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The Obama administration unveiled two broad initiatives Friday aimed at combating discrimination against transgender Americans in schools and health-care coverage, affirming the president’s goal of elevating transgender protections to one of the central civil rights issues of his presidency. The moves, both of which had been in the works for years, prompted an immediate backlash from conservatives who disparaged the measures as government overreach. White House officials countered that they reflected one of the administration’s core principles: protecting those targeted for discrimination because of their identity. (Eilperin, 5/13)

Insurers and hospitals can't discriminate against patients because of their gender identity under the Affordable Care Act, federal officials said Friday, but patient groups complained the rule doesn't go far enough. The Department of Health and Human Services finalized a rule that prohibited discrimination in health care based on a long list of characteristics ranging from race to pregnancy, gender identity and "sex stereotyping." It doesn't mean insurers have to cover all treatments associated with gender transitioning but they just can't outright deny them either. But the rule doesn't go far enough in clarifying what is discrimination, some say. (O'Donnell, 5/13)

Health officials included the transgender discrimination ban in a rule implementing an Affordable Care Act provision barring health providers from discriminating by sex or race. The rule includes broad protections for transgender people, like requiring insurers to cover treatments for transgender people that they would cover for other enrollees, and allowing people to use facilities that match their gender identity. The move on health care stopped short of granting such protections to gay, lesbian and bisexual people, showing the complexity of what constitutes illegal sex discrimination. Administration officials were considering whether they could include sexual orientation in the bias rule. Health and Human Services officials said that while they had wanted to set such protections for gay people, they were uncertain about whether they could. (Barrett and Radnofsky, 5/13)

HHS could find itself facing pushback from religious hospitals seeking exemption from some of the rule's provisions, including transition-related surgeries. Others might find it difficult to comply because of costs and complications. The rule is expected to be more costly than anticipated, requiring an estimated $960 million in training and administrative costs for state and federal agencies over its first few years of implementation, the agency said. That's up from the $558 million outlined in the proposed rule. (Dickson, 5/13)