{"id":610,"date":"2015-03-28T21:39:48","date_gmt":"2015-03-28T21:39:48","guid":{"rendered":"http:\/\/www.emily-esque.com\/wp\/?p=610"},"modified":"2015-03-28T21:47:11","modified_gmt":"2015-03-28T21:47:11","slug":"comment-to-dept-of-labor-sex-gender-identity-discrimination-and-trans-exclusionary-health-insurance","status":"publish","type":"post","link":"http:\/\/www.emily-esque.com\/wp\/?p=610","title":{"rendered":"Comment to Dept. of Labor &#8211; Sex \/ Gender Identity Discrimination and Trans-Exclusionary Health Insurance"},"content":{"rendered":"<p style=\"text-align: left;\">This weekend I filed my <a href=\"http:\/\/www.emily-esque.com\/wp\/wp-content\/uploads\/2015\/03\/OFCCP-Sex-Discrimination-Comment-2015-03-26-final.pdf\">comment to the Department of Labor&#8217;s Office of Federal Contract Compliance Programs<\/a>, relating to <a href=\"http:\/\/www.regulations.gov\/#!documentDetail;D=OFCCP-2015-0001-0001\">their proposed rule updating the prohibition on discrimination on the basis of sex by Federal contractors<\/a>.<\/p>\n<p style=\"text-align: left;\"><!--more--><\/p>\n<hr \/>\n<p style=\"text-align: center;\">Before the<br \/>\nDepartment of Labor<br \/>\nOffice of Federal Contract Compliance Programs<\/p>\n<p style=\"text-align: center;\">\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af<br \/>\nDiscrimination on the Basis of Sex<br \/>\n80 Fed. Reg. 5245 (Jan. 30, 2015)<\/p>\n<p style=\"text-align: center;\">\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af<br \/>\nSubmitted by Emily T. Prince, Esq.<\/p>\n<p style=\"text-align: center;\">\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af\u00af<\/p>\n<p style=\"text-align: left;\">The regulations proposed by the Office of Federal Contract Compliance Programs (OFCCP) are a positive first step in answering the many questions left unresolved by OFCCP in its December 2014 direct final rule implementing Executive Order 13672, prohibiting discrimination by Federal contractors on the basis of sexual orientation and gender identity. As OFCCP correctly notes, discrimination on the basis of sexual orientation and gender identity is also inherently discrimination on the basis of sex, and therefore such discrimination is within the scope of the proposed updates to regulations prohibiting discrimination on the basis of sex.<a href=\"#_ftn1\" name=\"_ftnref1\">[1]<\/a> However, there are several areas where the rule requires improvement. Most importantly, \u00a7\u00a060-20.6, \u201cOther fringe benefits,\u201d must be revised to clarify that offering insurance contracts that specifically exclude coverage for care related to the transition of the beneficiaries (\u201ctrans-exclusionary insurance contracts\u201d) is an unlawful employment practice. Additionally, the text of the rule in \u00a7\u00a060-20.2, \u201cGeneral prohibitions,\u201d must be amended to clarify that transgender and non-binary employees must have access to appropriate changing facilities.<\/p>\n<p>Many insurance contracts, including those offered by the Federal government to Federal employees, specifically exclude coverage for care related to the transition of beneficiaries from their sex assigned at birth through clauses that restrict coverage notwithstanding any other provision of the plan. As an illustrative example: since 1974<a href=\"#_ftn2\" name=\"_ftnref2\">[2]<\/a> the Federal Employees Health Benefits Program (FEHB Program) has excluded from health insurance for Federal employees any \u201cservices, drugs, or supplies related to sex transformation.\u201d Despite a FEHB Program Carrier Letter issued in June 2014,<a href=\"#_ftn3\" name=\"_ftnref3\">[3]<\/a> which made clear that the exclusions were voluntary on the part of insurance carriers participating in the FEHB Program, over 95% of the plans available to Federal employees continue to exclude transition-related care.