Timeline of transgender health care rights

Published 5:20 AM ET, Thu May 31, 2018
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1981 -- Medicare forbids coverage for transgender-related surgeries. Private insurers follow suit.
May 1989 -- The Supreme Court rules that discrimination based on "sex stereotyping" -- such as denying a promotion to a woman because she's not feminine enough -- violates the Civil Rights Act of 1964.
1993 -- The Minnesota legislature amends the state human rights act to ban discrimination based on sexual orientation, including nonconformity to sex stereotypes.
2005 -- California becomes the first state to prohibit health care plans from discriminating based on gender identity or expression.
March 2010 -- The Affordable Care Act (ACA), also known as Obamacare, becomes law. Section 1557 of the act bans discrimination based on sex and other characteristics in federally funded health care programs and activities. It does not explicitly interpret sex to include gender identity, but courts will interpret it that way in coming years.
March 2012 -- The Department of Health and Human Services (HHS) bans marketplace plans from discriminating based on gender identity.
April 2012 -- The Equal Employment Opportunity Commission rules that employment discrimination based on transgender status violates the Civil Rights Act of 1964. The decision from the Department of Labor's enforcement agency creates a precedent that is later applied to certain health care plans.
07/12/12 -- HHS's Office for Civil Rights announces that it will accept complaints alleging gender identity discrimination under the ACA.
December 2012 -- The American Psychiatric Association approves an update to its diagnostic manual to eliminate gender identity disorder and replace it with gender dysphoria.
May 2014 -- Medicare lifts its decade-old ban on "transsexual surgery."
May 2016 -- HHS OCR issues a final version of Section 1557 clarifying that it forbids health care discrimination based on gender identity. All blanket exclusions for gender-affirming care must be removed from policies that HHS regulates by January 2017.
December 2016 -- A Texas federal court judge issues a preliminary injunction barring HHS from enforcing the gender identity provisions of section 1557's ban of sex-based discrimination. The anti-discrimination rule itself still stands.
January 2017 -- HHS OCR rule prohibiting any federally-assisted insurance plans from wholesale exclusions of gender-affirming care takes effect. Though HHS cannot enforce it, individuals can still sue over violations of the rule.
February 2018 -- In an effort to address the "issues" that the Texas judge identified in his injunction, Department of Justice lawyers tell the court that HHS OCR submitted a draft of a proposed rule to the White House.
April 2018 -- HHS submits the draft proposed Section 1557 rule to the office of Management and Budget OMB for interagency review under Executive Order 12886, and informed the Franciscan Alliance court in its on April 16, 2018 status report.