On Thursday, President Trump’s American Health Care Act passed the House of Representatives by a vote of 217-213, and it is now headed to the Senate. If passed by the Senate as it is currently constituted, it will result in the repeal and replacement of President Obama’s Affordable Care Act. The original version of the AHCA failed after facing opposition by both moderate Republicans and the hard right leaning Freedom Caucus. This time around, President Trump and House Speaker Ryan were able to push it through by removing provisions such as requiring insurance companies to cover preexisting conditions, a move which was favorable to the Freedom Caucus. To bring moderate Republicans on board, they also added $8 billion over five years to subsidize those with preexisting conditions who would be affected. Opponents of the bill claim this amount wouldn’t nearly be enough to cover them. The bill received no yes votes from Democrats.
What has many up in arms is the fact that many members of the house voted for the bill without reading it. They also didn’t wait for it to be reviewed by the Congressional Budget Office (CBO), meaning it passed without anyone knowing what it will cost.
How does this affect the transgender community?
- The CBO did review the original version of the AHCA, and they estimated a total of 24 million people would lose their health coverage as a result. Currently there are no indications that this number will change with the new version. Those most affected would be low-income individuals and families as well as the elderly. It is estimated that transgender people are four times more likely to be live in poverty compared to the general population.
- Being transgender is considered a preexisting condition and this will allow insurance companies to charge higher premiums or deny coverage altogether.
- The bill cuts $880 billion from Medicaid. This will affect over 14 million U.S. residents. Many low-income transgender people (in states that are enrolled) receive low cost insurance from Medicaid that covers transgender care.
- The bill will remove the ACA’s essential benefits requirement, which requires insurers to cover essential services needed by the transgender community including mental health care, prescription drugs, hospitalization, laboratory, and pediatric services.
- The AHCA will defund Planned Parenthood, where 65 locations provide transgender specific care across the United States.
The final analysis of the 1800 page bill has yet to be released and is pending review by the CBO. It remains to be seen whether the Senate will pass the bill, modify it, or vote it down altogether. Regardless, the initial implications of the bill have many in the LGBTQ+ community concerned.
In the meantime
On Tuesday, U.S. Department of Justice filed a motion for a voluntary remand and stay with regards to section 1557 of the current Affordable Care Act. Section 1557 prohibits entities from receiving federal funds if they discriminate on the basis of race, skin color, sex, age, disability, or national origin. It currently defines gender identity as included under sex discrimination. It provides a legal avenue for transgender patients who are denied health care or coverage from religious or religious affiliated providers who receive funding.
An injunction against section 1557 was issued in August by U.S. District Judge Reed O’Connor (R), which blocked enforcement of the guidelines. The right to sue for discrimination had been left in place. The DOJ has now sent the regulations to the Department of Health and Human Services to decide whether gender identity and pregnant women seeking abortions should be kept or removed. Many fear the current head of the HHS, Tom Price (R), will gut the guidelines and remove gender identity from being protected based on his long history of opposing LGBTQ+ rights.
Though the dust has yet to settle, it could be a bumpy road for the transgender community despite whether the AHCA passes the Senate or not.