SACRAMENTO, Calif.  Aug. 5, 2019 — California Insurance Commissioner Ricardo Lara, together with 17 state insurance commissioners, announced he is submitting a letter to U.S. Secretary of Health and Human Services, Alex Azar, urging the Trump administration to protect rules addressing unfair treatment of transgender consumers.
The commissioner notes the proposed changes by the Trump administration will undermine civil rights protections for millions of consumers, create an uneven playing field for health insurers and negatively affect state insurance markets.
The proposed changes impact the Affordable Care Act (ACA) Section 1557, which prohibits sex discrimination in health insurance and clarifies protections for transgender Americans from being denied lifesaving medically necessary care. On May 24, 2019, the Trump administration proposed regulations that ignore widely-recognized precedent and roll back protections that ensure equal protection from discrimination by insurers and providers.
“California law and the Affordable Care Act prohibit health insurance policies that discriminate against people based on their gender identity,” said Insurance Commissioner Ricardo Lara, who is California’s first statewide LGBT elected leader. “The Trump administration should withdraw this proposed rule, which will lead to confusion and discrimination. Everyone should have access to medically necessary health care—we should focus on expanding coverage, not limiting it.”
According to the 2015 U.S. Transgender Survey, 23% of transgender people reported that in the past year, they avoided going to the doctor when sick or injured out of fear of discrimination and 33% of transgender people who did see a health care provider in the past year were harassed, denied care, or even assaulted.
The signatories of this letter, including Commissioner Lara, believe this proposed rule attempts to give health insurers and providers a license to discriminate against transgender policyholders and will have a significant negative impact on a community already vulnerable to discrimination in health care, housing and employment.
Following California’s lead, 19 states plus the District of Columbia have determined that discriminatory policies targeting transgender Americans violate state laws and have issued directives and regulations ordering insurance carriers to halt this harmful practice. The ACA and its existing rules expanded this protection across the country, ensuring equal protection under the law.
The ACA clarified insurers’ responsibility to make sure transgender policyholders have equal access to the same health insurance and care as every other insured American. This includes health care related to gender transition, which is recognized by the medical community as medically effective and necessary for many individuals, as well as routine tests and treatments sometimes denied to transgender individuals based on the association with a specific gender.
Lara added, “As the Trump Administration continues its attacks on the LGBTQ community, I want transgender Californians to know that we will continue to protect them from discrimination and health insurers to know that we are reviewing their policies closely to make sure they comply with all applicable California laws and regulations.”

The California Department of Insurance, established in 1868, is the largest consumer protection agency in California. Insurers collect $310 billion in premiums annually in California. Since 2011 the California Department of Insurance received more than 1,000,000 calls from consumers and helped recover over $469 million in claims and premiums. Please visit the Department of Insurance website at www.insurance.ca.gov. Non-media inquiries should be directed to the Consumer Hotline at 800.927.4357. Teletypewriter (TYY), please dial 800.482.4833.