ACTION: June 28, 2017, The LBGT PA Caucus joined with other Medical and Mental Health Professionals to file an amicus brief in Fulcher v. Secretary of Veterans’ Affairs, challenging the U.S. Department of Veterans Affairs' refusal to engage in rulemaking to reconsider its ban on providing transition-related surgery to transgender veterans.
Congress passed the Veterans Health Care Eligibility Reform Act in 1996 to ensure that the medical needs of all American veterans would be met under the VA health care system. The VA later adopted this discriminatory rule that singles out transgender veterans and excludes coverage for medically necessary surgery to treat gender dysphoria, even when substantially similar surgeries are covered for non-transgender veterans. The VA recognizes the importance of treating gender dysphoria as a medical condition by covering hormone therapy, but irrationally denies surgical care, even though the same surgeries are covered for non-transgender veterans. The VA’s rule is so inconsistent that it can have no purpose other than to discriminate against transgender veterans.
Dee Fulcher is a transgender woman veteran of the U. S. Marine Corps who lives in Slidell, Louisiana. She is the parent of four children and the grandmother of twins. Dee served in the Marine Corps for eleven years where she specialized in hydraulic systems for helicopters. Dee achieved the rank of Platoon Sergeant and received several awards before being honorably discharged in 1992. Dee was diagnosed with gender dysphoria and began hormone therapy in December 2013. While Dee’s physician recommends reassignment surgery, she was informed by her doctor that no transition-related procedures would be covered by the VA.
Gio Silva is an Army veteran who lives in Denver, Colorado. He served in the Army from April 2008 to September 2012, when he medically retired. In July 2015, Gio’s physician recommended a mastectomy to treat his severe back pain, but in September 2015, while seeing a different doctor, Gio was told that the VA would not cover the common procedure because he is transgender. Gio suffers from physical and emotional pain because he was denied the surgery he needs.
Lambda Legal and Transgender Law Center filed a petition that sought to amend or repeal the rules that exclude medically necessary surgery for transgender veterans from the coverage provided to veterans through the VA. Lambda Legal and Transgender Law Center argue that the regulation is arbitrary and capricious and violates the Equal Protection clause of the Fifth Amendment by discriminating against transgender veterans on the basis of their sex and their transgender status. The LBGT PA Caucus, along with other Medical and Mental Health Professionals, as Amici Curiae, represent the interests of leading medical and mental health professionals dedicated to providing the proper health care and treatment for all individuals in need. Amici offer this brief to explain that the exclusion of medically necessary transition-related surgeries from the VA’s medical benefits package impinges upon medical and mental health professionals’ ability to provide medically necessary care to each veteran patient with gender dysphoria. Amici represent well-recognized organizations that promulgate the leading standards of care in the field and individual medical professionals charged with ensuring proper treatment for their patients.
Status update: August 2018: After intense questioning of the government at oral argument in the Fulcher appeal, and the court's demand for a post-argument briefing about why the VA has done nothing in the way of rulemaking over the last 2 years, the VA has initiated the rulemaking process. Comments on whether the VA should eliminate the "transgender surgical exclusion" from its medical benefits package are due September 7. The Caucus is will be submitting comments.###
June 20, 2018: On June 20, 2018, the LBGT PA Caucus joined with 41 other organizations to request that #OscarHealth (a health insurance company) immediately amend its plans and policies — in all states — by removing arbitrary exclusions that unfairly target #transgender people and deny coverage for medically necessary healthcare.
May 9, 2018: AAPA Signs on to Letter in Support of Legislative Efforts to End Conversion Therapy
With the endorsement and encouragement of the Policy & Education Committee of the LBGT PA Caucus, the American Academy of PAs has joined other professional organizations and associations in signing on to a Declaration on the Impropriety and Dangers of Sexual Orientation and Gender Identity Change Efforts.
This letter recognizes the harms associated with efforts to change an individual's sexual orientation or gender identity, especially in the pediatric population, and brings to light the issue of such practices still occurring throughout the US. It calls for legislative measures to "curtail the unscientific and dangerous practice of sexual orientation and gender identity change efforts."
August 15, 2017: At their August 15 meeting, the Board of Directors of the LBGT PA Caucus of the American Academy of PAs, Inc., unanimously passed a motion endorsing the following statement:
The LBGT PA Caucus — stands firmly together in solidarity with other marginalized communities. All of us at the LBGT PA Caucus condemn in the strongest possible terms the voices and the actions of domestic terrorists who gather in the name of hate. Violence in any form contradicts our collective vision of a healthy society...." Please read the full statement.
