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Withdrawal of Transgender Protections in ACA Reinforces Health Care Inequities

The rules in the Patient Protection and Affordable Care Act barring discrimination by health insurers and providers against transgender people offered essential protections for a population facing significant barriers to health care.

The administration’s withdrawal of those protections, announced Friday, disregards medical standards[i] [ii] and comes at a time when the COVID-19 pandemic has brutally exposed inequities that are pervasive throughout the U.S. health care system. Transgender adults are among those most likely to be uninsured and least likely to have access to routine health care.[iii] These inequities -- compounded by stigma and discrimination -- are among the factors contributing to high rates of HIV among transgender women, with the greatest impacts on African American and Latinx populations. While 14% of transgender women are living with HIV, 44 % of those are African American and 26% are Latinx.[iv]

The changes to the rules implementing Section 1557 of the Patient Protection and Affordable Care Act proposed by the White House call into question the administration’s commitment to ending HIV as an epidemic and will impede progress against the health and socioeconomic disparities plaguing our nation. We call upon the administration to prevent further harm to a group already vulnerable to serious illness and poor health outcomes and rescind this rule change before it takes effect in August.

[i] Infectious Diseases Society of America, HIV Medicine Association. Pediatric Infectious Diseases Society. Policy Statement: Discriminatory Laws and Policies Affecting Lesbian, Gay, Bisexual and Transgender Individuals and the HIV and STD Epidemics. October 2016. Online at
[ii] American Medical Association, GLMA. Health insurance coverage for gender affirming care of transgender patients. March 2019. Online at:
[iii] Gonzales G, Henning-Smith C. Barriers to Care Among Transgender and Gender Nonconforming Adults. Milbank Q. 2017;95(4):726‐748. doi:10.1111/1468-0009.12297.
[iv] Centers for Disease Control and Prevention. HIV and Transgender People. Available online: Accessed June 12, 2020.

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