<a href=\"#_ftn4\" name=\"_ftnref4\">[4]<\/a> Only 15 plans out of 304 FEHB Program plans available have voluntarily removed the clauses restricting access to medically necessary care on the basis that it is related to the gender identity of the beneficiary. This example makes clear the need for unequivocal action on the part of the Department of Labor to require Federal contractors to eliminate such sex-based discrimination.<\/p>\n<p>It cannot be argued that trans-exclusionary health insurance contracts do not discriminate on the basis of gender identity and on the basis of sex. Whether in the blunt language of FEHB Program\u2019s exclusion of care \u201crelated to sex transformation,\u201d or as in examples from the private market, \u201cany procedure or treatment, including hormone therapy, designed to change your physical characteristics from your biologically determined sex to those of the opposite sex\u201d or \u201call services related to gender dysphoria or gender identity disorder,\u201d<a href=\"#_ftn5\" name=\"_ftnref5\">[5]<\/a> such clauses are facially discriminatory. The plain language of such clauses reveals their intent to deny services to individuals solely on the basis of the individual\u2019s gender identity being inconsistent with the individual\u2019s sex assigned at birth. That activity, \u201ctreating an employee or applicant for employment adversely because [they have] undergone, is undergoing, or is planning to undergo sex-reassignment surgery or other processes or procedures designed to facilitate the adoption of a sex or gender other than the individual\u2019s designated sex at birth,\u201d is explicitly prohibited in the context of employment actions by the proposed rule at \u00a7 60-20.2(b)(11). To allow that exact form of discrimination to go unchecked in one of the places it most frequently appears would be to abdicate the responsibility of OFCCP in prohibiting discrimination on the basis of sex by Federal contractors.<\/p>\n<p>When addressing this issue in response to a Department of Health and Human Services (HHS) request for information on 42 U.S.C. \u00a7 18116, prohibiting discrimination on the basis of sex in health care services, numerous organizations spoke out against transition-related exclusions. In public comments, the American Public Health Association,<a href=\"#_ftn6\" name=\"_ftnref6\">[6]<\/a> the Center for American Progress,<a href=\"#_ftn7\" name=\"_ftnref7\">[7]<\/a> the National Center for Transgender Equality,<a href=\"#_ftn8\" name=\"_ftnref8\">[8]<\/a> Lambda Legal,<a href=\"#_ftn9\" name=\"_ftnref9\">[9]<\/a> Transgender Legal Defense and Education Fund,<a href=\"#_ftn10\" name=\"_ftnref10\">[10]<\/a> the National LGBTQ Task Force,<a href=\"#_ftn11\" name=\"_ftnref11\">[11]<\/a> the National Center for Lesbian Rights,<a href=\"#_ftn12\" name=\"_ftnref12\">[12]<\/a> the National Women\u2019s Law Center on behalf of 30 other organizations,<a href=\"#_ftn13\" name=\"_ftnref13\">[13]<\/a> Human Rights Campaign,<a href=\"#_ftn14\" name=\"_ftnref14\">[14]<\/a> and Whitman-Walker Health<a href=\"#_ftn15\" name=\"_ftnref15\">[15]<\/a> all spoke out against trans-exclusionary health insurance contracts, and called upon HHS to interpret 42 U.S.C. \u00a7 18116 as prohibiting such clauses. HHS has yet to respond to the comments.<\/p>\n<p>These comments draw upon the immense professional consensus that transition-related care is medically necessary and therefore that coverage for care should not be denied solely on the basis that it is related to transition.<\/p>\n<p>The Center of Excellence for Transgender Health at the University of California, San Francisco (the Center) provides recommendations to health care professionals who treat transgender individuals using evidence-based transgender medicine. As the Center states, \u201cOnce [an insurance carrier] labels the patient as transgender or transsexual, many types of coverage may be routinely denied, where they would be covered for patients who are not identified as transgender or transsexual. Physicians or their support staff members may need to interact with insurance claims processors on behalf of their transgender or transsexual patients to insist that medically necessary treatments are covered.