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Trump Administration Proposes Eliminating Protections For Transgender People In ACA


The Trump administration wants to redefine the word sex, at least in terms of the Affordable Care Act and who gets protected from discrimination. With us now to explain, NPR's Selena Simmons-Duffin, who is following this. Thanks for being here, Selena.


MARTIN: So explain this. We're talking specifically about transgender people - right? - and what kind of health care they can receive.

SIMMONS-DUFFIN: Well, in 2016, the Obama administration put out a rule that defined sex to include gender identity and added that as part of the Affordable Care Act. So the rule redefined discrimination on the basis of sex to include termination of pregnancy or pregnancy and gender identity. So it defined that as one's internal sense of being male, female, neither or a combination of male and female. And that would've allowed people who had complaints of discrimination on those bases to bring complaints before the Health and Human Services Office for Civil Rights...

MARTIN: Right.

SIMMONS-DUFFIN: ...Which is what fields these kinds of complaints. But the provision never took effect because of two lawsuits that resulted in injunctions. And Roger Severino, the director of the office in the Trump administration, says the new proposal will remove the gender identity language. And that probably makes those lawsuits moot.

MARTIN: OK, but what is the problem the Trump administration is trying to fix here?

SIMMONS-DUFFIN: So Severino was asked that on a press call today. He said if the lawsuits - basically, if the lawsuits had not been successful and the definition was allowed to take effect, it would've created billions of dollars in paperwork expenses - he says $3.2 billion over the next five years - to notify people of their rights under the rule and to process their complaints. And part of that, he said, were printing costs and things like translation and the cost of grievance procedures.

More broadly, they say they're just returning to a plain understanding of the meaning of the word sex - in other words, biological sex or sex at birth.

MARTIN: So it sounds like it was preemptive in nature. It has to do with whether or not those lawsuits were going to go through, and they're not anymore. And then this other, more philosophical idea of what sex means - I mean, what does this signal to transgender people?

SIMMONS-DUFFIN: So advocates for trans people were expecting this, and they're already reacting this morning. They say in addition to making it more permissible for health care workers to discriminate against trans people, it could discourage them from seeking care in the first place, which could have serious health impacts.

MARTIN: Part of what they're changing has to do with something called conscience rights, correct?

SIMMONS-DUFFIN: Right. So part of the definition of sex that's being changed today would have prohibited discrimination based on pregnancy or termination of pregnancy. So this new rule, if adopted, would remove that protection as well. And Severino said that will protect health care providers who do not want to perform abortions or other procedures that go against their moral or religious beliefs.

MARTIN: Thus, conscience protections - conscience rights.

SIMMONS-DUFFIN: Right. Exactly.

MARTIN: So just briefly, why do you think this is happening now?

SIMMONS-DUFFIN: Well, this is what Severino really came in to do. He was formerly with the Heritage Foundation. He's been very vocal about his religious beliefs and protecting those of others. He's really shaping his Office of Civil Rights to emphasize the protections of health care workers' moral and religious beliefs. And the changes today are part of that.

MARTIN: All right. NPR's Selena Simmons-Duffin for us. Thank you. We appreciate it.

SIMMONS-DUFFIN: Thank you. Transcript provided by NPR, Copyright NPR.

Selena Simmons-Duffin reports on health policy for NPR.