Public Comment Opportunity: Protect the Health Care Rights Law

 
Image source:  Larissa Puro

Image source: Larissa Puro

 

Below is language from what Praxis will submit as our public comment for a federal policy proposal impacting people receiving medical care. Please feel free to borrow and add your own unique voice from the non-italicized language below, to submit your comment HERE before the August 13th deadline.

This proposal would significantly affect the health and welfare of our communities and presents an important opportunity for us to share our perspectives. If you or someone you know could be impacted by these policies, we encourage you to share what you expect would be the consequences of this policy for you and your family or community.

Background: If finalized, this rule would end major parts of the Health Care Rights Law and expose various people seeking medical care to discrimination and/or health harms. Groups that would likely be especially impacted include LGBTQ+ people, people who have sought or may in the future seek abortions and other reproductive health services, people whose first language is not English, immigrants, people of color, and people with disabilities. 

Among some of the expected impacts are:

  • People who do not speak English well, or at all, could face barriers to seeing a doctor.

  • Patients who do not speak English won’t get important information about how to receive help in their preferred language. 

  • President Trump's plan will increase fear and uncertainty in limited English proficient and immigrant communities.

The Praxis Project submits this public comment in opposition to the Department of Health and Human Services proposal to roll back nondiscrimination protections in health and health education, Docket ID HHS-OCR-2019-0007-0001, published in the Federal Register on June 14, 2019.  

The Praxis Project is a national nonprofit that works to center community power in efforts to increase health justice and racial equity. We work closely with public health professionals and base-building community organizers from across the United States, to improve justice and equity in our nation’s most marginalized communities. Recognizing health injustice for marginalized communities, many of our base-building partners work every day to ensure that their neighbors, friends, and family have access to quality, comprehensive and affordable care in order to improve long-term health outcomes for children and adults. 

As one of the nation’s leading health justice and racial justice advocates, The Praxis Project opposes this proposed change because it poses significant risks to health - a human right - and safety for countless individuals and families. 

Access to affordable and comprehensive health care is an essential determinant of people’s health and wellbeing. Communities that face disinvestments in other health indicators - such as housing, food, education, and employment - would face significantly increased threats to care if this rule were to be implemented. Without protections through The Health Care Rights Law’s robust implementation, basic health for millions would inevitably be jeopardized. 

Threat to Gender Justice

In the past year, 1 in 3 transgender people faced discrimination or disrespect by a doctor which led to their delaying or not seeking preventive health care. Eliminating the general prohibition on discrimination based on gender identity - in addition to specific insurance coverage protections for people who are transgender - will widen this injustice. As a result, people who are transgender who cannot access any form of health care would face a range of untreated ailments that could bear grave - including life-threatening - results. We cannot move in the direction of improving illness and death while exacerbating existing discrimination - this completely contradicts our values as a nation

Threat to Reproductive Justice

Abortion care - and all reproductive care - is health care. Accordingly, we further oppose the adoption of blanket abortion and religious freedom exemptions for health care providers. This would embolden discriminatory providers and insurance companies. Given the recent attacks on reproductive justice, this rule would put basic reproductive care - including but not limited to abortions - out of reach for even more people alongside increased discrimination and barriers to reproductive justice.

Threat to Language Justice

Language should never serve as a condition of health care access. Weakening protections that provide access to interpretation and written translation services for individuals with limited English proficiency - as proposed by this rule - would put health at risk for millions of people who already face economic and health justice barriers, among other challenges. The ability to speak English should not prioritize some patients above others in understanding and accessing care. Rather, we must preserve and expand health for all patients - regardless of English proficiency, gender identity, race or class. Furthermore, the health care system is already experiencing a dangerous chilling effect due to the proposed rule regarding public charge. This rule layers on to the ongoing threats to LEP immigrants’ health.

The rollback of provisions to ensure equal access would also negatively impact people with disabilities and people living with HIV, hepatitis, and other chronic illnesses. Discrimination or stereotypes against people with disabilities or people living with chronic illnesses should never be allowed to determine the care they receive.

All of the above-mentioned risks to specific populations would result in even more dire consequences if the rule, upon being adopted, eliminated the following legal elements:

  1. The entire regulation that prohibits discrimination on the basis of race, color, national origin, sex, age or disability in health insurance issuance, coverage, cost-sharing, marketing, and benefit design

  2. Prohibitions on discrimination based on gender identity and sexual orientation in 10 other Medicaid, private insurance, and education program regulations outside Section 1557 

  3. Both a) provisions affirming the right of private individuals to challenge alleged violations of Section 1557 in court and to obtain money damages, and b) requirements for covered entities to provide non-discrimination notices and grievance procedures. People’s ability to hold their health care providers accountable is a basic element of accessible and comprehensive care

  4. Regulations on health programs and activities that do not receive federal funding

  5. Prohibitions on discrimination based on association with another person based on that person’s race, color, national origin, sex, age or disability

The Health Care Rights Law is a civil rights law that protects people from being discriminated against. Like every other civil rights law, the Department must uphold and enforce this law to its fullest extent.

Instead of putting patients first, this rule would compromise people’s existing rights against discrimination and be healthy and safe. Discriminating against some - and endangering the lives and health of all - would undermine federal law and lead to irreparable health, social and economic harms. We urge the Department to rescind this proposal and prioritize dignified care for all people.

Other ways to take action: See HERE and #PutPatientsFirst , #ProtectTransHealth, and #LanguageAccess

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1. ‘Base-building’ refers to grassroots organizers’ identification of community members to build relationships with and leadership of through engaging those community members around shared issues and interests (Community Catalyst, n.d.)