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UPDATE: HB 1466 Killed In Committee

Less than half a dozen General Assembly Delegates were enough to prevent Virginia's transgender community from receiving health care protections.

Marilyn Drew Necci | February 7, 2018

UPDATE, 2/7/2018: Well, here we are again — another chance at a legislative victory for Virginia’s LGBTQ community ends before it really even gets a shot. Yesterday, a subcommittee within the House Of Delegates’ Committee on Commerce and Labor voted to “pass by indefinitely” on HB 1466, the bill that would have prevented health insurance companies operating within Virginia from discriminating against trans people by refusing to cover trans-related health care.

The vote was split along party lines, with five Republicans voting to pass by indefinitely, while three Democrats voted against doing so. Fun fact: one of the Republicans was David Yancey, who only obtained his seat when his name was drawn out of a hat (well, a bowl, but close enough). If Democrat Shelly Simonds’ original one-vote victory had been certified, this might all have gone a very different way.

Regardless, at least for this session, HB 1466 is dead. Planned Parenthood Advocates of VA gave us the bad news late yesterday afternoon, and their CEO, Jennifer Allen, had this to say: “No person should be denied health insurance coverage because of who they are. However, transgender patients often face barrier after barrier when seeking health care. We are disappointed that conservative delegates defeated HB 1466 that would have eliminated health insurance discrimination against transgender individuals.”

It’s disappointing to see progress for thousands across Virginia being derailed by five people. However, during Equality Virginia’s Day Of Action event on Monday, EV director James Parrish made clear that the bills they are fighting for, including HB 1466, will be brought back in future sessions if they don’t pass this year. So the fight will continue. And GayRVA will be there to bring you the news when it does.

Original article from 1/23/2018 follows:

The quest for health care is full of horrific obstacles for Virginia’s transgender population. Outright denial of coverage, paying more than cis people for similar services, and being denied coverage for transition-related procedures and services are all possible hurdles trans people will have to deal with when seeking health insurance in Virginia. However, Delegate Debra Rodman wants to change all that. Last week, she introduced HB 1466, a bill created in conjunction with Planned Parenthood Advocates of Virginia, which is designed to prevent insurance companies from discriminating based on “gender identity or transgender status.”

Rodman, who defeated longtime Republican incumbent John O’Bannon this November to become the new representative for the 73rd District, is an associate professor of anthropology at Randolph-Macon College, where she also heads the women’s studies department. She has served as an expert witness in Federal court defending Central American refugees, many from the LGBTQ community, who have fled violence and persecution in their home countries.

At a time when we’re seeing the old saw about “religious freedom” invoked by as high an authority as the Department of Health and Human Services, in order to allow doctors to refuse treatment to members of the LGBTQ community, Rodman hopes to prevent discrimination from running rampant in her home state. “Despite federal attempts to protect doctors who seek to discriminate against LGBT people, I know that we can do better here in Virginia,” she told GayRVA in a statement. “I put forward HB 1466 because I care about the transgender community and know they deserve access to the same medical care I have.”

HB 1466, which is co-sponsored by Danica Roem, will forbid “a health carrier from denying or limiting coverage or imposing additional cost sharing or other limitations or restrictions on coverage under a health benefit plan for health care services that are ordinarily or exclusively available to covered individuals of one sex to a transgender individual based on the fact that the individual’s sex assigned at birth, gender identity, or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available.”

Afton Bradley, the Transgender Health Care Services Manager for Planned Parenthood, helped us decode this particular bit of legalese. “Often when we think about the reasons why trans individuals are discriminated against, it’s based on body parts, and how our health care and medical standards have defined ‘gender’ or ‘sex’,” he explained. “We’ll have a patient who comes in to get a PAP smear or an annual exam, and just because they’re listed as male [on their insurance], they are denied that initial claim, and we have to fight to get it overturned.”

HB 1466 also “prohibits a health carrier from (i) subjecting an individual to discrimination under a health benefit plan on the basis of gender identity or being a transgender individual or (ii) requiring that an individual, as a condition of enrollment or continued enrollment under a health benefit plan, pay a premium that is greater than the premium for a similarly situated covered person enrolled in the plan on the basis of the covered person’s gender identity or being a transgender individual,” another very specifically worded provision that can be rather difficult to break down into layman’s terms.