\u201d<a href=\"#_ftn16\" name=\"_ftnref16\">[16]<\/a><\/p>\n<p>The Center\u2019s statements are consistent with the most recent statements of the foremost authority on transgender health, the World Professional Association for Transgender Health (WPATH). WPATH publishes the Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People (SOC), currently in its seventh version.<a href=\"#_ftn17\" name=\"_ftnref17\">[17]<\/a> The SOC state, with respect to insurance carriers denying medically necessary care, \u201cIn many places around the world, access to health care for transsexual, transgender, and gender-nonconforming people is also limited by a lack of health insurance or other means to pay for needed care. WPATH urges health insurance companies and other third-party payers to cover the medically necessary treatments to alleviate gender dysphoria.\u201d<a href=\"#_ftn18\" name=\"_ftnref18\">[18]<\/a><\/p>\n<p>In 2013, Lambda Legal compiled a list of professional organization statements supporting transgender people in health care, including support for WPATH\u2019s Standards of Care.<a href=\"#_ftn19\" name=\"_ftnref19\">[19]<\/a> These organizations include the American Medical Association,<a href=\"#_ftn20\" name=\"_ftnref20\">[20]<\/a> the American Psychiatric Association,<a href=\"#_ftn21\" name=\"_ftnref21\">[21]<\/a> the American Psychological Association,<a href=\"#_ftn22\" name=\"_ftnref22\">[22]<\/a> the American Academy of Family Physicians,<a href=\"#_ftn23\" name=\"_ftnref23\">[23]<\/a> the American College of Nurse Midwives,<a href=\"#_ftn24\" name=\"_ftnref24\">[24]<\/a> the National Association of Social Workers,<a href=\"#_ftn25\" name=\"_ftnref25\">[25]<\/a> the National Commission on Correctional Health Care,<a href=\"#_ftn26\" name=\"_ftnref26\">[26]<\/a> and the American College of Obstetricians and Gynecologists.<a href=\"#_ftn27\" name=\"_ftnref27\">[27]<\/a><\/p>\n<p>There is no serious question that the intent and impact of trans-exclusionary health insurance clauses was to discriminate against individuals on the basis of gender identity and against treatment for the diagnosis of \u201cgender identity disorder\u201d or \u201cgender dysphoria.\u201d Any denial of any claim on the basis of these exclusions necessarily constitutes discrimination on the basis of transition from one\u2019s assigned sex at birth. The maintenance of such exclusions is discriminatory in both effect and, by its plain text, its intended application to deny medically necessary care to individuals solely on the basis that the care at issue is for the purpose of transition.<\/p>\n<p>Such discrimination is illegal under Federal law, and Federal agencies and contractors are implicitly forbidden from engaging in such discrimination under the terms of the proposed rule. In <em>Macy v. Holder<\/em>,<a href=\"#_ftn28\" name=\"_ftnref28\">[28]<\/a> the U.S. Equal Employment Opportunity Commission held that discrimination on the basis of gender identity was unlawful discrimination on the basis of sex under Title VII on three separate but equally controlling bases. One of these bases addressed transition. The Commission held that discriminating against the act of transition was discrimination \u201cbecause of sex,\u201d drawing the analogy that it would be similarly unlawful discrimination \u201cbecause of religion\u201d to discriminate against someone on the basis of religious conversion. <a href=\"#_ftn29\" name=\"_ftnref29\">[29]<\/a> Discrimination against claims for \u201csex transformation\u201d or other similar exclusion language is necessarily within the scope of the conduct prohibited by <em>Macy<\/em>.