Biden administration restores health protections for gay and transgender people

The Biden administration on Friday announced expansive new protections for gay and transgender medical patients, barring government-funded health care providers and insurers from discriminating based on sexual orientation and gender identity.

The new rule reverses a policy instituted by the Trump administration and helps fulfill part of President Biden’s vow to restore civil rights protections for LGBTQ people that were removed by his predecessor.

Today’s rule is a giant step forward for this country toward a more equitable and inclusive health care system, and it means Americans across the country now have a clear way to act on their rights against discrimination when they go to the doctor, they talk to their health. Plan or participate with HHS-led health programs, Xavier Becerra, the secretary of health and human services, said in a statement.

The rule revises federal policy in an area that has become a political watershed, with more than 20 Republican-led states banning or restricting care for gender-affirming minors in recent years. and is likely to raise legal challenges. Even the history of the rule illustrates the political sensitivities at play: it has now taken three different forms under three successive presidents.

The Affordable Care Act, passed in 2010, established a broad set of civil rights protections in the US health care system through what is known as Section 1557. It prohibits discrimination against patients based on race, color, national origin, sex, age, or disability in any federally funded health program or activity that covers a broad part of the United States health care system.

In 2016, the Obama administration issued a less expansive version of the rule that the Biden administration ended Friday, requiring health care providers to provide medically appropriate treatment to transgender patients. Officials at the time argued that the Affordable Care Act’s protections against discrimination included gender identity. Obama’s rule became mired in litigation, and the Trump administration refused to enforce it.

Conservative opponents of the rule have argued that the policy could effectively coerce doctors into performing medical services they may have objected to, including on religious grounds. The Trump administration in 2020 formally narrowed the legal definition of sex discrimination to not include protections for transgender people.

The rule finalized Friday by the Biden administration states that it preserves religious exemptions and does not require or mandate the provision of any particular medical service.

Section 1557 prohibits discrimination on certain prohibited bases and does not interfere with individualized clinical judgment about the appropriate course of care for a patient, the rule says.

After the Supreme Court ruled in 2020 that the Civil Rights Act of 1964’s ban on sex discrimination also applied to discrimination based on sexual orientation and gender identity, the Biden administration began reversing the policy of the Trump administration.

Republican officials continued to work to preserve the Trump-era government. In 2022, after the Biden administration issued a proposed version of the rule that ended Friday, a group of Republican attorneys general wrote to Mr. Becerra, suggesting they could sue if the Department of Health and Human Services followed the policy.

The proposed rule drew intense scrutiny from advocates and opponents. The Department of Health and Human Services said Friday it had collected more than 85,000 comments.

Groups pushing to reverse the Trump-era rule praised the Biden administration’s decision on Friday. Countless Americans can now take comfort in knowing that they can’t be taken away from the health care they need just because of who they are or who they love, said Kelley Robinson, president of the Human Rights Campaign.