Take action to prevent LGBTQ+ discrimination in healthcare!

All people who need medical care should be able to see their doctor without worrying about being mistreated, bullied, or denied care—and you can take action now to help ensure that that happens!  The Biden Administration recently released a proposed rule to update Section 1557 of the Affordable Care Act (ACA) to strengthen LGBTQ+ nondiscrimination protections in healthcare. Read below to learn more about this proposed rule and how you can take action to ensure it is finalized!

Do you have a story about a time where you experienced anti-LGBTQ+ discrimination in healthcare and would like to tell your story? Add your voice to this important issue here.

While much progress toward LGBTQ+ equality has been made in recent decades, LGBTQ+ people still face widespread discrimination, including discrimination in healthcare. Currently, 21 states and 5 territories still have no explicit nondiscrimination protections for LGBTQ+ people in public accommodations, including doctor’s offices.[1] Furthermore, only 42% of LGBTQ+ Americans live in states with health insurance nondiscrimination protections that include sexual orientation and gender identity. Discrimination in healthcare settings endangers LGBTQ+ people’s well-being. For example, 15% of LGBTQ+ Americans report postponing or avoiding medical treatment due to fear of discrimination, while 1 in 3 trans individuals needed to educate providers in order to receive adequate and affirming care.[2]  This is especially concerning given the recent surge of anti-trans legislation, making it even easier for providers and medical administrators to refuse care to LGBTQ+ patients.[3]

About the proposed rule for Section 1557

Section 1557 is the nondiscrimination provision of the ACA, and it prohibits federally funded healthcare programs or facilities from discriminating based on race, color, national, origin, sex, age, or disability. The Obama Administration finalized a rule guiding implementation of Section 1557, stating that the sex discrimination protections outlined in Section 1557 include discrimination based on gender identity and sex stereotyping. This was a critical step forward in protecting LGBTQ+ people in healthcare.

In response to Obama’s Section 1557 rule, a group of religiously affiliated healthcare providers hoping to block the rule filed a lawsuit called Franciscan Alliance v. Azar. The Trump Administration sided with the plaintiffs and decided to release its own Section 1557 rule, which was finalized in June 2020. Trump’s Section 1557 rule removed the gender identity and sex stereotyping protections put in place by Obama. The new Section 1557 rule also removed existing sexual orientation and gender identity protections from ten other healthcare regulations governing Medicaid programs, the PACE program, insurance marketplace enrollment, and education programs receiving federal assistance. Trump’s rule also removed provisions that prohibited health insurance plans from discriminating against transgender people.[4] These drastic changes to the Section 1557 undermined and reversed the progress made to protect LGBTQ+ people in healthcare, once again leaving LGBTQ+ patients vulnerable to discriminatory treatment and outright refusal of care.

The Biden Administration has been taking steps to reverse harms caused to the LGBTQ+ community. On August 4, the Biden Administration released its own Section 1557 rule to clarify and enhance protections for LGBTQ+ people in healthcare. Some of the much needed updates to the 1557 rule include explicit non-discrimination protections based sexual orientation and gender identity. Biden’s Section 1557 proposed rule also adds nondiscrimination protections on the basis of sex characteristics, offering protections for intersex individuals. The new proposed rule reinstates protections in CMS programs that were removed by the Trump Administration, and it also now adds nondiscrimination protections when using telehealth. Importantly, the new proposed rule specifically says that healthcare programs may not deny or limit services for gender affirmation if those services are provided for other purposes.  

You can take action to ensure that this proposed rule is finalized and that LGBTQ+ people are protected in healthcare!

• You can review the full proposed 1557 rule here. The proposed rule is now open for public comments! Do you have a story about a time where you experienced anti-LGBTQ+ discrimination in healthcare and would like to tell your story? You can add your voice to this important issue here.
• Continue to report any discrimination you experience in healthcare to the Health and Human Services Office of Civil Rights here.

1. lgbtmap.org/equality-maps/non_discrimination_laws/public-accommodations
2. americanprogress.org/article/state-lgbtq-community-2020/
3. lgbtmap.org/file/Healthcare-Religious-Exemptions.pdf
4. kff.org/racial-equity-and-health-policy/issue-brief/the-trump-administrations-final-rule-on-section-1557-non-discrimination-regulations-under-the-aca-and-current-status/