<\/p>\n<p>Because the only possible reading of trans-exclusive health insurance clauses is that they discriminate on the basis of gender identity, the final rule must add a new paragraph to \u00a7\u00a060-20.6, \u201cOther fringe benefits,\u201d reading:<\/p>\n<p>(d) It shall be an unlawful employment practice for a contractor to offer health insurance that does not cover care related to gender identity or any process or procedure designed to facilitate the adoption of a sex or gender other than the beneficiary\u2019s designated sex at birth.<\/p>\n<p>While such conduct should also be covered by \u00a7\u00a060-20.2(b)(11), an explicit prohibition is necessary to avoid confusion and promote compliance with Executive Orders 11246 and 13672.<\/p>\n<p>Similarly, to avoid confusion, \u00a7\u00a060-20.2(b)(9) and (b)(10) must be revised to avoid a drafting error that could be exploited to allow transgender employees to be denied access to changing rooms. Paragraphs (b)(9) and (b)(10) currently read that the following are unlawful employment practices:<\/p>\n<p>(9) Making any facilities and employment-related activities available only to members of one sex, except that if the contractor provides restrooms or changing facilities, the contractor must provide separate or single-user restrooms or changing facilities to assure privacy between the sexes;<\/p>\n<p>(10) Denying transgender employees access to the bathrooms used by the gender with which they identify;<\/p>\n<p>The discrepancy in language between paragraphs (b)(9) and (b)(10) would likely require clarification to ensure that transgender and non-binary employees have access to changing facilities \u201cused by the gender with which they identify,\u201d to use the language of paragraph (b)(10). Changing facilities, along with restrooms, are frequently turned into battlegrounds by those who would deny transgender and non-binary people access.<a href=\"#_ftn30\" name=\"_ftnref30\">[30]<\/a> It must be clear that access to such facilities may not be denied on the basis of gender identity. As such, the final rule must be revised to read:<\/p>\n<p>(9) Making any facilities and employment-related activities available only to members of one sex, except that if the contractor provides restrooms or changing facilities, the contractor must provide separate or single-user restrooms or changing facilities to assure privacy <span style=\"text-decoration: line-through;\">between the sexes<\/span> <span style=\"text-decoration: underline;\">based on sex and gender identity<\/span>;<\/p>\n<p>(10) Denying <span style=\"text-decoration: line-through;\">transgender<\/span> employees access to the <span style=\"text-decoration: line-through;\">bathrooms<\/span> <span style=\"text-decoration: underline;\">restrooms or changing facilities <\/span><span style=\"text-decoration: line-through;\">used by the gender with which they identify<\/span> <span style=\"text-decoration: underline;\">consistent with their gender identity<\/span>;<\/p>\n<p>This change will ensure that the final rule precludes discriminating against transgender or non-binary employees in access to restrooms or changing facilities.<\/p>\n<p>&nbsp;<\/p>\n<p>Sincerely,<\/p>\n<p>Emily T. Prince, Esq.<\/p>\n<hr \/>\n<p><a href=\"#_ftnref1\" name=\"_ftn1\">[1]<\/a> <em>See<\/em>, <em>e.g.<\/em>, Chris Geidner, \u201cThe Growing Effort to Protect LGBT People From Discrimination Under the Civil Rights Act of 1964,\u201d Feb. 18, 2015, available at <a href=\"http:\/\/www.buzzfeed.com\/chrisgeidner\/the-growing-effort-to-protect-lgbt-people-from-discriminatio\">http:\/\/www.buzzfeed.com\/chrisgeidner\/the-growing-effort-to-protect-lgbt-people-from-discriminatio<\/a> (citing a February 3, 2015 EEOC memo from the Office of Field Programs stating \u201c(1) Complaints of discrimination on the basis of transgender status or gender-identity-related discrimination should be accepted under Title VII and investigated as claims of sex discrimination in light of Commission precedent; and (2) Individuals who believe they have been discriminated against because of their sexual orientation should be counseled that they have a right to file a charge with the EEOC, and their charges should be accepted under Title VII and investigated as claims of sex discrimination in light of Commission precedent.