BILL ANALYSIS
AB 1586
Page A
Date of Hearing: May 3, 2005
ASSEMBLY COMMITTEE ON HEALTH
Wilma Chan, Chair
AB 1586 (Koretz) - As Introduced: February 22, 2005
SUBJECT : Insurers: health care service plans: discrimination.
SUMMARY : Defines the term "sex" to include, but be not limited
to, a person's gender, as specified, under existing law that
prohibits health care service plans (health plans) and insurers
from specified discriminatory acts.
EXISTING LAW
1)Defines "gender" to mean sex, and includes a person's gender
identity and gender related appearance and behavior whether or
not stereotypically associated with the person's assigned sex
at birth.
2)Provides for the licensure and regulation of health plans by
the Department of Managed Health Care (DMHC) and of health
insurers by the Department of Insurance (DOI).
3)Requires health plans to cover a number of basic health care
services and permits DMHC to define the scope of the services
and to exempt plans from the requirement for good cause.
4)Prohibits health plans from refusing to enter into any
contract or canceling or declining to renew or reinstate any
contract because of the race, color, national origin,
ancestry, religion, sex, marital status, sexual orientation,
or age of any contracting party, prospective contracting
party, or person reasonably expected to benefit from that
contract as a subscriber, enrollee, member, or otherwise.
5)Prohibits the terms of any health plan contract from being
modified, and the benefits or coverage of any contract from
being subject to any limitations, exceptions, exclusions,
reductions, copayments, coinsurance, deductibles,
reservations, or premium, price, or charge differentials, or
other modifications because of the race, color, national
origin, ancestry, religion, sex, marital status, sexual
orientation, or age of any contracting party, potential
contracting party, or person reasonably expected to benefit
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from that contract as a subscriber, enrollee, member, or
otherwise. Exempts premium, price, or charge differentials
because of the sex or age of any individual when it is based
on objective, valid, and up-to-date statistical and actuarial
data.
6)Prohibits health plans from charging different premium rates
to individual enrollees within the same group solely on the
basis of the enrollee's sex.
7)Prohibits insurers from failing or refusing to accept an
application for, or issuing a policy to an applicant for,
health insurance (unless such insurance is to be issued to the
applicant by another insurer under the same management and
control), or canceling such insurance, under conditions less
favorable to the insured than in other comparable cases,
except for reasons applicable alike to persons of every
marital status, sex, race, color, religion, national origin,
or ancestry. Prohibits sex, race, color, religion, national
origin, or ancestry of itself from constituting a condition or
risk for which a higher rate, premium, or charge may be
required of the insured for such insurance.
FISCAL EFFECT : None.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, despite
existing anti-discrimination statutes, many people in
California continue to experience discrimination by insurance
companies and health plans on the basis of gender,
particularly members of California's transgender community.
The author states that simply because they are transgender,
many people are denied the ability to purchase insurance or
are denied coverage for medically necessary procedures under
contracts they are able to secure. This bill will add
additional language to existing anti-discrimination provisions
under state law prohibiting insurance companies and health
care service plans from discriminating on the basis of gender
in the creation or maintenance of service contracts or the
provision of benefits or coverage.
2)BACKGROUND . According to the Gay and Lesbian Alliance Against
Defamation (GLAAD) "transgender" is an umbrella term for
people whose gender identity and/or gender expression differs
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from the sex they were assigned at birth. Transgender people
can be female-to-male (FTM) or male-to-female (MTF) and may or
may not choose to alter their bodies hormonally and/or
surgically. According to the Transgender Law Center,
transition-related health care and services can include blood
work, hormones, mental health therapy, and gender confirmation
surgery. Surgery can include "top surgery," which for FTMs
means removal of the breasts and chest reconstruction to a
male chest, and for MTFs, breast augmentation. "Bottom
surgery" refers a number of options for genital
reconstruction. In 2002, the Transgender Law Center and the
National Center for Lesbian Rights released a report titled
"Trans Realities: A Legal Needs Assessment of San Francisco's
Transgender Communities," which stated that 93% of the
transgender people surveyed have utilized medical services as
a part of their transition. The study also found that
transgender people in the San Francisco Bay Area face
significant barriers to accessing transition-related health
care and often experience discrimination in accessing other
forms of health care. Nearly one in three respondents
experienced some form of health care-related gender identity
discrimination, including routine denial of coverage by health
insurers for transition-related procedures, and discriminatory
or inappropriate behavior by health care providers and office
staff.
3)TRANSGENDER COMMUNITY HEALTH PROJECT . In 1999, the
Transgender Community Health Project, which is part of the
Center for HIV Information at the University of California,
San Francisco, published a report based on a survey they
administered to transgender persons in collaboration with a
number or entities, including public health clinics, the San
Francisco Department of Public Health, and HIV/AIDS advocacy
and community groups. The report indicated that transgender
individuals face complex social, physical and mental health,
and substance use issues. Drug use was common among
interviewees, as was mental health intervention
(hospitalization and/or medication). The researchers found
that 52% of MTF and 57% of FTM subjects were uninsured.
