February 10, 2022 – A new insurance rule proposal to limit discrimination in health plans has sparked a debate over transgender health care.
The policy, known as Notice of Benefits and Payment Settings, is part of the Biden administration’s 2023 proposal for government health insurance exchanges. The rule would require health plans to ensure that the design and implementation of their benefits do not discriminate based on sexual orientation, gender identity, age, socio-demographic factors or age. other conditions.
The Obama administration first implemented the standard, but the Trump administration removed “sexual orientation” and “gender identity” from anti-discrimination language in 2020. The Biden proposal would restore protections for these categories.
“We believe such amendments are warranted in light of existing patterns of discrimination in health care and are necessary to better address barriers to health equity for LGBTQI+ people,” the ministry wrote. of Health and Social Services. in the proposed rule.
The Biden administration, Democratic lawmakers and advocacy groups have noted that the rule is vital for LGBTQ consumers to access care. But some private insurance companies have said the policy could drive up costs and the language on what constitutes discrimination is too vague. Conservative groups have also argued that there is no clinical evidence to cover care that affirms gender identity, such as hormone blockers or surgery.
Under the proposed rule, an insurer in government health exchanges would not be classified as providing “essential health benefits” under federal law if discrimination was found, Call reported. State regulators would be required to enforce the proposal.
The Department of Health and Human Services and the Centers for Medicare and Medicaid Services listed examples of alleged discrimination that would be prohibited, such as limiting gender-specific care under a health plan. Several state health plains do not address coverage or limit coverage of specific services for transgender people, Roll Call reported.
Health benefit plans would not have to cover all possible health care services, wrote Katie Keith, a researcher at Georgetown University’s Center on Health Insurance Reforms. in an article for Health Affairs. However, an insurer cannot have a different policy or restricted plans for transgender people than patients whose gender identity and sexual orientation match their birth sex.
The proposed rule has drawn a flurry of backlash in recent weeks. America’s Health Insurance Plans, a trade association for health insurance companies, said the non-discrimination framework is too broad and limits insurers’ ability to design plans with controlled costs.
The rule “could create a slippery slope by eliminating benefit limits based on clinical evidence, supporting value-based care and ensuring affordable premiums,” the group wrote. in a response letter.
Some conservative groups have also pushed back on coverage requirements. The Family Research Council and the Heritage Foundation have questioned the benefits or validity of gender-responsive care, according to Roll Call.
On the other hand, the HIV+ Hepatitis Policy Initiative said the new rule could help patients who have long faced coverage issues. For example, some insurers place HIV drugs on the most expensive plan tiers, which can result in significant patient expense.
“It’s not just HIV. It’s different [chronic disease] patients too,” said Carl Schmid, executive director of the patient advocacy group.
Other insurers, such as the Alliance of Community Health Plans, said the updated rule did not give them enough time to implement the changes. Under the proposal, insurers would have 60 days from final publication to ensure that plans comply with the non-discrimination framework. The group suggested an effective date of 2024 or later, rather than 2023.
At the same time, some insurance groups have said they are ready for change now. The Association for Community Affiliated Plans, which represents small nonprofit plans, said many of its member health plans have already committed resources to ensure all patients can access services, including medical services. affirmation or gender identity support for LGBTQ patients.
“We see that their pioneering work is – and should be – increasingly the norm,” wrote Margaret Murray, CEO of the association. in a response letter.
Comments on the proposed rule were due Jan. 27. Now the proposal will go through the annual approval process.