During a pandemic and a national uprising against racist terror the Trump administration handed down another devastating blow: the Department of Health and Human Services announced it had completed revisions to the Affordable Care Act removing anti-discrimination protections for women and LGBTQ people in healthcare.
June 12 was a brutal day for the LGBTQ community. People learned of the brutal murders of two Black trans women – Dominique “Rem’Mie” Fells of Philadelphia and Riah Milton of Liberty Township, Ohio – even as we continue to fight for justice for Tony McDade, a Black trans man killed by police in Tallahassee, Florida, last month. It was also the fourth anniversary of the Pulse nightclub shooting, when a gunman killed 49 people and wounded 53 others at a gay club in in Orlando, Florida, in 2016.
Then, in the evening, the DHHS announced it had finalized long-anticipated changes to Section 1557 of the Affordable Care Act, removing language that protected women and LGBTQ people from discrimination in healthcare.
Being female or queer is a ‘pre-existing condition’
Although the Trump administration first announced its intent to change the clause in May 2019, the Religious Right has been working to undermine the protections since they were introduced by former President Barack Obama in 2016, challenging the new rule in courts that ultimately upheld the rule.
The language of Section 1557 formerly defined gender as “one’s internal sense of gender, which may be male, female, neither, or a combination of male and female,” but this has now been removed. While the new language doesn’t explicitly define gender as congruous with “biological sex,” it was the DHHS in 2018 which led the charge for two other government departments – Justice and Education – to erase trans people by using just such language.
The impact on oppressed genders and sexualities cannot be overstated: from reproductive health to mental health, HIV prevention and treatment, and transition-related therapies and surgical procedures, women and LGBTQ people have a far greater dependency on medical institutions than their straight, cisgender, and male counterparts.
The fear is not idle, either: in a survey conducted in 2017, when these protections were supposedly in effect, 29 percent of trans people reported that a health care provider refused to see them due to their gender identity, and 12 percent reported being denied gender transition care; the discrimination faced by gay and bisexual people as a result of HIV/AIDS stigma is infamous.
Women, and especially women of color, also face bias from medical professionals who “psychologize” their symptoms (i.e. “it’s all in your head”) or dismiss them as exaggerations. Women’s ability to control their reproductive functions through pharmaceudical contraception or abortion has also come under assault.
In effect, the law has now made being female or LGBTQ into a “pre-existing condition” of the kind the ACA was supposed to end the prejudice against.
The Democrats’ rejection of a public and universal health care system set the stage for the present catastrophe. Now, the health needs of tens of millions are subject to the personal morals and whims of the capitalist bosses who employ them.
Reducing overhead costs is clearly the concern of the DHHS’s Office for Civil Rights, which boasted on its blog of $2.9 billion in savings over five years as a result of not having to include information about patients’ discrimination protections in their health care paperwork. It also echoes Trump’s 2017 ban on transgender people serving in the military, which he said had “burdened” the budget with “tremendous medical costs.”
The rule will go into effect 60 days after its formal publication on June 19, but LGBTQ rights organizations such as the Human Rights Campaign and Lambda Legal have made clear their intent to challenge the rule change in the courts.
Impending Supreme Court rulings
The move presages anticipated opinions from the U.S. Supreme Court on whether Title VII of the 1964 Civil Rights Act protects LGBTQ people from employment discrimination, and another that could open the door for a total repeal of a woman’s right to an abortion.
While the ACA has severe failings as a public health program, its anti-discrimination protections stand out in a country where the Red Cross still refuses blood donations from gay and trans people, and people with AIDS and COVID-19 are being disqualified from receiving life-saving ventilator care in some areas if someone else judged more valuable to society needs the ventilator.
The ACA as written is an important victory for working and oppressed people against the profit-seeking free-for-all that is the United States’ capitalist healthcare system, and it must be defended, even as we push for a truly socialist healthcare system that puts people before profits. As Liberation News has reported, the attacks on women and LGBTQ people aim to reassert a triumphant patriarchy that controls everyone’s reproductive roles, ensuring they only serve capitalist ends.
Women and LGBTQ people are part and parcel of the working class and these assaults must be called out for what they are: an attack on the working class as a whole.
Defend LGBTQ rights! Defend women’s rights!