Thirteen percent of MTF and 39% of FTM interviewees reported
being denied or having difficulties obtaining health care.
4)SELECT COMMITTEE ON LGBT FAMILIES . In November 2004 and
February 2005, the Assembly Select Committee on Lesbian, Gay,
Bisexual and Transgender (LGBT) Families held informational
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hearings on transgender health care. At the hearings,
community members presented information on anti-transgender
bias among some health care professionals, a lack of basic
information concerning transgender health care, health
insurance plans that explicitly exclude coverage for
transition related health care, health insurers who deny
applications for policies based on the applicants history of
receiving transition-related medical care, and ways that state
and local governments can partner with the community to
address these concerns.
5)EXAMPLE OF DENIAL . According to the author, transgender
applicants have been denied individual policies because they
have a previous diagnosis of gender dysphoria. The author
reports that in one case, a transgender FTM person in his
mid-30s who was starting his own business applied for an
individual policy with a major California health insurer for
catastrophic coverage with a $2,000 deductible. The insurer
sent a denial letter on July 30, 2002 stating they were unable
to offer "enrollment in any of our medically underwritten
health insurance plans." The reason cited was a health
history of "gender identity disorder of adolescent or ADU
treated with testosterone." The policy applied for already
excluded coverage for any treatment related to gender identity
disorder, including hormones.
6)PREVIOUS LEGISLATION . AB 1999 (Kuehl), Chapter 933, Statutes
of 1998, defined "gender" in the Penal Code as this bill
proposes to do in the Health and Safety and Insurance Codes,
AB 537 (Kuehl, et al), Chapter 587 Statutes of 1999, did so in
the Education Code, and AB 196 (Leno), Chapter 164, Statutes
of 2003, amended the California Fair Employment and Housing
Act (FEHA) to refer to the definition of "gender" established
in the Penal Code under AB 1999.
7)SUPPORT . According to the sponsor of this bill, Equality
California, despite existing anti-discrimination statutes,
many people in California continue to experience
discrimination by insurance companies and health plans on the
basis of gender, particularly members of the transgender
community. Equality California, the Grey Panthers, Stop AIDS
Project, Transgender Resources and Neighborhood Space, Asian
and Pacific Islander American Health Forum, AIDS Legal
Referral Panel, the Gay and Lesbian Adolescent Social
Services, Inc., the Asian and Pacific Islander Wellness
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Center, the Filipino Task Force on AIDS, Lambda Letters
Project, the San Francisco Labor Council, AFL-CIO, and
numerous other organizations write that by clarifying that the
definition of sex is the same as that found in FEHA and other
provisions of California law, this bill will insure that
insurance companies and health plans understand their legal
obligation to refrain from discriminating against transgender
people in the creation and maintenance of contracts and the
provision of services and benefits. The California
Psychological Association supports this bill and its aim to
discourage discrimination of enrollees and insureds, thus
increasing individuals gaining access to necessary mental and
health services. Planned Parenthood Affiliates of California
writes that this bill is in keeping with Planned Parenthood's
mission to preserve and protect the essential privacy and
rights of each individual and to provide programs which
enhance understanding of individual and societal implications
of human sexuality.
REGISTERED SUPPORT / OPPOSITION :
Support
Equality California (Sponsor)
Access Institute of Research
AIDS Legal Referral Panel
Asian and Pacific Islander American Health Forum
Asian & Pacific Islander Wellness Center
Being Alive South Bay
California Medical Association
California Psychological Association
Dimensions Collaboration at Castro Mission Health Center
Filipino Task Force on AIDS
Gay and Lesbian Adolescent Social Services, Inc.
Gay-Straight Alliance Network
Gender Education & Advocacy, Inc.
Gray Panthers
Harvey Milk Lesbian, Gay, Bisexual, and Transgender Democratic
Club
Orange County Transgender Coalition
Lambda Legal
Lambda Letters Project
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Lavender Youth Recreation & Information Center
Metropolitan Community Church Los Angeles
Ministry in Action Commission, St. Mark's United Methodist
Church
National Center for Lesbian Rights
Parents, Families and Friends of Lesbians and Gays Central Coast
Chapter
Parents, Families and Friends of Lesbians and Gays Los Angeles
Planned Parenthood Affiliates of California
San Francisco Labor Council, AFL-CIO
San Francisco Lesbian Gay Bisexual Transgender Community Center
San Francisco Lesbian Gay Bisexual Transgender Pride Celebration
Committee, Inc.
Southern California Nevada Conference of the United Church of
Christ
Stonewall Democratic Club of Greater Sacramento
Stop AIDS Project
The Center - San Diego County
Transgender Law Center
Transgender Resources and Neighborhood Space Project, University
of California San Francisco, Center for AIDS Prevention Studies
Tri-City Health Center
UNITE HERE Local 11
31 Individuals
Opposition
None on file.
Analysis Prepared by : Melanie Moreno / HEALTH / (916)
319-2097