," said the coalition in a May 28 statement.

"In addition, permitting health care entities that receive federal funding to refuse care to patients who have had a pregnancy termination will have a dangerous effect on access to care," the statement said. "Allowing religious exemptions as the rule proposes will discriminate against women seeking necessary reproductive health care services. Any such exemption would be contrary to congressional intent and the express purpose of Section 1557 and has the potential to cause great harm to our patients."

The proposed change would strip away key elements of the 2016 rule -- including the definitions of terms such as discrimination on the basis of sex, certain language-translation requirements and a mandated written grievance procedure -- while limiting its antidiscrimination scope.

The AAFP's objection to the proposed rule change reflects its longstanding opposition to "all discrimination in any form, including, but not limited to, that on the basis of actual or perceived race, color, religion, gender, sexual orientation, gender identity, ethnic affiliation, health, age, disability, economic status, body habitus or national origin."

Transgender patients already face discrimination and barriers to care.

The National Center for Transgender Equality's 2015 U.S. Transgender Survey, published in 2016, polled some 27,000 transgender Americans and found that one-third of them who had seen a health care professional in the past year had at least one negative experience related to being transgender, such as harassment or denial of care. One-quarter of the respondents reported having experienced a problem with insurance related to being transgender. And 23 percent said they had avoided seeing a physician for needed care because they feared they would be mistreated.

Isabel Lowell, M.D., a family physician who founded QMed, a Decatur, Ga., clinic for transgender and nonbinary people, told AAFP News that her patients have shared with her their own accounts of discrimination.

One of Lowell's patients, she said, wrote to her, "My last primary care physician told me that if I had a cold or a broken bone, he would treat me, but could not (or would not) accept me as a transgender person. I was instructed to only come to the office presenting myself as a man."

Fresh Perspectives: Protect Transgender and Intersex Patients
(11/20/2018)

American Family Physician: Editorial: Transgender Care Resources for Family Physicians
(9/15/2006)