The ACA’s Section 1557 Extends to Gender Identity
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A recent court ruling in Minnesota has affirmed that the provision of the Affordable Care Act extends to transgender and gender non-conforming people, and has dealt another possible setback to employers and the third-party entities that administer self-funded health plans.
The court ruling stems from a dispute around the ACA’s Section 1557 and protected groups between Brittany Tovar, her transgender son Reid Olson, and Tovar’s former employer Essentia Health, and Innovis Health, LLC, which served as the third-party administrator (TPA) of the employer’s health plan doing business as Health Partners, Inc. Tovar, a nurse in Minnesota, had a company health plan that included a blanket exclusion of transgender services. This didn’t affect the employee directly, but did affect her transgender child. The child was denied coverage for a gender reassignment surgery after being diagnosed with gender dysphoria, a medical condition in which a person’s gender identity is determined to be different from the one assigned at birth.
The mom filed legal challenges based on a claim of sexual discrimination against her employer, and a claim of discrimination in violation of the ACA filed against the company health plan’s third-party administrator (TPA).
Plaintiffs Tovar and Olson sued Essentia and HealthPartners for violation of Section 1557 of the ACA, which prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in certain health programs.
A U.S. District Court Judge initially dismissed the legal challenges ruling that Tovar did not have standing to pursue such legal actions. A decision by the U.S. Court of Appeals for the Eighth Circuit, however, left room for proceeding with a portion of the case, saying that the mom could pursue legal action against the TPA in district court, specifying a violation under Section 1557 of the ACA. The court ruled that the TPA could be held responsible for the details of the health plan offered by the employer.
HealthPartners and Essentia both moved to dismiss the complaint. However, the U.S. District Court, District of Minnesota ruled in favor of Tovar and her son. The Memorandum and Opinion issued by the court explicitly stated that gender identity is a protected group set forth by Section 1557. “Section 1557 expressly forbids that anyone, ‘on the ground [of sex] . . . be denied the benefits of . . . any health program or activity.’” 42 U.S.C. § 18116. Olson has an interest in being treated equally and not discriminated against on account of his gender identity. The Court concludes that Olson’s interest therefore falls within the zone of interests meant to be protected by Section 1557.”
Gender Justice Staff Attorney Christy Hall stated in an announcement: “Today’s ruling affirms what we’ve long known, that discrimination based on gender identity is discrimination based on sex, and it is against the law.”
The ruling is a reminder of the protections that the ACA provides to all Americans.
To learn more about ACA compliance in 2018, click here.
For ACA reporting in 2019, organizations should review this link for important dates and requirements.
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