The 2010 Patient Protection and Affordable Care Act (ACA) has been a critical piece of legislation for expanding access to health care, including for the LGBTQ community. One of its critical features is a statutory prohibition on discrimination in health care based on sex. NCLR advocated extensively with the U.S. Department of Health and Human Services (HHS), the federal agency that enforces these protections, to ensure that sexual orientation and gender identity are included within the scope of the ACA nondiscrimination rule. In 2016, HHS issued a rule specifying that it would indeed interpret the nondiscrimination provision as covering LGBTQ people.

Unfortunately HHS under the Trump administration has taken a different view, and is in the process of seeking to change the regulations to take away some of the explicit protections for sexual orientation and gender identity. NCLR filed extensive comments in the record opposing these changes and is continuing to monitor developments in this area.

It is important to note that while HHS can make changes to its regulations, it cannot change the underlying statute, which still contains the prohibition against sex discrimination. Some courts have interpreted the statute to include sexual orientation and gender identity regardless of what HHS does. If you experience discrimination in health care due to your sexual orientation or gender identity you still have the ability to take legal action.

On February 27, 2019, Representative Pramila Jayapal (WA) introduced the Medicare for All Act of 2019 (H.R.1384/S.1804) to establish a national health insurance program to combat the high costs of healthcare and health-related services for all U.S. residents. The Medicare for All Act would provide guaranteed access to affordable healthcare for all persons living in the U.S. Establishing an universal healthcare system is a top priority for LGBTQ people, because they are less likely to have health insurance than non-LGBTQ people.

Annie and Lyndy had been together for nearly thirteen years when Annie suffered a debilitating stroke. About ten years later, Annie entered hospice care while Lyndy continued to care for her. Despite legal documents designating Lyndy as the person responsible to make medical decisions for her, a state entity removed Annie from her shared home with Lyndy and petitioned for a public guardian.

California fertility service providers are permitted to offer people seeking to conceive using a known sperm donor access to certain fertility services on the same terms as different-sex couples under Assembly Bill 2356 (2012), which went into effect January 1, 2013. This bill was authored by Assemblymember Nancy Skinner and co-sponsored by Equality California and the National Center for Lesbian Rights.

Increasingly, women in same-sex couples, transgender people, and single women are asking trusted friends to act as sperm donors in order to conceive a child. California was the first state to legally recognize that people may use known donors (not just anonymous sperm donors) to conceive a child.

However, people using known donors could not access the same fertility services as women in different-sex relationships. Different-sex couples can have insemination services using fresh sperm. Known donors’ sperm must typically be frozen and quarantined for six months. Insemination using fresh sperm is more effective and less costly.

AB 2356 allows providers to provide insemination services using fresh (unfrozen) sperm to people using known donors. Providers are not required to offer this service, but this law clarifies that they may offer it.

The National Center for Lesbian Rights was a lead partner with the Department of Health and Human Services (HHS) on the development of the administration’s historic Hospital Visitation Rule. The Rule came at the direction of President Obama who urged HHS to identify ways to protect the hospital visitation rights of all patients through policy change. NCLR worked closely with HHS on the final rule, which guarantees equal treatment in hospital visitation to all patients and their loved ones regardless of sexual orientation, gender identity, biological relationship, or marital status. Subsequent to the introduction of that Rule in 2011, we have worked closely with HHS on implementation. We co-hosted a webinar with HHS, which provided education on the impact of the Rule and “Best Practices‚” for working with the LGBTQ community. We continue to work with HHS to clarify that this Rule also applies to nursing homes and hospice facilities.

Vanessa Adams is a transgender woman who was diagnosed by Federal Bureau of Prison (BOP) medical professionals with Gender Identity Disorder (GID) in 2005 while she was incarcerated in a BOP prison. Over the next few years, she made at least 19 written requests asking for medical treatment for GID. The BOP denied all of her requests outright based on its so-called “freeze frame” policy in which treatment for any person with GID is kept frozen at the level provided at the time he or she entered BOP custody. In Ms. Adams’ case, this meant that because she had not received treatment for GID before being incarcerated, BOP would not provide her with medically necessary care even though its own doctors diagnosed her with GID, told her about treatments available for GID, and knew about the seriousness of her medical condition. As a result of these denials of treatment, Ms. Adams attempted suicide multiple times and engaged in other avenues of self- treatment in an attempt to live more consistently with her gender identity.