\u201d)<\/p>\n<p><a href=\"#_ftnref2\" name=\"_ftn2\">[2]<\/a> <em>See<\/em> United States Office of Personnel Management, FOIA Response FOIA\/PA 2014-03980, Aug. 7, 2014, available at <a href=\"http:\/\/www.emily-esque.com\/wp\/wp-content\/uploads\/2015\/03\/2014-08-25-FOIA-Response-from-OPM-re-Transgender-Exclusions-redacted.pdf\">http:\/\/www.emily-esque.com\/wp\/wp-content\/uploads\/2015\/03\/2014-08-25-FOIA-Response-from-OPM-re-Transgender-Exclusions-redacted.pdf<\/a>.<\/p>\n<p><a href=\"#_ftnref3\" name=\"_ftn3\">[3]<\/a> United States Office of Personnel Management, FEHB Program Carrier Letter No. 2014-17, June 13, 2014, available at <a href=\"http:\/\/www.opm.gov\/healthcare-insurance\/healthcare\/carriers\/2014\/2014-17.pdf\">http:\/\/www.opm.gov\/healthcare-insurance\/healthcare\/carriers\/2014\/2014-17.pdf<\/a>.<\/p>\n<p><a href=\"#_ftnref4\" name=\"_ftn4\">[4]<\/a> <em>See<\/em> United States Office of Personnel Management, FOIA Response 2015-00122, Nov. 24, 2014, available at <a href=\"http:\/\/www.emily-esque.com\/wp\/wp-content\/uploads\/2014\/11\/FY-2015-00122-Emily-T-Prince-Transgender-Final-11-24-14_Redacted.pdf\">http:\/\/www.emily-esque.com\/wp\/wp-content\/uploads\/2014\/11\/FY-2015-00122-Emily-T-Prince-Transgender-Final-11-24-14_Redacted.pdf<\/a>. <em>See also<\/em> Emily Prince, \u201cOPM Continues to Have Nothing New to Say About Anti-Trans Discrimination,\u201d Nov. 26, 2014, available at <a href=\"http:\/\/www.emily-esque.com\/wp\/?p=464\">http:\/\/www.emily-esque.com\/wp\/?p=464<\/a> (calculating the percentage of health carriers continuing to exclude transition-related care).<\/p>\n<p><a href=\"#_ftnref5\" name=\"_ftn5\">[5]<\/a> Kellan Baker and Andrew Cray, Center for American Progress, \u201cEnsuring Benefits Parity and Gender Identity Nondiscrimination in Essential Health Benefits,\u201d Nov. 15, 2012, available at <a href=\"https:\/\/www.americanprogress.org\/wp-content\/uploads\/2012\/11\/BakerHealthBenefits-2.pdf\">https:\/\/www.americanprogress.org\/wp-content\/uploads\/2012\/11\/BakerHealthBenefits-2.pdf<\/a>.<\/p>\n<p><a href=\"#_ftnref6\" name=\"_ftn6\">[6]<\/a> American Public Health Association, \u201cComment on Department of Health and Human Services: Request for Information Regarding Nondiscrimination in Certain Health Programs or Activities,\u201d Sep. 30, 2013, available at <a href=\"http:\/\/www.regulations.gov\/#!documentDetail;D=HHS-OCR-2013-0007-0117\">http:\/\/www.regulations.gov\/#!documentDetail;D=HHS-OCR-2013-0007-0117<\/a>.<\/p>\n<p><a href=\"#_ftnref7\" name=\"_ftn7\">[7]<\/a> Center for American Progress, \u201cComment on Department of Health and Human Services: Request for Information Regarding Nondiscrimination in Certain Health Programs or Activities,\u201d Sep. 30, 2013, available at <a href=\"http:\/\/www.regulations.gov\/#!documentDetail;D=HHS-OCR-2013-0007-0084\">http:\/\/www.regulations.gov\/#!documentDetail;D=HHS-OCR-2013-0007-0084<\/a>.<\/p>\n<p><a href=\"#_ftnref8\" name=\"_ftn8\">[8]<\/a> National Center for Transgender Equality, \u201cComment on Department of Health and Human Services: Request for Information Regarding Nondiscrimination in Certain Health Programs or Activities,\u201d Sep. 30, 2013, available at <a href=\"http:\/\/www.regulations.gov\/#!documentDetail;D=HHS-OCR-2013-0007-0155\">http:\/\/www.regulations.gov\/#!documentDetail;D=HHS-OCR-2013-0007-0155<\/a>.<\/p>\n<p><a href=\"#_ftnref9\" name=\"_ftn9\">[9]<\/a> Lambda Legal, \u201cComment on Department of Health and Human Services: Request for Information Regarding Nondiscrimination in Certain Health Programs or Activities,\u201d Sep. 30, 2013, available at <a href=\"http:\/\/www.regulations.gov\/#!documentDetail;D=HHS-OCR-2013-0007-0161\">http:\/\/www.regulations.gov\/#!documentDetail;D=HHS-OCR-2013-0007-0161<\/a>.