Allowing public school students nationwide to use the bathroom that matches their gender identity wasn't the only step the Obama administration took toward promoting transgender equality last week.
The administration also finalized a rule protecting individuals from discrimination in health care, including discrimination on the basis of gender identity and sex stereotyping.
The 362-page rule, which executes a key provision of the Affordable Care Act, drew less attention than Obama's directive for public schools. But Hannah Willard, of the advocacy group Equality Florida, called it "especially huge" because transgender people routinely face discrimination in health care.
"A lot of transgender people are denied life-saving medications, hormone treatments, access to gender-affirming surgeries," Willard said. "These are things that make life worth living for some people."
The new rule applies to both providers and insurance companies. It requires doctors and hospitals that accept Medicare or Medicaid to treat patients "consistent with their gender identity," including when it comes to bathroom access.
The rule also prohibits providers from denying health services that are typically available to individuals of one gender. For example, a physician cannot refuse to treat a transgender male for ovarian cancer if the treatment is medically necessary.
What's more, health insurance companies that offer plans on the Obamacare marketplaces cannot limit coverage or deny claims for transgender patients seeking sex-specific health services like hysterectomies just because the patient is transgender. And while they aren't required to cover gender transitions, they can no longer categorically deny coverage for the procedures.
That's not just for plans offered on the marketplace, but for any plans those insurers administer, according to a list of frequently asked questions provided by the U.S. Department of Health and Human Services.
"A central goal of the Affordable Care Act is to help all Americans access quality, affordable health care," Health Secretary Sylvia Burwell said in a statement. "(This) announcement is a key step toward realizing equity within our health care system."
It is unclear how often individuals are denied services or coverage because of their sex or gender identity. But the federal health department's Office for Civil Rights identified 10 recent allegations of discrimination. In one case, a transgender individual said a Colorado wellness center declined to cover her mammogram because she had transitioned from male-to-female. In another, a transgender woman said she was repeatedly addressed as a man by lab employees.
Experts say the new rule is significant both because of its scope and its ambitious goal.
"For the first time, it expands protection against sexual discrimination into the health context," said MaryBeth Musumeci, of the non-profit Kaiser Family Foundation. "That had not been done before."
It should help clinics like the Metro Wellness Centers, which provide health services to members of the LGBTQ community in Tampa and St. Petersburg.
Metro offers hormone replacement therapy. But some insurance companies won't reimburse the clinic for the service because the doctor is an internist — not an endocrinologist, Chief Executive Officer Lorraine Langlois said.
"It is really hard to get paid for some of these services," Langlois said, adding that her phone is "ringing off the hook with transgender folks looking for hormone replacement therapy and follow-up care."
Willard, of Equality Florida, said such treatments are more than just elective procedures. She cited a 2014 study by the American Foundation for Suicide Prevention that found two in five transgender people had tried to kill themselves.
"That alone is more than enough reason to make sure transgender people have access to these basic medical services, and that they are seen and affirmed by their government," she said.
The new rule is effective July 18, but health insurance companies have until Jan. 1 to make changes to their plans.
What will it mean for costs?
Florida Association of Health Plans President Audrey Brown said her members were in the process of reviewing the rule and "determining what, if any, impacts this will have in terms of cost going forward."
Contact Kathleen McGrory at email@example.com or (727) 893-8330. Follow @kmcgrory.