ACTION: June 14, 2017, The LBGT PA Caucus joined 165 other organizations in signing on to comments to Oppose the American Health Care Act (H.R. 1628) Oppose Repeal of the Affordable Care Act; Medicaid Block Grants/Per Capita Caps; and Defunding of Planned Parenthood
OUTCOME: The bill did not become legislation
ACTION: February 20, 2016, the LBGT PA Caucus submitted a letter to South Dakota Gov. Daugaard regarding anti-transgender bill HB1008 (also referred to as the nationally infamous paranoid potty bill) that would have restricted transgender students' use of restrooms, locker rooms and other gender-specific facilities in public schools by requiring that every restroom, locker room, and shower room in all K-12 public schools to be “designated for and used only by students of the same biological sex.” The language leaves no room for transgender students, defining biological sex as “the physical condition of being male or female as determined by a person’s chromosomes and anatomy as identified at birth.” In addition, the bill is inconsistent with federal law that prohibits discrimination in any educational program that receives federal funding including public schools and protects students from discrimination based on their gender identity (eg, excluding transgender students from the facilities that correspond to their gender identity).
The LBGT PA Caucus notified the Society of PAs in Pediatrics of this issue, they also sent a letter. The American Academy of Pediatrics, the American Counseling Association, the American School Counselor Association, the Child Welfare League of America, the National Association of School Psychologists, the National Association of Social Workers, and the National Education Association all expressed their grave concerns and objections in their joint letter.
OUTCOME: March 1, 2016, Gov. Daugaard vetoed HB 1008 and made these comments.
ACTION: February 1, 2016, The LBGT PA Caucus signed on to a public comment letter to the Centers for Medicare & Medicaid Services (CMS) regarding changes to the HealthCare.gov (aka Obamacare) application to reflect the needs and experiences of LGBT individuals. Signing on greatly contributes to the work of adding SOGI questions to state specific insurance marketplace applications and works in concert with state’s effort to broaden LGBT Data Collection efforts amongst government agencies.
Briefly, these comments recommend that: 1) the sex question should be updated to the two-step question that collects both gender (that is, current gender) and sex assigned at birth (that is, sex on the original birth certificate), and 2) an optional sexual orientation question should be added. These comments also support a greater emphasis in the application process on notifying applicants of the relevant (LGBT-inclusive) nondiscrimination policies.
ACTION: November 9, 2015, the LBGT PA Caucus and the AAPA submitted comments to the Office for Civil Rights at the US Department of Health and Human Services in response to a proposed rule regarding Section 1557 (the nondiscrimination provision) of the Affordable Care Act. (More on Section 1557 here and here.)
Our comments are 30 pages that includes a full analysis on sexual orientation, sex stereotypes, and gender identity protections that is supported by science and AAPA policy.
In addition to quoting AAPA's policies and positions about issues such as sexual orientation discrimination in health care, transgender insurance exclusions, and the harmful effects of a religious exemption, our comments focused on the following three overarching recommendations to HHS:
ACTION: May 29, 2015, the LBGT PA Caucus joined with the members of the LGBT Cancer Best Practices Expert Advisory Committee, convened by LGBT HealthLink and National LGBT Cancer Network to provide comments on Stage 3 Meaningful Use proposed rule CMS-3310-P, published March 30, 2015, and strongly urge the Center for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) to require that all electronic health care forms include gender identity and sexual orientation in demographic sections of electronic health records.
ACTION: October 15, 2014, the LBGT PA Caucus joined with the American College of Surgeons and other organizations in urging the Centers for Disease Control and Prevention (CDC) to review or withdraw its 1991 publications regarding recommendations regarding transmission of HIV from healthcare workers (HCW) to patients.
ACTION: April 28, 2014, the LBGT PA Caucus joined with 152 other organizations in strongly supporting the inclusion of collecting sexual orientation and gender identity (SOGI) data in elecronic health records as a certification requirement of the meaningful use of EHR program in response to the US Department of Health and Human Services proposed rules regarding the voluntary 2015 edition electronic health record certification criteria; interoperability updates and regulatory improvements, including 2017 certified EHR technology (CEHRT) proposals.
