Insurance coverage barriers continue to obstruct access to healthcare for transgender people in the United States, even after the Biden administration said it would apply the Affordable Care Act's anti-discrimination provisions to issues of gender identity and sexual orientation. A patchwork of state initiatives, ranging from categorical restrictions on coverage to mandates for coverage, complicate the issue for consumers and insurers. A recent court ruling in Iowa upholding the state's nondiscrimination provisions and paving the way for coverage for gender-transitioning surgery in its Medicaid program may help reinforce health coverage protections in more parts of the country, experts and advocates said. It could also bolster similar lawsuits seeking to ensure Medicaid-program coverage for low-income transgender Americans. Advocates are also pushing for states to add more explicit guidance for coverage of care related to gender transition in private insurance and federal-state administered Medicaid plans. The aim is to prevent coverage denials rooted in continuing debates over which treatments are ‘medically necessary” or conform to accepted standards of medicine. The Affordable Care Act's Section 1557 bars healthcare discrimination based on sex, but its interpretation has varied as administrations have sparred over its inclusion of individuals who identify as transgender or non-binary. The U.S. Department of Health and Human Services under former President Donald Trump said it would treat gender discrimination based on the biological sex assigned at birth--either male or female--and not enforce protections against discrimination based on gender identity or cases where individuals identified differently from the sex assigned to them at birth. The health agency reversed that stance in May and is working on new rules to clarify the provision. About 11.3 percent of U.S. LGBT adults identified as transgender individuals, a Gallup survey showed in February this year. Gallup estimated transgender individuals represent about 0.6 percent of the U.S. adult population.
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