<\/p>\n<p><a href=\"#_ftnref10\" name=\"_ftn10\">[10]<\/a> Transgender Legal Defense and Education Fund, \u201cComment on Department of Health and Human Services: Request for Information Regarding Nondiscrimination in Certain Health Programs or Activities,\u201d Sep. 30, 2013, available at <a href=\"http:\/\/www.regulations.gov\/#!documentDetail;D=HHS-OCR-2013-0007-0158\">http:\/\/www.regulations.gov\/#!documentDetail;D=HHS-OCR-2013-0007-0158<\/a>.<\/p>\n<p><a href=\"#_ftnref11\" name=\"_ftn11\">[11]<\/a> National LGBTQ Task Force, \u201cComment on Department of Health and Human Services: Request for Information Regarding Nondiscrimination in Certain Health Programs or Activities,\u201d Oct. 17, 2013, available at <a href=\"http:\/\/www.regulations.gov\/#!documentDetail;D=HHS-OCR-2013-0007-0105\">http:\/\/www.regulations.gov\/#!documentDetail;D=HHS-OCR-2013-0007-0105<\/a>.<\/p>\n<p><a href=\"#_ftnref12\" name=\"_ftn12\">[12]<\/a> National Center for Lesbian Rights, \u201cComment on Department of Health and Human Services: Request for Information Regarding Nondiscrimination in Certain Health Programs or Activities,\u201d Sep. 30, 2013, available at <a href=\"http:\/\/www.regulations.gov\/#!documentDetail;D=HHS-OCR-2013-0007-0145\">http:\/\/www.regulations.gov\/#!documentDetail;D=HHS-OCR-2013-0007-0145<\/a>.<\/p>\n<p><a href=\"#_ftnref13\" name=\"_ftn13\">[13]<\/a> National Women\u2019s Law Center on Behalf of 30 Organizations, \u201cComment on Department of Health and Human Services: Request for Information Regarding Nondiscrimination in Certain Health Programs or Activities,\u201d Sep. 30, 2013, available at <a href=\"http:\/\/www.regulations.gov\/#!documentDetail;D=HHS-OCR-2013-0007-0125\">http:\/\/www.regulations.gov\/#!documentDetail;D=HHS-OCR-2013-0007-0125<\/a>.<\/p>\n<p><a href=\"#_ftnref14\" name=\"_ftn14\">[14]<\/a> Human Rights Campaign, \u201cRequest for Information Regarding Nondiscrimination in Certain Health Programs or Activities,\u201d Sep. 30, 2013, available at <a href=\"http:\/\/www.regulations.gov\/#!documentDetail;D=HHS-OCR-2013-0007-0039\">http:\/\/www.regulations.gov\/#!documentDetail;D=HHS-OCR-2013-0007-0039<\/a>.<\/p>\n<p><a href=\"#_ftnref15\" name=\"_ftn15\">[15]<\/a> Whitman-Walker Health, \u201cResponse of Whitman-Walker Health to Request for Information on Regulations to Implement the Nondiscrimination Requirements in Section 1557 of the Affordable Care Act,\u201d Sep. 30, 2013, available at <a href=\"http:\/\/www.regulations.gov\/#!documentDetail;D=HHS-OCR-2013-0007-0063\">http:\/\/www.regulations.gov\/#!documentDetail;D=HHS-OCR-2013-0007-0063<\/a>.<\/p>\n<p><a href=\"#_ftnref16\" name=\"_ftn16\">[16]<\/a> Insurance Issues, <em>Primary Care Protocol for Transgender Patient Care, Center of Excellence for Transgender Health<\/em>, University of California, San Francisco, Department of Family and Community Medicine, April 2011, available at <a href=\"http:\/\/transhealth.ucsf.edu\/trans?page=protocol-insurance\">http:\/\/transhealth.ucsf.edu\/trans?page=protocol-insurance<\/a>.<\/p>\n<p><a href=\"#_ftnref17\" name=\"_ftn17\">[17]<\/a> Standards of Care Version 7, World Professional Association for Transgender Health, 2011, available at <a href=\"http:\/\/admin.associationsonline.com\/uploaded_files\/140\/files\/Standards%20of%20Care,%20V7%20Full%20Book.pdf\">http:\/\/admin.associationsonline.com\/uploaded_files\/140\/files\/Standards%20of%20Care,%20V7%20Full%20Book.pdf<\/a>.<\/p>\n<p><a href=\"#_ftnref18\" name=\"_ftn18\">[18]<\/a> Id. at 33.<\/p>\n<p><a href=\"#_ftnref19\" name=\"_ftn19\">[19]<\/a> Lambda Legal, <em>Professional Organization Statements Supporting Transgender People in Health Care<\/em>, July 2, 2013, available at <a href=\"http:\/\/www.lambdalegal.org\/sites\/default\/files\/publications\/downloads\/fs_professional-org-statements-supporting-trans-health_4.pdf\">http:\/\/www.lambdalegal.org\/sites\/default\/files\/publications\/downloads\/fs_professional-org-statements-supporting-trans-health_4.pdf<\/a>.