CSC Urges U.S. District Court to Prevent Discrimination Against Patients
The Cancer Support Community joined more than a dozen patient groups representing millions of Americans with serious health conditions in filing an amicus brief ("friend of the court") urging the U.S. District Court for the Southern District of New York to preserve protections in the Affordable Care Act for patients who identify as lesbian, gay, bisexual, transgender and/or queer (LGBTQ+) receiving health care services and restore translation notices for patients with limited English proficiency (LEP). This follows a statement that CSC joined with other patient groups in opposing the administration’s rule, as it has the potential to encourage discrimination in health care.
The brief makes it clear that many patients who identify as LGBTQ+ and non-native English speakers already face significant health disparities and allowing discrimination and limiting language translation of notices—as permitted under a June 2020 rule—would further widen these gaps and lead to delays in access to timely treatment, lower the quality of medical care, and result in poorer health outcomes.
In June 2020, amid the ongoing COVID-19 pandemic, the Trump Administration issued a final rule that eliminated broad protections for people who identify as LGBTQ+ and those with limited English proficiency under Section 1557 of the ACA. Section 1557 of the ACA prohibits discrimination based on race, color, national origin, sex, age, and disability in health programs and activities receiving federal financial assistance. It is the first federal civil rights law to prohibit discrimination in health care based on sex. The 2020 final rule:
- Removed explicit protections against discrimination of patients based on sex stereotyping and gender identity by providers and institutions
- Reduced critical protections that provide access to interpretation and translational services for LEP individuals
Barriers to Care
The LGBTQ+ community has long faced discrimination, bias, stigma, and substandard care, and often faces barriers accessing care within the health care system. In 2016, the LGBTQ+ community was identified as a “health disparity population” by the National Institute on Minority Health and Health Disparities. Evidence shows that LGBTQ+ “populations have less access to health care and higher burdens of certain diseases, such as depression, cancer, and HIV/AIDS.” Prohibiting medical providers from discriminating on the basis of sexual orientation or gender identity must be part of the solution to these many harms suffered by many patients who identify as LGBTQ+.
Similarly, individuals with limited English proficiency face significant barriers accessing health and cancer care. Studies show that this community has disproportionately lower rates of cancer screening than English-proficient patients (Ridgeway et al., 2020) and that language barriers can create significant challenges as patients seek to understand medical information and make treatment decisions (Chou, et al., 2016).
What Comes Next?
At CSC we believe—as outlined in the brief—that discrimination on the basis of sex, gender identity, transgender status, sexual orientation, national origin, language proficiency, and similar characteristics have no place in our health care system. CSC will continue to advocate for health care policies that break down inequities and enable all individuals to have access to affordable medical care and support.
Other organizations are also taking action against this rule. Whitman-Walker Health, a CSC Health Care Partner, in conjunction with Lambda Legal and other LGBTQ groups, have sued the Trump administration, arguing that, among other things, the rule violates the Administrative Procedure Act, the Fifth Amendment’s guarantee of equal protection and due process, and the free speech and establishment clauses of the U.S. Constitution.
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Chou, F. Y., Kuang, L. Y., Lee, J., Yoo, G. J., & Fung, L. C. (2016). Challenges in Cancer Self-management of Patients with Limited English Proficiency. Asia-Pacific journal of oncology nursing, 3(3), 259–265. https://doi.org/10.4103/2347-5625.189815
Ridgeway, J.L., Njeru, J.W., Breitkopf, C.R. et al. Closing the Gap: Participatory Formative Evaluation to Reduce Cancer Screening Disparities among Patients with Limited English Proficiency. J Canc Educ (2020). https://doi.org/10.1007/s13187-020-01706-4