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Wolf Administration Opposes Trump Administration Proposal to Strip Transgender Individuals of Health Care Protections


Harrisburg, PA – The Wolf Administration today announced it is filing comments formally opposing the Trump Administration’s proposed rule that would strip protections from discrimination under the Patient Protection and Affordable Care Act (ACA) for people who are transgender.

“This proposed rule is contrary to law and, further, threatens the health and well-being of some of Pennsylvania’s most vulnerable citizens by not affording equal access to health care coverage on the basis of gender identity,” wrote Insurance Commissioner Jessica Altman. Her agency, along with the departments of Human Services, Health, and Aging submitted comments opposing this proposal.

Altman noted the Trump Administration proposed rule is not consistent with federal law, including section §1557 of the ACA and the civil rights laws referenced in this section. Those civil rights laws, prohibiting discrimination “on the basis of sex” or “because of…sex,” have been interpreted by courts to encompass gender identity within the definition of “sex” for purposes of non-discrimination requirements.

“Governor Wolf and the Insurance Department have been on record since issuing a notice to insurers in April 2016 that we are dedicated to ensuring all consumers have access to robust and affordable coverage regardless of one’s gender identity,” Altman said. “Today, I reiterate what Governor Wolf said more than three years ago, that despite the release of the Trump Administration’s proposed rule, it is the policy of the Commonwealth to treat all residents of this Commonwealth with dignity and respect, regardless of race, gender, creed, color, sexual orientation or gender identity or expression, and discrimination on any grounds should be prohibited.”

In terms of those health insurance policy forms, which are documents outlining what policies must cover, that fall under the Insurance Department’s jurisdiction, Altman said her department will continue to expect that:

  • A policy will not contain any discriminatory terms, conditions or benefit provisions contrary to State and Federal laws.
  • A policy affirmatively will include nondiscriminatory terms, conditions and benefit provisions consistent with State and Federal laws.
  • A policy will not exclude services based on gender identity and will not contain a categorical exclusion of coverage for all health services related to gender transition.
  • A policy will affirmatively provide that medically necessary covered services will be available to a policyholder regardless of their gender identity.

Department of Human Services Secretary Teresa Miller noted that the Trump Administration ending non-discrimination requirements would endanger the health and well-being of vulnerable populations. Permitting discrimination on the basis of gender identity and sexual orientation, limiting access to translation services for non-English speakers, and allowing services to be denied because of religious freedom will result in more people choosing to go without necessary health services. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) people can have higher rates of depression, substance misuse, and suicide attempts – serious behavioral health concerns that would be further challenged under this proposed rule. Denying services to vulnerable populations could increase costs to the Medicaid program by leading people to go longer without quality, necessary medical care.

“By ending non-discrimination requirements for health services, the Trump Administration is allowing for medical professionals to deny vital, life-saving services and could result in health care that is ineffective or inappropriate for LGBTQ and other vulnerable individuals. This will only exacerbate the health problems for the LGBTQ and other communities,” said Secretary Teresa Miller. “These changes also open the door to further discrimination and could allow for denial of medical services to children of LGBTQ couples, women who have had abortions, people with limited English proficiency, and more. The Trump Administration’s constant attacks on vulnerable populations will lead to fewer people seeking medical care for fear of discrimination. This is unacceptable and cruel.”

Pennsylvania and Governor Tom Wolf have been committed to working to ensure the rights of all citizens. This includes the state’s LGBTQ Affairs Commission, the first of its kind in the country. The commission exists to ensure that no one faces barriers or obstacles based on sexual orientation, gender identity and expression.

“We continue to decry actions by the federal government that threaten the very health and well-being of some of our most vulnerable citizens,” Secretary of Health Dr. Rachel Levine said. “The continuous attacks on the rights of transgender Americans, must stop. Gov. Wolf has shown that protecting the rights of all Pennsylvanians is essential to our continued success and prosperity — the federal government should do the same.”

Last year, the Department of Aging hosted its inaugural statewide LGBTQ Aging Summit as a result of grassroots efforts made by numerous LGBTQ and senior advocacy groups. The summit provided older LGBTQ Pennsylvanians, interested stakeholders, and provider organizations the opportunity, over two days, to share best practices in caring for LGBTQ older adults, to address barriers they face, and to discuss how to promote awareness and strategies for inclusion. The department has since continued its efforts to improve and promote inclusion statewide by considering feedback from regional planning sessions held at the summit on how to ensure the provider network for seniors in Pennsylvania is culturally sensitive and affirming.

“As a member of Governor Wolf’s LGBT Workgroup, and in collaboration with our many LGBTQ partners, aging services providers, and stakeholders, the Department of Aging has made its commitment to diversity, increased cultural competency, and inclusion a major priority,” said Department of Aging Secretary Robert Torres. “This proposed ruling would exclude a community, solely based on their gender identity, that is already facing unique challenges and deserving of equal access to health care. Our department is proud to stand with the LGBTQ community and advocate for protections they rightfully deserve.”

In concluding its comments, the Wolf Administration strongly urged the federal Department of Health and Human Services’ Office of Civil Rights to recognize that section 1557 of the ACA includes protections against discrimination on the basis of gender identity, and decline to finalize the proposed rule.

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