Here's the Advocate with the details:
The Department of Health and Human Services filed documents in court today indicating that it’s backing away from a trans-inclusive nondiscrimination rule applying to the Affordable Care Act.
In December, a federal judge in Texas blocked HHS “from enforcing the Rule’s prohibition against discrimination on the basis of gender identity or termination of pregnancy,” today’s court filing notes. In the filing, HHS asks for time to reconsider the rule, saying its reconsideration may render moot the lawsuit challenging it. HHS has no problem with the rule remaining on hold while the agency reviews it, says the document, filed in U.S. District Court for the Northern District of Texas.
The lawsuit, Franciscan Alliance v. Burwell, was filed last August by five states and a group of religiously affiliated health care providers (Sylvia Matthews Burwell being the HHS secretary at the time; she has now been succeeded by Trump appointee Tom Price). Under Price, HHS decided not to appeal the preliminary injunction blocking the rule’s enforcement, and now the department appears poised to scrap it.
The rule applies to the implementation of the Affordable Care Act’s Section 1557, which bans discrimination based on race, sex, and several other factors by health care providers that receive federal funds, which almost all of them do. During the Obama administration, HHS regulators, deciding how to apply Section 1557, held that this includes discrimination based on gender identity, plus discrimination in reproductive health care.
TL;DR: The Trump administration is essentially scrapping Section 1557, the Affordable Care Act provision that outlaws discrimination based on gender identity.
Eroding the non-discrimination rule is a shameless act of bigotry. It's also a sneaky way of weakening the reach of the Affordable Care Act without having to do the dirty work of comprehensively overhauling the law. The closest parallel I can think of is the Hyde Amendment, passed in 1976. The Hyde Amendment bans federal funds from covering abortion. It doesn't make abortion illegal, because that would require overturning Roe v. Wade, but like this decision not to enforce the ACA's protections for trans patients, it's a roundabout way of making health care less accessible to a select group of Americans that just happens to already be marginalized.
That's by design.
All too often, this is what happens when hard-line Republican lawmakers can't restrict health care directly: Instead of cutting off access for all, they cut off access for whoever's in reach.
With the Hyde Amendment, that meant women who rely on government-subsidized health care. Congressman Henry Hyde, who first introduced the amendment, wasn't coy about this. He said straight-out that if he couldn't cut off access to abortion for all women, he could at least do it for women who get their health care through the government—that means women on Medicaid, but also women in the military, government employees, women covered by the Indian Health Service, women in the Peace Corps, women who live in Washington D.C., and women in prison. These are the women Hyde chose to target with his legislation, and he said as much:
“I certainly would like to prevent, if I could legally, anybody having an abortion: a rich woman, a middle-class woman or a poor woman. Unfortunately, the only vehicle available is the… Medicaid bill.”
You read that right. Hyde was saying he'd like to prevent women of all socioeconomic backgrounds from having abortions, but he can't legally, so poor women who rely on Medicaid are his "only vehicle available." By the same token, the Trump Administration can't repeal the Affordable Care Act for everyone, so they're going to repeal it for transgender people.
That's what this amounts to, and we'd do well to pay attention, because it's likely we're going to see more sneaky, unjust decisions from this administration that target marginalized people, because marginalization is the very thing that makes them "the only vehicle available." What's particularly ironic about all of this is that the GOP often frames the Democrats as the intrusive party of big government, but the Trump administration's meddling in ordinary people's health care is a perfect example of the worst government overreach imaginable.