The Department of Health and Human Services issued a final regulation Friday that will pressure health insurers to cover sex change operations, which could then be subsidized by taxpayers through Medicare, Medicaid, and Obamacare.
The final rule comes the same day the Obama administration ordered schools to let children use whatever bathroom or locker room matches "their chosen gender identity," or risk losing federal funding.
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The agency released its final "Nondiscrimination in Health Programs and Activities" rule, which enforces Section 1557 of the Affordable Care Act.
The regulation "prohibits discrimination based on race, color, national origin, sex, age, or disability; enhances language assistance for individuals with limited English proficiency; and protects individuals with disabilities," the agency said in a release.
Doctors and health insurers also cannot deny "health care or health coverage based on an individual’s sex, including discrimination based on pregnancy, gender identity, and sex stereotyping."
In a fact sheet on the portion of the rule regarding sex discrimination, the government explains that health care providers cannot refuse to cover all services related to a sex change—such as hormone therapy, breast implants, and the surgery itself—as a matter of policy.
"Categorical coverage exclusions or limitations for all health care services related to gender transition are discriminatory," the agency said.
The rule also includes a bathroom provision, stating that "individuals must be treated consistent with their gender identity, including in access to facilities."
Additionally, health care providers "may not deny or limit treatment for any health services that are ordinarily or exclusively available to individuals of one gender based on the fact that a person seeking such services identifies as belonging to another gender."
The regulation will apply to virtually all hospitals, health care providers, and insurance companies.
"The Section 1557 final rule applies to any health program or activity, any part of which receives funding from the Department of Health and Human Services (HHS), such as hospitals that accept Medicare or doctors who receive Medicaid payments; the Health Insurance Marketplaces and issuers that participate in those Marketplaces; and any health program that HHS itself administers," the agency said.
The Obama administration praised the rule as a win for "civil rights."
The regulation is the "first federal civil rights law to broadly prohibit discrimination on the basis of sex in federally funded health programs," the agency said.
"A central goal of the Affordable Care Act is to help all Americans access quality, affordable health care," said Health and Human Services Secretary Sylvia M. Burwell. "Today’s announcement is a key step toward realizing equity within our health care system and reaffirms this administration's commitment to giving every American access to the health care they deserve."
The agency told the Washington Free Beacon that the rule does not force health insurance companies to cover sex reassignment surgeries, but companies cannot deny treatments related to a gender transition outright.
"The final rule does not require covered entities to cover any particular procedure or treatment for transition-related care, including gender reassignment surgery. However, it does bar a covered entity from categorically excluding from coverage or limiting coverage for all gender transition-related services," an agency spokesperson said.
The rule itself could open the door for lawsuits by transgender individuals, who could claim that being denied a service related to a sex-change violates their civil rights because it is now illegal to deny care on the basis of gender identity.
Several states already had policies in place that ban private insurance companies and Medicaid providers from excluding services for a gender transition. California, Oregon, Washington, Colorado, Illinois, New York, Vermont, Rhode Island, Connecticut, Massachusetts, and the District of Columbia all have "explicitly prohibited private health insurance plans sold in the state from having exclusions for transition-related care," according to the National Center for Transgender Equality. The final rule now essentially makes those laws national.
The Obama administration removed a ban from Medicare covering gender reassignment surgeries in 2014.
The average surgery cost for a man to become a woman is $23,000.