The
rule of law is the most advanced method of self-government humankind
has developed throughout history to avoid mob rule or the kingdom of the
individual, each for self, power to the strongest, most armed richest.
It's not perfect, it's complex and it's evolving.
As explained
above, when a law is passed an agency in the executive branch is
required to enforce it as written by issuing regulations for clarity.
The proposed rule discussed herein is Section 1557 of the Affordable
Care Act. Section 1557 is the first federal civil rights law that bars
sex discrimination in federally funded health care, As I explained
above, case law has established that sex discrimination covers gender
identify and nonconformity. The ACA however does not explicitly
prohibit discrimination based on sexual orientation. HHS must enforce
what exists, no more no less. HRC is asserting that sex discrimination
also covers discrimination based on sexual orientation. Despite its
assertion, that is an open question at best. I searched but could not
find any information on this matter explaining the basis for its
assertion on its web site. All I have to go on in trying to understand
their assertion is the request for comments I linked.
Therein,
HRC states: "Numerous federal courts and the Equal Employment
Opportunity Commission
have determined that discrimination on the basis of sexual orientation
is sex discrimination under federal law." However, I can find no basis
for that statement on its site or elsewhere, it simply provides no
documentation to support its assertion. Perhaps it thinks it too
complicated too understand. HRC correctly asserts that unless HHS
determines that sex discrimination covers sexual orientation, the ACA
does not prohibit discrimination based on sexual orientation. The fact
is the ACA does not prohibit discrimination based on sexual orientation;
to include such a basis would violate the Constitutional doctrine of
separation of powers in effect for over 200 years. Congress has the
authority to pass legislation in the ACA or separately prohibiting
sexual orientation discrimination without which federal agencies cannot
prohibit it unless Courts find otherwise.
HHS, however, is
so concerned with discrimination based on sexual orientation that it
addresses the matter in the proposed rule despite no explicit provision
in the law as follows:
"The proposed rule makes clear HHS’s commitment, as a matter of policy,
to banning discrimination based on sexual orientation and requests
comment on how a final rule can incorporate the most robust set of
protections against discrimination supported by the courts on an ongoing
basis.
As a matter of policy, we support banning discrimination in health
programs and activities not only on the bases identified previously, but
also on the basis of sexual orientation. Current law is mixed on
whether existing Federal nondiscrimination laws prohibit discrimination
on the basis of sexual orientation as a part of their prohibitions of
sex discrimination. To date, no Federal appellate court has concluded
that Title IX's prohibition of discrimination “on the basis of sex”—or
Federal laws prohibiting sex discrimination more generally—prohibits
sexual orientation discrimination, and some appellate courts previously
reached the opposite conclusion. (22)
However, a recent EEOC
decision concluded that Title VII's prohibition of discrimination “on
the basis of sex” precludes sexual orientation discrimination because
discrimination on the basis of sexual orientation necessarily involves
sex-based considerations. The EEOC relied on several theories to reach
this conclusion: A plain interpretation of the term “sex” in the
statutory language, an associational theory of discrimination based on
“sex,” and the gender-stereotype theory announced in Price Waterhouse.
(23) The EEOC's decision cited several district court decisions that
similarly concluded that sex discrimination included sexual orientation
discrimination, using these theories. (24) The EEOC also analyzed and
called into question the appellate decisions that have concluded that
sexual orientation discrimination is not covered under Title VII. The
EEOC decision applies to workplace conditions, as well as hiring,
firing, and promotion decisions, and is one of several recent
developments in the law that have resulted in additional protections for
lesbian and gay individuals against discrimination. (25)
The
final rule should reflect the current state of nondiscrimination law,
including with respect to prohibited bases of discrimination. We seek
comment on the best way of ensuring that this rule includes the most
robust set of protections supported by the courts on an ongoing basis."
Legal experts can disagree with the assessment expressed above by HHS and HRC as is its right has chosen to do so. After again reading OCR's position as stated above, I see that EEOC has determined that sex discrimination precludes discrimination based on sexual orientation. But OCR states that no Federal appellate court has issued a decision consistent with that EEOC decision and states that as a matter of Constitutional principles, OCR cannot assert that sex discrimination covers sexual orientation discrimination.
Another
area addressed in the proposed rule is the principle of religious
exemption. Due to recent Supreme Court rulings and other legislation, I
find the status of case law in this matter too confusing for me to
contemplate. All I know is no service provider should ever be able to
deny services or discriminate due to religious beliefs. The proposed
rule has language finessing a fine line between compliance with existing
case law without upholding it while asserting that religious exemptions
so should not be allowed.
So what does this all mean? I concludes as follows:
Everyone
should submit comments either through HRC or directly to HHS on the 3
issues of some controversy in the proposed rule, the more the better,
you know the bigots will be submitting their comments:
1) Concurring with the Rule as written to prohibit discrimination based on gender status or nonconformity;
2)
Expressing objection to discrimination based on sexual orientation -
while HHS is unlikely to include explicit prohibitions, your comments
are documented and count and can be used to show Congress the widespread
support for passing laws to prohibit discrimination based on sexual
orientation;
3) Expressing objections to allow religious exemptions for health care service providers.
So
why did I take so long to state something so simple - because I was
puzzled by HRC's assertion and wanted to determine its validity and
basis for myself, because I wanted to educate anyone interested in the
history of discrimination in health care and the current state of case
law regarding discrimination against gays and transgenders, and to
explain why discrimination against transgenders is prohibited before
discrimination based on sexual orientation but not to defend the lack of
laws prohibiting discrimination
During my last presentation prior to
retirement, I was as surprised as I was pleased to discuss OCR's
authority to enforce provisions of the ACA prohibiting discrimination
against transgenders in the provision of health care services, and that
those who believed they had experienced such discrimination could file a
complaint with OCR, even if I wouldn't be around to investigate it and
issue findings, and before an audience of health providers that included
staff and clients who are transgender or gender nonconforming.
For those who have read this far, after you have submitted your
comments, with elections approaching, you can ask candidates for office
in your district or state whether they would vote in favor of amending
the Civil Rights Act of 1964 to include the basis of sexual orientation
to once and for all prohibit discrimination against lesbians and gays
throughout the United States in employment, housing, health care, public
accommodations and all other areas with one simple amendment.
Links:
Fact Sheet: Nondiscrimination in Health Programs and Activities Proposed Rule
Section 1557 of the Affordable Care Act:
http://www.hhs.gov/ocr/civilrights/understanding/section1557/nprmsummary.html
FAQs - Section 1557 of the Affordable Care Act, Notice of Proposed Rulemaking:
http://www.hhs.gov/ocr/civilrights/understanding/section1557/nprmprqas.html
Nondiscrimination in Health Programs and Activities - Proposed Rule:
http://www.regulations.gov/#!documentDetail;D=HHS-OCR-2015-0006-0001
http://www.hhs.gov/ocr/civilrights/resources/providers/index.htmlhttp://www.hhs.gov/ocr/civilrights/resources/factsheets/hivaids.pdfhttp://www.hhs.gov/ocr/civilrights/resources/specialtopics/hiv/index.html
http://www.hhs.gov/ocr/office/file/index.html - how to file a complaint