In the wake of the Orlando massacre, Jane Sarasohn-Kahn writes at Health IT News about health disparities faced by the LGBT community in America.

The U.S. Centers for Disease Control, has an over-arching goal to improve the health, safety, and well-being of lesbian, gay, bisexual, and transgender individuals. The CDC points out that LGBT individuals face health disparities linked to societal stigma, discrimination, and denial of civil and human rights. These challenges have been associated, in clinical peer-reviewed literature, with higher rates of psychiatric disorders, substance abuse, and suicide.

Experiences of violence are frequent for LGBT individuals

--CDC

Key social determinants of health continue to plague LGBT health: these include, but are not limited to, legal discrimination in access to health insurance, employment, housing, and retirement benefits; laws protecting against bullying in schools; and shortage of health care providers knowledgeable and culturally competent in LGBT health.

Lesbians are less likely to get preventive services for cancer, LGBT youth are more likely to be homeless, and LGBT individuals have the highest rates of tobacco, alcohol, and other drug use, according to CDC analyses of the literature.

--Sarasohn-Kahn

In the middle of May, the Department of Health and Human Services Office for Civil Rights issued a new rule affecting national nondiscrimination protections for LGBT people in health facilities and programs. The new rule interprets the provisions of Section 1557 of the Affordable Car Act as follows:

LGBT Americans face numerous barriers to health — from providers who just don’t understand their unique health needs, to difficulty getting health insurance because they can’t get coverage through a partner or a spouse. And unfortunately way too many LGBT individuals face discrimination and bigotry in the health care system.

--HHS Secretary Kathleen Sebelius, 2012

The Section 1557 final rule is critical to addressing the remaining barriers to coverage and care that LGBT people across the country routinely experience. These barriers include discrimination such as health care providers using harsh or abusive language, blaming patients for their health status, and being physically rough or abusive. Close to 8 percent of LGB people and more than 25 percent of transgender people have been denied health care outright on the basis of who they are. In addition, there are those turned away because of an association with an LGBT individual. In Michigan in 2014, for example, Bay Contreras, the six-day-old daughter of a lesbian couple, was denied care by a pediatrician simply because she has two moms.

The rule also protects people with “atypical sex characteristics and intersex traits,” which the rule describes as including “people born with variations in sex characteristics, including in chromosomal, reproductive, or anatomical sex characteristics that do not fit the typical characteristics of binary females or males.”

Employers are beginning to figure out what this means:

The new ACA regulations may require employer group health plans to provide coverage for transgender surgery and other transgender health benefits. This new requirement takes effect as of the first day of the first plan year beginning on or after Jan. 1, 2017.

The new regulations prohibit discrimination on the basis of race, color, national origin, sex, age or disability under a health program or activity receiving federal funds. As part of this ban on discrimination, blanket exclusions in group health plans for all care relating to gender dysphoria or gender transition will no longer be permitted. Rather, transgender surgery and other transgender health benefits must be provided on a nondiscriminatory basis. For example, if a group health plan provides coverage for a hysterectomy for a female participant experiencing medical issues during menopause, then it would also be appropriate to cover a hysterectomy for a participant whose physician recommends it to treat gender dysphoria.

Employer group plans which must comply include:

• Plans sponsored by hospitals, home health agencies, nursing homes and other health care providers receiving funds under Medicare Part A or Medicaid;
• Fully insured group health plans (sponsored by any employer) where the insurer is offering coverage on an exchange; and
• Self-funded group health plans (sponsored by any employer) administered by an insurer offering coverage on an exchange.

In the regulations, OCR explains that while it has jurisdiction over an insurer offering coverage on an exchange (even with respect to its business of administering self-funded plans), it does not have jurisdiction over employer-sponsors of self-funded group health plans. However, OCR indicates that if such a self-funded plan is discriminatory, it may refer the matter to EEOC to pursue an employment discrimination claim against the employer sponsoring the plan.