Equal access to Obamacare for all Americans – includinglesbians, gays, bisexuals and transgenders.

It's a tall order, but ensuring it happens is now part of themission at the U.S. Health and Human Services Office for CivilRights. The agency is a nearly $40 million operation thathistorically has investigated discrimination charges againsthospitals and other providers in cases that typically involved thedisabled or minorities.

By year's end, if not before, the OCR will detail just how itplans to go about doing its new job of helping LGBT Americans gainequal access to the benefits outlined in the Patient Protection andAffordable Care Act.

Once it does, one of the more important battles in the fight forLGBT rights in the United States will have been won, at least onpaper.

“Significantly, this is the first time that sex discriminationin health care is prohibited by a national civil rights law,” HHSnoted in its budget paperwork in early April.

PPACA is unequivocal on this point, promising health careregardless of race, color, national origin, disability, age orgender.

“Health is an LGBT equality issue,” said Kellan Baker, associatedirector for LGBT research and communications at the Center forAmerican Progress. “If we don't have our health, we don't haveanything. I would say that the ACA and the changes at HHS are someof the most significant opportunities for LGBT equality that wehave seen in a long time.”

Hashing out just how to make it all work will be top of mind forthe OCR in coming months. There will be a series of “listeningsessions” before the final rules are crafted.

Equal rights are of keen interest to many Americans, but amongthose “listening” most intently are those in the LGBT community.Employers, insurers and the benefits community at large are payingclose attention, too.

As advocates will point out, 51% of small business offer coverage tosame-sex partners of employees, and more than 60% of Fortune 500 companies do thesame. The PPACA promotes the expansion of these practices andauthorizes the coming insurance exchanges to offer coverage thatincludes same-sex couples and their children.

The health system's problems can be especially pronounced in theLGBT community, advocates say, and discrimination that's based onreal or perceived sexual orientation or gender identity iscommonplace.

Access to health care services, including preventive care suchas cancer screenings, are a huge part of the problem.

According to a 2011 report from the Center for AmericanProgress, gay men and lesbians experience elevated rates of certaincancers, including breast cancer, melanoma, and non-Hodgkin'slymphoma, because of the difficulty they have in accessing healthcare. Also, lesbian and bisexual women are at greater risk thanheterosexual women for chronic diseases linked to smoking andobesity.

The Center for American Progress is a left-leaning group,leaving it open to attack by skeptics. But its statistics about thehealth of the LGBT community are viewed as reliable as anyoneelse's, albeit incomplete.

The problem with LGBT health statistics in general is that,while there are more than 9 million Americans who identify as LGBT,federal and state governments have not routinely collected data onpeople's sexual orientation or gender identity.

That started to change in January of this year, when the federalgovernment began to collect sexual orientation on its mostimportant health assessment tool, the National Health InterviewSurvey. But there's a long way to go before enough of this data iscollected, and doing so won't be easy.

Based on the numbers that are available, the National Academy ofSciences, in a report released in 2011, agreed that gay andtransgender people often face “barriers to equitable health care”and receive substandard care when they seek it.

“Fearing discrimination and prejudice,” it said, “many lesbian,gay, bisexual and transgender people refrain from disclosing theirsexual orientation or gender identity to researchers and healthcare providers.”

In part, that's because as states finalize the details ofbenefit plans and packages expected to be sold on the cominginsurance exchanges, or marketplaces, the question is just how muchvariation might be seen between plans.

One big variable already identified clearly: While many of thosewith HIV live in the nearly 30 states that have either alreadyopted for Medicaid expansion under PPACA or are in the process ofdoing so, there are many more who live in states still sitting onthe sidelines.

And then there's the concern shared by all – whether theexchanges will be up and running in October.

“That's not a long time from now and we're talking aboutmillions of people who will need help figuring out how to enrollthemselves and their families. It's a real complicated challenge,”Baker said.

It's a sentiment that helps explains another concern runningthrough Baker's head:

“We really are looking forward to seeing some strongimplementation of Section 1557 of the law.”

This article was originally posted at BenefitsPro.com, a sister site of CreditUnion Times.