<\/p>\n<p><a href=\"#_ftnref20\" name=\"_ftn20\">[20]<\/a> American Medical Association, Resolution H-195.950, <em>Removing Financial Barriers to Care for Transgender Patients<\/em>, (Res. 122; A-08).<\/p>\n<p><a href=\"#_ftnref21\" name=\"_ftn21\">[21]<\/a> American Psychiatric Association, <em>Position Statement on Access to Care for Transgender and Gender Variant Individuals<\/em>, 2012, available at <a href=\"http:\/\/www.psych.org\/File%20Library\/Advocacy%20and%20Newsroom\/Position%20Statements\/ps2012_TransgenderCare.pdf\">http:\/\/www.psych.org\/File%20Library\/Advocacy%20and%20Newsroom\/Position%20Statements\/ps2012_TransgenderCare.pdf<\/a>; American Psychiatric Association, <em>Position Statement on Discrimination Against Transgender and Gender Variant Individuals<\/em>, 2012, available at <a href=\"http:\/\/www.psychiatry.org\/File%20Library\/Advocacy%20and%20Newsroom\/Position%20Statements\/ps2012_TransgenderDiscrimination.pdf\">http:\/\/www.psychiatry.org\/File%20Library\/Advocacy%20and%20Newsroom\/Position%20Statements\/ps2012_TransgenderDiscrimination.pdf<\/a>.<\/p>\n<p><a href=\"#_ftnref22\" name=\"_ftn22\">[22]<\/a> American Psychological Association, <em>Transgender, Gender Identity, &amp; Gender Expression Non-Discrimination<\/em>, 2008, available at <a href=\"http:\/\/www.apa.org\/about\/policy\/transgender.aspx\">http:\/\/www.apa.org\/about\/policy\/transgender.aspx<\/a>.<\/p>\n<p><a href=\"#_ftnref23\" name=\"_ftn23\">[23]<\/a> American Academy of Family Physicians, <em>Transgender Care<\/em>, Resolution No. 1004, 2012, available at <a href=\"http:\/\/www.aafp.org\/dam\/AAFP\/documents\/about_us\/special_constituencies\/2012RCAR_Advocacy.pdf\">http:\/\/www.aafp.org\/dam\/AAFP\/documents\/about_us\/special_constituencies\/2012RCAR_Advocacy.pdf<\/a>.<\/p>\n<p><a href=\"#_ftnref24\" name=\"_ftn24\">[24]<\/a> American College of Nurse Midwives, <em>Transgender \/ Transsexual \/ Gender Variant Health Care<\/em>, 2012, available at <a href=\"http:\/\/www.midwife.org\/ACNM\/files\/ACNMLibraryData\/UPLOADFILENAME\/000000000278\/Transgender%20Gender%20Variant%20Position%20Statement%20December%202012.pdf\">http:\/\/www.midwife.org\/ACNM\/files\/ACNMLibraryData\/UPLOADFILENAME\/000000000278\/Transgender%20Gender%20Variant%20Position%20Statement%20December%202012.pdf<\/a>.<\/p>\n<p><a href=\"#_ftnref25\" name=\"_ftn25\">[25]<\/a> National Association of Social Workers, <em>Transgender and Gender Identity Issues<\/em>, 2008, available at <a href=\"https:\/\/www.socialworkers.org\/da\/da2008\/finalvoting\/documents\/Transgender%202nd%20round%20-%20Clean.pdf\">https:\/\/www.socialworkers.org\/da\/da2008\/finalvoting\/documents\/Transgender%202nd%20round%20-%20Clean.pdf<\/a>.<\/p>\n<p><a href=\"#_ftnref26\" name=\"_ftn26\">[26]<\/a> National Commission on Correctional Health Care, <em>Transgender Health Care in Correctional Settings<\/em>, 2009, available at <a href=\"http:\/\/www.ncchc.org\/transgender-health-care-in-correctional-settings\">http:\/\/www.ncchc.org\/transgender-health-care-in-correctional-settings<\/a>.<\/p>\n<p><a href=\"#_ftnref27\" name=\"_ftn27\">[27]<\/a> American College of Obstetricians and Gynecologists, <em>Health Care for Transgender Individuals<\/em>, 2011, available at <a href=\"http:\/\/www.acog.org\/Resources_And_Publications\/Committee_Opinions\/Committee_on_Health_Care_for_Underserved_Women\/Health_Care_for_Transgender_Individuals\">http:\/\/www.acog.org\/Resources_And_Publications\/Committee_Opinions\/Committee_on_Health_Care_for_Underserved_Women\/Health_Care_for_Transgender_Individuals<\/a>.<\/p>\n<p><a href=\"#_ftnref28\" name=\"_ftn28\">[28]<\/a> <em>Macy v. Holder<\/em>, U.S. Equal Employment Opportunity Commission Appeal No. 0120120821 (April 20, 2012).<\/p>\n<p><a href=\"#_ftnref29\" name=\"_ftn29\">[29]<\/a> <em>Id<\/em>. at 13-14; <em>see also<\/em> <em>Schroer v. Billington<\/em>, 577 F. Supp. 2d 293 (D.D.C. 2008).<\/p>\n<p><a href=\"#_ftnref30\" name=\"_ftn30\">[30]<\/a> <em>See<\/em>, <em>e.g.