"On behalf of organizations dedicated to promoting access to comprehensive, high-quality health care for patients nationwide, we write in strong opposition to the proposed prohibition on coverage of evidence-based treatment of gender dysphoria (referred to in the proposal as “sex-trait modification”) as an essential health benefit (EHB) advanced in the Centers for Medicare and Medicaid Services (CMS) “Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability” Proposed Rule. This provision creates a dangerous precedent by excluding coverage for medically necessary health care from the EHB package for individual and small-group market health insurance plans without justification. An unjustified coverage exclusion of this nature represents an inappropriate intrusion into the practice of evidence-based health care and discriminates against patients simply because they are transgender."