The Obama administration proposed a new rule Thursday that would ban discrimination against transgender people in the health care system, saying stereotypes about sexual identity have no place in provision of health insurance or medical care.
"The proposed rule, Nondiscrimination in Health Programs and Activities, will assist some of the populations that have been most vulnerable to discrimination and will help provide those populations equal access to health care and health coverage," the Health and Human Services Department said in a statement.
"Section 1557 of the Affordable Care Act (ACA) extended civil rights protections banning sex discrimination to health programs and activities. Previously, civil rights laws enforced by HHS's Office for Civil Rights barred discrimination based only on race, color, national origin, disability, or age."
The issue's at front and center of U.S. society. On the same day, a federal judge ordered Kentucky clerk Kim Davis to jail after she refused to issue marriage licenses to same-sex couples. And the right to same-sex marriage was only decided by the Supreme Court in June.
"This proposed rule is an important step to strengthen protections for people who have often been subject to discrimination in our health care system," HHS Secretary Sylvia Burwell said in a statement.
The rule prohibits insurance companies from denying coverage to transgender people, allows them the right to use the facilities, such as restrooms, according to their gender identity and says providers may not discriminate on the basis of their own notions of masculinity or femininity.
"This is a huge step," said Michael Silverman, director of the Transgender Legal Defense and Education Fund in New York. "It covers a lot of ground."
Jocelyn Samuels, head of the HHS office of civil rights, said the rule does not require insurers to pay for someone to receive sex-change treatment. Medicare and Medicaid, as well as any service providers who accept federal dollars would have to follow the rules.
"This provision provides nationwide protection against sex discrimination in health care and services for the first time," said Marcia Greenberger, co-president of the National Women's Law Center.
"When women are charged more for health care, when their health needs, including reproductive health care, are excluded from coverage or marginalized, when medical research excludes women, when female doctors are paid less for the same work, when clinics deny care to LGBTQ individuals, the health, financial security, and very futures of women and their families are threatened."
But not everyone was happy with the rule.
Carl Schmid, deputy executive director of The AIDS Institute, an advocacy group, said it doesn't go far enough.
"The AIDS Institute and others have provided countless examples of marketplace plans that employ discriminatory benefit design by placing all medications to treat a certain condition on the highest cost tier, not covering certain medications, imposing excessive medication management tools, and charging patients high cost sharing," Schmid said in a statement.
His organization says many insurers deliberately put HIV medications in the most expensive coverage tiers, forcing patients to make high co-pays even for generic drugs.