<\/em>, Marianne Mollmann, International Gay and Lesbian Human Rights Commission, \u201cEnough with the Bathrooms: Stigma, Stereotypes, and Barriers to Trans Equality,\u201d May 28, 2014, available at <a href=\"http:\/\/www.huffingtonpost.com\/marianne-mollmann\/enough-with-the-bathrooms_b_5043042.html\">http:\/\/www.huffingtonpost.com\/marianne-mollmann\/enough-with-the-bathrooms_b_5043042.html<\/a>; Luke Brinker and Carlos Maza, \u201c15 Experts Debunk Right-Wing Transgender Bathroom Myth,\u201d Mar. 20, 2014, available at <a href=\"http:\/\/mediamatters.org\/research\/2014\/03\/20\/15-experts-debunk-right-wing-transgender-bathro\/198533\">http:\/\/mediamatters.org\/research\/2014\/03\/20\/15-experts-debunk-right-wing-transgender-bathro\/198533<\/a>; <em>see also<\/em> Mark Joseph Stern, \u201cFlorida\u2019s Vicious Anti-Trans Bathroom Bill Easily Survives Its First Vote,\u201d Mar. 5, 2015, available at <a href=\"http:\/\/www.slate.com\/blogs\/outward\/2015\/03\/05\/florida_trans_bathroom_bill_easily_survives_first_vote.html\">http:\/\/www.slate.com\/blogs\/outward\/2015\/03\/05\/florida_trans_bathroom_bill_easily_survives_first_vote.html<\/a>, Jack Brammer, \u201cIn Surprise Vote, Kentucky Senate Panel Approves Limits on Transgender Students\u2019 Choices,\u201d Feb. 23, 2015, available at <a href=\"http:\/\/www.kentucky.com\/2015\/02\/23\/3710823_in-surprise-vote-kentucky-senate.html\">http:\/\/www.kentucky.com\/2015\/02\/23\/3710823_in-surprise-vote-kentucky-senate.html<\/a>, and Mitch Kellaway, \u201cTexas Bill Would Jail Those Whose Chromosomes Don\u2019t Match the Restroom They\u2019re Using\u201d, Feb. 24, 2015, available at <a href=\"http:\/\/www.advocate.com\/politics\/transgender\/2015\/02\/24\/texas-bill-would-jail-those-whose-chromosomes-dont-match-restroom-th\">http:\/\/www.advocate.com\/politics\/transgender\/2015\/02\/24\/texas-bill-would-jail-those-whose-chromosomes-dont-match-restroom-th<\/a> (discussing state legislative attempts in Florida, Kentucky, and Texas to prevent transgender, non-binary, and intersex people from using restrooms consistent with their sex and gender identity in defiance of Federal law).<\/p>\n","protected":false},"excerpt":{"rendered":"<p>This weekend I filed my comment to the Department of Labor&#8217;s Office of Federal Contract Compliance Programs, relating to their proposed rule updating the prohibition on discrimination on the basis of sex by Federal contractors.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2},"jetpack_post_was_ever_published":false},"categories":[1],"tags":[],"class_list":["post-610","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"jetpack_publicize_connections":[],"jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p5pI5m-9Q","jetpack_featured_media_url":"","_links":{"self":[{"href":"http:\/\/www.emily-esque.com\/wp\/index.php?rest_route=\/wp\/v2\/posts\/610","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/www.emily-esque.com\/wp\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/www.emily-esque.com\/wp\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/www.emily-esque.com\/wp\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/www.emily-esque.com\/wp\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=610"}],"version-history":[{"count":4,"href":"http:\/\/www.emily-esque.com\/wp\/index.php?rest_route=\/wp\/v2\/posts\/610\/revisions"}],"predecessor-version":[{"id":615,"href":"http:\/\/www.emily-esque.com\/wp\/index.php?rest_route=\/wp\/v2\/posts\/610\/revisions\/615"}],"wp:attachment":[{"href":"http:\/\/www.emily-esque.com\/wp\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=610"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/www.emily-esque.com\/wp\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=610"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/www.emily-esque.com\/wp\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=610"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}