A little more than a week ago, the United States Department of Health and Human Services took a major step toward redressing the long history of policies and practices that marginalize transgender people in our health-care system. 

On Sept. 3, the Health Department issued its proposed rules on anti-discrimination protections under the Affordable Care Act, rules that have been eagerly awaited by the transgender community. The regulations make it clear that transgender persons are protected against discrimination in both health-care coverage and health-care services, under the theory of sex discrimination. 

Under these recommended guidelines, if a private or government insurer covers estrogen treatments for a non-transgender patient, it would need to cover them for transgender patients as well. The rule also would protect transgender people from discrimination at health-care facilities, meaning that no hospital that accepts federal funding could refuse to treat someone on the basis of gender identity.   

While the proposed regulations do not require insurers to cover gender reassignment surgery, some procedures related to gender reassignment surgery that are covered for non-transgender persons—such as a hysterectomy or top surgery—may have to also be covered for transgender persons. 

These proposed regulations go a long way toward assisting a community that is often snubbed and shunned by health-care providers receive sorely needed access. For years private health insurers have had blanket exclusions for transgender related health treatment, including hormone therapy. Under the Affordable Care Act, participating states must select a state benchmark insurance plan that provides a standard of minimum coverage that all other private health insurers must adhere to. 

The State of Michigan picked Priority Health as its benchmark plan. Priority Health prohibits coverage for any medical service or procedures related to gender transition. As a result of this, some private insurers that previously were covering hormone therapy, are now refusing to pay for such therapy, citing the state’s chosen benchmark plan. 

In addition, Michigan’s current Medicaid policy prohibits any payment for medications related to gender identity conditions, depriving the most financially needy of transgender persons of access to essential medications necessary to their transition. Clearly such private and public policies would violate the proposed regulations.

In a recent national survey, 19 percent of transgender persons reported being refused medical care, 28 percent were subjected to harassment and 2 percent said that they were victims of violence in doctors’ offices.   Such statistics point out the serious need for reform.


The proposed regulations provide an important tool to challenge the widespread discrimination against transgender people in accessing health services, and it lights a path toward reforming these unfair and medically unwarranted policies and practices.

Hopefully, it will also be a path that takes transgender men and women from the edges of our health-care system into the mainstream where they belong.

By Jay Kaplan, staff attorney for the ACLU of Michigan LGBT Project