ACTION: April 20, 2014, the LBGT PA Caucus responded to CMS's proposed rules regarding Patient Protection and Affordable Care Act: Exchange and Insurance Market Standards for 2015 and Beyond along with various other organizations by submitting comments responding to a number of issues of particular importance to LGBT individuals and families, including:
OUTCOME: to follow
ACTION: February 25, 2014, the LBGT PA Caucus was among 57 organizations to submit: "...comment on the draft 2015 Letter to Issuers in the Federally-facilitated Marketplace (Letter). These policies will help ensure that consumers [including LGBT individuals and families] receive the full benefit of the protections provided by the Affordable Care Act and advance the goal of ensuring that every individual in the United States can access affordable health care that meets their needs."
OUTCOME: On March 14, 2014, HHS clarified that, starting in 2015, if an insurance company offers coverage to opposite-sex spouses through the federally-facilitated marketplace, it cannot choose to deny that coverage to same-sex spouses. In other words, insurance companies will not be permitted to discriminate against married same-sex couples when offering coverage. This will further enhance access to health care for all Americans, including those with same-sex spouses.
"...The following serves to clarify the meaning of the terms used in 45 CFR 147.104(e) for the purposes of describing the requirements health insurance issuers must meet to ensure guaranteed availability of coverage." Read the Same-Sex Spouses FAQ here
You can also read the blog, Making Health Care Coverage More Accessible and Equitable for Same-Sex Couples, here.
ACTION: August 27, 2010, at the request of the LBGT PA Caucus, the American Academy of Physician Assistants (AAPA) was among 53 organizations to submit comments to CMS on the proposed rule regarding Changes to the Hospital and Critical Access Hospital Conditions of Participation to Ensure Equal Visitation Rights for All Patients.Why nondiscrimination in hospital visitation is so important:
The stories of heartbreaking and insulting treatment around hospital visitation are unbelievably common among LGBT people:
Sometimes, these tragedies get public attention, such as the incident in Florida involving Janice Langbehn and her partner Lisa Pond. But the vast majority of these injustices go unnoticed or unreported because of the lack of recourse for victims.
There are several reasons for this disparate treatment of LGBT patients and their families. One reason is the small number of states that extend legal relationship recognition to same-sex couples, whether through marriage, domestic partner registries, or civil unions. A second reason is the inconsistent way same-sex marriages, domestic partnerships, and civil unions are recognized by other jurisdictions. A same-sex couple can be lawfully married in Iowa, for example, but lose that legal status when they cross into any adjoining state. Still another reason is the ways by which so many LGBT people create and sustain family which, due to a history of familial estrangement and legal discrimination, is through bonds of affection and affinity rather than blood or formal "legal" status.
The overarching problem to date has been the lack of uniform guidance for hospitals and other health care facilities protecting the right of patients to designate visitors and ensure that advance health care directives ("AHDs") and other similar legal documents are respected. As a result, hospitals and their staffs deal with these situations in vastly different ways that are often profoundly harmful to LGBT people.
These reasons highlight why the Rule is so important, so praiseworthy, and so long-overdue
OUTCOME: (this page is in progress) [reference to rule addressing nondiscrimination in hospital visitation was implemented and effects those systems accepting Medicare and Medicaid patients]
ACTION: November 20, 2008, LBGT PA Caucus and the Physician Assistant AIDS Network (PAAN), signed onto an amicus brief on a court case in the state of Wisconsin that if left unaddressed will set a new precedence regarding HIV employment discrimination and appears to be based on the courts arbitrary, or inconsistent with medical knowledge, distinction between HIV and AIDS.
This brief explains to the court the relationship between HIV and AIDS and why the court was incorrect in viewing HIV and AIDS as distinctly separate medical conditions. A second brief was also filed on behalf of HIV advocacy groups that explains why, in the context of employment discrimination on the basis of HIV status, proof that the individual meets the definition of “disabled” under the ADA may include evidence related to the impact on that individual of having AIDS.
An amicus brief was initially filed on behalf of AIDS Resource Center of Wisconsin, AAHIVM (of which PAs are members), Association of Nurses in AIDS Care, HIV Medicine Association and Howard Brown Health Center. To illustrate the broad level of concern in the scientific community (including the medical and health care communities) about the court’s misunderstanding of the relationship between HIV and AIDS and it’s misuse of that distinction to deny people with HIV the protection of the ADA, additional friends-of-the-court were invited.
OUTCOME: to follow