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Kavanaugh puts LGBT community’s health care at risk

August 10, 2018

As a proud transgendered Latina woman living in Texas, I’m extremely concerned about President Donald Trump’s latest nominee to the Supreme Court. Brett Kavanaugh’s record and positions on the Affordable Care Act and abortion rights, and his support for “religious freedom,” which largely allows Christian fundamentalists to discriminate against those who don’t share their beliefs, spell loss of liberty for the rest of us.

Texas is already ground zero for attacks on health care and individual rights. Since President Trump’s election, Gov. Greg Abbott and Attorney General Ken Paxton have consistently teamed up with him to roll back hard-won protections against discrimination for “pre-existing conditions” under the ACA. These rules ensure that LGBT people like me get fair treatment in health care.

Thanks to Abbott and Paxton, Texas is leading a legal challenge against the ACA to overturn the rules that stop insurance companies from denying coverage, charging more or placing caps and limits on anything insurers deem a “pre-existing condition” — that’s everything from gender to high blood pressure to cancer. The case is moving quickly and is eventually expected to land in the Supreme Court. Close to 1 million Texans depend on the ACA for their health coverage.

Before the ACA, many transgender people had to lie about their gender identity to get affordable coverage since insurance companies could deny coverage or charge much higher rates based on the gender that insurers deemed as high-risk. Even with coverage, trans people often couldn’t get basic services they needed during transition from one sex to another, such as hormone replacement therapy or mental health counseling to help adjust and cope with transition. Trans people who were not able to get coverage or medicines were forced underground, sometimes seeking black market solutions that carried risk of botched treatments and unintended consequences.

Today, the ACA prohibits discrimination against transgender people or denial of health services, such as reassignment treatment that can include surgery, counseling and hormone therapy.

The new tax law weakens the ACA by repealing a key provision that requires everyone to have coverage to pay for permanent tax breaks for corporations. The result, according to the Congressional Budget Office, will be millions more uninsured people. That action combined with the Trump administration’s refusal to make cost-sharing reduction payments and continuous attacks on the ACA exchanges have already increased premiums for many families. Rates in Texas are expected to go up by 20 percent for some enrollees.

At the same time, the president is opening up new avenues for discrimination against LGBT people. Earlier this year, he created a new office in Health and Human Services that empowers health care workers to refuse to provide any treatment or procedure — even when sanctioned by a doctor — that violates their religious views, including sexual reassignment surgery, abortion and end-of-life decisions. The Division of Religious Freedom is located in the HHS Office of Civil Rights, but rather than ensure freedom for patients, it protects those who discriminate.

Trump’s recent ACA rule change on short-term junk plans also allows insurance companies to sell coverage that doesn’t comply with nondiscrimination rules, putting nonconforming, LGBTQ and transgender people — and anyone else with a pre-existing condition — at risk of losing their health care.

The president has been clear that any judge he nominates to the Supreme Court must pass a litmus test: The nominee must be against the ACA. Kavanaugh clearly meets that criteria. As a lower court judge, he argued against the ACA repeatedly since its passage in 2010.

For a long time, I was a pretty private transgender person. I didn’t feel the need to advertise my gender identity. Over the last two years, though, I’ve stepped up as an activist because I know that for the transgender community, the right to nondiscrimination in health care is a linchpin of our civil rights and fundamental to our liberation.

Sofia Sepulveda is a trans Latina from San Antonio and is a member of the Texas Organizing Project Education Fund.

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