BILL ANALYSIS
AB 1586
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ASSEMBLY THIRD READING
AB 1586 (Koretz)
As Introduced February 22, 2005
Majority vote
HEALTH 8-2
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|Ayes:|Chan, Berg, Cohn, De La |
| |Torre, Jones, Montanez, |
| |Negrete McLeod, |
| |Ridley-Thomas |
| | |
|-----+--------------------------|
|Nays:|Aghazarian, Strickland |
| | |
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SUMMARY : Defines the term "sex" to include, but be not limited
to, a person's gender, as specified, under existing law that
prohibits health care service plans (health plans) and insurers
from specified discriminatory acts.
EXISTING LAW :
1)Defines "gender" to mean sex, and includes a person's gender
identity and gender related appearance and behavior whether or
not stereotypically associated with the person's assigned sex at
birth.
2)Requires health plans to cover a number of basic health care
services and permits the Department of Managed Health Care to
define the scope of the services and to exempt plans from the
requirement for good cause.
3)Prohibits health plans from refusing to enter into any contract
or canceling or declining to renew or reinstate any contract
because of the race, color, national origin, ancestry, religion,
sex, marital status, sexual orientation, or age of any
contracting party, prospective contracting party, or person
reasonably expected to benefit from that contract as a
subscriber, enrollee, member, or otherwise.
4)Prohibits the terms of any health plan contract from being
modified, and the benefits or coverage of any contract from
being subject to any limitations, exceptions, exclusions,
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reductions, copayments, coinsurance, deductibles, reservations,
or premium, price, or charge differentials, or other
modifications because of the race, color, national origin,
ancestry, religion, sex, marital status, sexual orientation, or
age of any contracting party, potential contracting party, or
person reasonably expected to benefit from that contract as a
subscriber, enrollee, member, or otherwise. Exempts premium,
price, or charge differentials because of the sex or age of any
individual when it is based on objective, valid, and up-to-date
statistical and actuarial data. Prohibits health plans from
charging different premium rates to individual enrollees within
the same group solely on the basis of the enrollee's sex.
5)Prohibits insurers from failing or refusing to accept an
application for, or issuing a policy to an applicant for, health
insurance (unless such insurance is to be issued to the
applicant by another insurer under the same management and
control), or canceling such insurance, under conditions less
favorable to the insured than in other comparable cases, except
for reasons applicable alike to persons of every marital status,
sex, race, color, religion, national origin, or ancestry.
Prohibits sex, race, color, religion, national origin, or
ancestry of itself from constituting a condition or risk for
which a higher rate, premium, or charge may be required of the
insured for such insurance.
FISCAL EFFECT : None
COMMENTS : According to the Gay and Lesbian Alliance Against
Defamation (GLAAD) "transgender" is an umbrella term for people
whose gender identity and/or gender expression differs from the
sex they were assigned at birth. Transgender people can be
female-to-male (FTM) or male-to-female (MTF) and may or may not
choose to alter their bodies hormonally and/or surgically.
According to the Transgender Law Center, transition-related health
care and services can include blood work, hormones, mental health
therapy, and gender confirmation surgery. In 2002, the
Transgender Law Center and the National Center for Lesbian Rights
released a report titled "Trans Realities: A Legal Needs
Assessment of San Francisco's Transgender Communities," which
stated that 93% of the transgender people surveyed have utilized
medical services as a part of their transition. The study also
found that transgender people in the San Francisco Bay Area face
significant barriers to accessing transition-related health care
and often experience discrimination in accessing other forms of
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health care. Nearly one in three respondents experienced some
form of health care-related gender identity discrimination,
including routine denial of coverage by health insurers for
transition-related procedures, and discriminatory or inappropriate
behavior by health care providers and staff.
In 1999, the Transgender Community Health Project, which is part
of the Center for HIV Information at the University of California,
San Francisco, published a report based on a survey they
administered to transgender persons in collaboration with a number
or entities, including public health clinics, the San Francisco
Department of Public Health, and HIV/AIDS groups. The report
indicated that transgender individuals face complex social,
physical and mental health, and substance use issues. Drug use
was common among interviewees, as was mental health intervention
(i.e., hospitalization and/or medication). The researchers found
that 52% of MTF and 57% of FTM subjects were uninsured. Thirteen
percent of MTF and 39% of FTM interviewees reported being denied
or having difficulties obtaining health care.
According to the author, transgender applicants have been denied
individual policies because they have a previous diagnosis of
gender dysphoria. The author reports that in one case, a
transgender FTM person in his mid-30s applied for an individual
policy with a major California health insurer for catastrophic
coverage with a $2,000 deductible. The insurer sent a denial
letter on July 30, 2002, stating they were unable to offer
"enrollment in any of our medically underwritten health insurance
plans." The reason cited was a health history of "gender identity
disorder of adolescent or ADU treated with testosterone." The
policy applied for already excluded coverage for any treatment
related to gender identity disorder, including hormones.
Previous legislation: AB 1999 (Kuehl), Chapter 933, Statutes of
1998, defines "gender" in the Penal Code as this bill proposes to
do in the Health and Safety and Insurance Codes, AB 537 (Kuehl),
Chapter 587, Statutes of 1999, did so in the Education Code, and
AB 196 (Leno), Chapter 164, Statutes of 2003, amends the
California Fair Employment and Housing Act to refer to the
definition of "gender" established in the Penal Code under AB
1999.
Analysis Prepared by : Melanie Moreno / HEALTH / (916)
319-209FN: 0010135
AB 1586
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