“When we think about things like hormone treatment, and surgeries, and other affirming medical practices that are medically necessary, often the insurances that our patients and other people in Virginia are covered under specifically exclude these services,” Bradley said. “Or, when patients try to get them covered, they’re told that they are cosmetic or elective, and are not a part of their plan. [The way] a lot of insurance plans, including our state Medicaid, are laid out now, when it comes to anything transition-related, whether that be surgery or hormones, even mental health treatment to an extent–all those things are outright denied.”

On the other hand, he points out, “When we look at the American Medical Association, the American Psychological Association, basically any national or international governing board of health care, even [some private] insurance companies, [they] all have independent statements saying that we do affirm that these procedures are medically necessary.”

While some might see the current moves by Trump’s HHS at the heart of these discriminatory maneuvers, Bradley points out that issues like this have existed in the field of transgender health care for a long time. “One of the really big pros of the Affordable Care Act, when it was passed, was removing pre-existing conditions as places for insurance to deny or to charge more [for coverage],” Bradley said. “Before the ACA, trans people were often charged higher for the same insurance plans, or were denied because it came up in their health history that they [had been] treated for whatever the medical diagnosis at the time [was], whether that was gender dysphoria, or gender identity disorder.”

Since the passage of the Affordable Care Act in 2009, advocates of trans health care have seen the terrain shift slightly. However, problems still remain in getting trans people accessible and affordable coverage. “When folks are trying to go and seek out insurances that are affirming, meaning that they would cover their hormones and surgery, often these plans [have] a higher premium and a higher deductible, and [are] unaffordable,” Bradley said. “When they have spoken to insurance companies to make sure they are getting plans that are inclusive and accessible, they’ve noticed a difference [in the rates] they’ve been quoted after [insurance companies] have seen their health history. I don’t think it’s as black and white as it has been in the past, with people being outright denied access to health care and insurance, but definitely we still see this inflation in terms of rates.”

Strictly speaking, in the wake of the ACA, none of this should have been legal. Section 1557, the nondiscrimination provision of the Affordable Care Act, prohibits discrimination on the basis of sex. However, as Bradley explains, the language within the ACA was still quite vague. “With section 1557,” he said, “A lot of advocates in Virginia and nationwide were like, ‘This is great language, but how do we enforce it?’”

HB 1466 is an attempt to clarify the federal protections that exist, by “stating a lot of what is already in place at the federal level, and trying to make sure that there is actually more definition about that,” said Bradley. “Because right now, the policy that exists at the federal level is more vague and broad.” For this reason, he hopes the bill will have a chance to get through the often-difficult process of passing the General Assembly.

“I think that it does have a good chance to make it forward when you look at what the bill is saying. It’s not saying that we’re asking for anything additional thats not already supposed to be protected under the Affordable Care Act that was passed years ago,” said Bradley. “What this has done is take that a step further, to really find out what that means, to not discriminate based on gender. Other states have had really good success [with similar initiatives], from North Carolina to California to Montana.”

Bradley also feels that the growing public dialogue around trans issues makes it easier for a proposition like this to find acceptance and success. “More people are hearing our stories, and hearing about the discrimination that trans people face,” he said. “So I think it’s becoming more of a kitchen table conversation. Folks who go beyond the trans community and direct allies are tuning in and hearing these stories, these alarming problems that the community still faces.”

Today, HB 1466 was assigned to a subcommittee within the House of Delegates’ Committee on Commerce and Labor, where it will need to pass a vote in order to pass on for consideration by the broader legislature. Where its prospects are concerned, Bradley is cautiously optimistic. “I think there’s definitely a good opportunity,” he said of the bill’s chances. “Of course, whenever we bring [up] trans health issues, there’s definitely been an argument in Virginia for the last few years about what that means for taxpayers.”

However, he points out, “We know that the cost it takes to cover somebody who’s not getting access to care, the cost on their own mental health and well-being, is far greater than the cost it takes to provide somebody affirming health care.” With that in mind, he says, “We’ll cross our fingers.” Here at GayRVA, we will too. And if opportunities for our readers to get involved and help out with getting this bill passed come up, we’ll be sure and let you know.