December 11, 2019

December 11, 2019

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December 10, 2019

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December 09, 2019

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Transgender Woman Seeks Coverage Under ACA (Affordable Care Act)

A transgender woman recently filed a complaint in the U.S. District Court for the Central District of Illinois against her primary care physician, as well as the not-for-profit health-care clinic with which her physician is affiliated, for alleged violation of the anti-discrimination provision of the Affordable Care Act (ACA).Taylor v. Lystila, No. 14-cv-2072 (C.D. Ill.). According to the complaint, plaintiff began self-administering hormones that she had purchased on the internet in early 2013. Thereafter, plaintiff’s physician allegedly refused to monitor her hormone levels or provide any sort of long-term transition-related treatment. Plaintiff claims to have been told by the clinic that it was not obligated “to treat people like you.”

Plaintiff contends that the clinic and her physician fall under the purview of ACA § 1557(a), 42 U.S.C. § 18116(a), and the prohibitions against discrimination contained therein, because the clinic receives federal funds in the form of Medicare and Medicaid. Section 1557(a) mandates that “an individual shall not . . . be excluded from participation in, be denied the benefits of, or be subjected to discrimination under, any health program or activity, any part of which is receiving Federal financial assistance . . . .” Unlike other provisions of the ACA, section 1557(a) is not enforced through ERISA. Rather, violations are made enforceable through Title VI of the Civil Rights Act (prohibiting discrimination based on race or national origin in any program or activity receiving federal financial assistance), Title IX of the Education Amendments of 1972 (prohibiting discrimination based on sex in any federally-funded education program or activity), and the Age Discrimination Act (prohibiting discrimination based on age in any program or activity receiving federal financial assistance). Curiously, rather than citing any of the enforcement mechanisms set forth in section 1557(a), plaintiff stated that she brought the action under the Declaratory Judgment Act (which does not create an independent basis for jurisdiction).

It remains to be seen how the defendants will frame their response and how the litigation will pan out. It will be interesting to see how plaintiff supports her basis for jurisdiction (should any challenges arise to this aspect of her case). Although this is not an ERISA case, it is one example of the ways in which plaintiffs are beginning to explore various aspects of the ACA.

M. Todd Mobely also contributed to this article.

© 2019 Proskauer Rose LLP.

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About this Author

Robert Rachal, Employment Attorney, Proskauer Rose Law Firm
Senior Counsel

Robert Rachal's work focuses on complex ERISA litigation, and he also advises employers on ERISA benefit and fiduciary issues. Robert has assisted clients in the defense of numerous class actions under ERISA. 

504.310.4081