Health Care Providers Urge Trump Administration to Delay Rule Change to the Affordable Care Act | National Center for Transgender Equality

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Friday, May 29, 2020

Health Care Providers Urge Trump Administration to Delay Rule Change to the Affordable Care Act

More than 1,000 medical and mental health providers have signed onto a letter in opposition to pending rules that would reinterpret nondiscrimination protections from the Affordable Care Act. 

 

The new rule sets the Trump administration’s view that the law doesn’t protect patients from discrimination because they are transgender, pregnant, or have a same-sex partner or family member. It also instructs hospitals and insurance companies that they are no longer required to provide patients with notices of their rights or how to get information in different languages.

 

The letter also urges the US Department of Health and Human Services to delay any rule change affecting access to health care until at least 90 days after the end of the COVID-19 public health emergency.

“As the death toll and hardships created by the COVID-19 pandemic continue to grow, the Trump administration and the Department of Health and Human Services should be working to expand access to health care, not creating excuses for providers to turn away transgender Americans,” said Mara Keisling, executive director of the National Center for Transgender Equality, a co-organizer of the letter. “The pending rules are heartless and wrong-headed. The rules should be rejected. But the least the Trump administration could do to help protect the health of transgender people is to delay their implementation until we are through this crisis.”

Section 1557 of the Affordable Care Act, also referred to as the Health Care Rights Law, prohibits discrimination on the basis of race, national origin, sex, age, or disability in health care programs or activities. It is the first federal civil rights law to prohibit discrimination based on sex in health care.

As proposed by the U.S. Department of Health and Human Services, this rule would falsely tell hospitals and health care insurance plans that they could:

  • Refuse testing or treatment because a patient is transgender or doesn’t conform to sex stereotypes.
  • Refuse testing or treatment because a patient has had an abortion.
  • Refuse testing or treatment to patients based on a provider or staff member’s personal beliefs.
  • Refuse testing or treatment based on sexual orientation, even in programs that have banned such discrimination since the G.W. Bush administration. 
  • Incorporate discriminatory plan benefit designs that eliminate/limit coverage critical to people with disabilities or preexisting conditions and place certain kinds of treatments needed by people with specific disabilities on the most expensive copay tiers.
  • No longer notify patients of their right to receive information in their primary language.
  • No longer notify patients of their right to file a grievance if they’re mistreated.

“The pending rule changes will impede the delivery of life-saving health care even as the country grapples with more than 100,000 deaths with COVID-19,” said Hector Vargas, executive director of GLMA: Health Professionals Advancing LGBTQ Equality and co-organizer of the letter. “Health care providers are the frontlines of this pandemic and know that our medical systems and essential workers are overwhelmed. We also know that Section 1557 is essential in our efforts to prevent deaths. The pending changes are irresponsible and unnecessary.”

The letter addressed to Secretary Alex Azar of the US Department of Health and Human Services is below:

 

Re: Nondiscrimination in Health and Health Education Programs and Activities, Final Rule (RIN 0945-AA11)

On behalf of the more than 1,000 undersigned medical and mental health providers, we write to the administration in opposition to the pending final rule that would reinterpret the Affordable Care Act’s nondiscrimination provisions so that the law will no longer protect patients from discrimination if they are transgender, pregnant, or have a same-sex partner or family member in a same-sex partnership. In addition, the new changes will direct hospitals and insurance providers that they will no longer have to provide notices of patient rights or instructions to get access to information in different languages. 

As medical and mental health care providers, we vehemently oppose these rule changes and believe they will impede delivering of the highest quality of health care to the most marginalized, especially during a national public health crisis that has cost over 93,000 lives (1). We are on the frontlines of this pandemic and know firsthand that our medical systems and essential workers are heavily burdened and overwhelmed as the death toll continues to rise. We know that Section 1557 is essential in our efforts to prevent deaths during the current pandemic. Changes to this interpretation will be irresponsible and unnecessary as it will perpetuate discrimination and create unnecessary barriers for patients in accessing critical information about their rights and their health.

We know that this pandemic has already disproportionately impacted people of color. For example, data has already indicated that black and Latinx people in New York City are two times more likely to die compared to white people (2). In addition, we know that the LGBTQ community, especially LGBTQ people of color, are disproportionately impacted by this virus. This rule change will allow service providers to deny medical care, including testing and treatment for COVID-19, to many communities that are at greatest risk from this deadly virus and worsen health disparities. That's why we-- and this nation’s leading health professional associations, including the American Medical Association, American Nurses Association, American Academy of Pediatrics, American Psychiatric Association, American Psychological Association and National Association of Social Workers, among others -- have repeatedly opposed this proposal even before this current crisis. 

As proposed by the U.S. Department of Health and Human Services, this rule would falsely tell hospitals and health plans that they could:

  • Refuse testing or treatment because a patient is transgender or doesn’t conform to sex stereotypes.
  • Refuse testing or treatment because a patient has had an abortion.
  • Refuse testing or treatment to patients based on a provider or staff member’s personal beliefs.
  • Refuse testing or treatment based on sexual orientation, even in programs that have banned such discrimination since the G.W. Bush administration. 
  • Incorporate discriminatory plan benefit designs that eliminate/limit coverage critical to people with disabilities or preexisting conditions and place certain kinds of treatments needed by people with specific disabilities on the most expensive copay tiers.
  • No longer notify patients of their right to receive information in their primary language.
  • No longer notify patients of their right to file a grievance if they’re mistreated.

For all of these reasons, we urge the administration to suspend this rule change. At a minimum, this rulemaking process should be suspended until at least 90 days after the termination of the current COVID-19 Public Health Emergency declared by Secretary Azar on January 31, and after a large majority of states are no longer subject to stay-at-home orders and closure of non-essential businesses.

HHS has called this pandemic “an emergency of unprecedented magnitude”; yet this administration has continued to fail us and the people that have been directly impacted by this crisis by creating barriers to testing, contact tracing, personal protective equipment and other critical supplies to save lives. We urge you to focus on the current crisis instead of exacerbating negative health outcomes from this deadly pandemic. If you have any questions, please contact Hector Vargas of GLMA or Debbie Ojeda-Leitner of NCTE.

Sincerely, 
The Undersigned

(1) “Cases in the US.” CDC. May 19, 2020. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html
(2) Crear-Perry, Joia and McAfee, Michael. “To Protect Black Americans from the Worst Impacts of COVID-19, Release Comprehensive Racial Data.” Scientific American. April 24, 2020.https://blogs.scientificamerican.com/voices/to-protect-black-americans-from-the-worst-impacts-of-covid-19-release-comprehensive-racial-data/.

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