Final Rule Could Limit Access to Equitable Cancer Care for Sexual and Gender Minority Community

June 16, 2020

On June 12, the U.S. Department of Health and Human Services (HHS) released a final rule establishing changes to Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs or activities.

The rule finalizes a change in Section 1557 to a more narrow interpretation of sex. The American Society of Clinical Oncology (ASCO) previously expressed concerns that such a change would inhibit access to equitable cancer care and adequate insurance coverage to meet the needs of Sexual and Gender Minority (SGM) individuals with cancer.

“The American Society of Clinical Oncology (ASCO) encourages HHS to maintain the definition defined in the 2016 Section 1557 regulation, which redefined discrimination ‘on the basis of sex’ to include gender identity,” said former ASCO President Howard A. Burris III, MD, FACP, FASCO, in a 2019 comment letter. “Doing so would preserve the protections afforded to patients and healthcare consumers under the Affordable Care Act and prohibit discrimination on the basis of sexual orientation and gender identity.”

ASCO's comments were informed by its position statement on reducing cancer health disparities among SGM populations. The Society continues to encourage individual institutions to adhere to the prior definitions of sex and gender, which redefined discrimination “on the basis of sex” to include gender identity, protecting patients in the SGM community.

On June 15, the Supreme Court ruled in a landmark case that employees cannot be fired for being SGMs. The decision determines that Title VII of the 1964 Civil Rights Act, which forbids discrimination “on the basis of sex," applies to SGM populations—a decision that aligns with recommendations in ASCO’s position statement to improve cancer care and outcomes for SGM individuals.  

ASCO will continue its work to ensure that the SGM community has equitable access to cancer care.

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