ASCO Submits Comments on Proposed Changes that Could Impact Sexual and Gender Minorities with Cancer

August 15, 2019

On August 9, ASCO submitted a comment letter to Alex M. Azar II, Secretary of Health and Human Services (HHS), regarding the proposed rule on Sec. 1557 of the Affordable Care Act (ACA)—Nondiscrimination in Health and Health Education Programs or Activities.

ASCO’s comments specifically focused on the proposed change to remove “gender identity” from the defined discrimination categories covered by “on the basis of sex,” which would directly impact the care of sexual and gender minorities (SGM), including individuals who are lesbian, gay, bisexual, transgender, and intersex.

The Society is concerned that implementing the proposed rule would substantially curtail the rights and protections of SGM patients and reduce the anti-discrimination requirements on health insurers and medical providers. The new limited definitions and scope described in proposed interpretation of Section 1557 could inhibit access to equitable cancer care and adequate insurance coverage.

The SGM population bears a disproportionate cancer burden. The disparities in cancer outcomes stem from the unique cancer risks, needs, and challenges, including discrimination and gaps in quality of care. This population exhibits low uptake rates of cancer screening and therefore may present with late-stage disease. Additionally, due to fear of discrimination and stigmatization, SGM populations often do not disclose their sexual orientation to health care providers, which may create additional barriers to high-quality care. Further, transgender individuals already experience limitations in insurance coverage for transition-related care and cancer screening, given that the individual’s anatomy may not be compatible with the gender listed in his or her policy.

ASCO is committed to addressing the needs of SGM populations as a diverse group at risk for receiving disparate care and having suboptimal experiences, including discrimination, throughout the cancer care continuum.

In April 2017, ASCO issued a position statement that contained recommendations for reducing cancer health disparities among SGM populations. The recommendations were designed to focus attention on the challenges facing the SGM community—including discrimination and greater risk of anxiety and depression, resulting in disparate care—and concrete steps that can help minimize health disparities among SGM individuals.

Read the full comment letter.

Watch a video that summarizes ASCO’s position statement recommendations for reducing cancer health disparities among SGM populations.