Know your rights: Anti-discrimination protections in the ACA

UPDATE: President Biden has opened the enrollment period for the Affordable Care Act health insurance plans for 2022. You can now enroll in one of these plans until January 15, 2022, at healthcare.gov. Some states have their own open enrollment periods and websites for signing up. Check to see if your state does. We also have more information about how to get insurance and learn what kinds of plans to watch out for.

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Imagine paying more for health insurance just because you’re a woman. Or dealing with hostile doctors who refuse to use your preferred gender pronoun. The final rule on Section 1557 of the Affordable Care Act (ACA), which went into effect this summer, is designed to put a stop to these and many other forms of discrimination in the health care system. Maybe “Section 1557” doesn’t have the catchiest name, but it accomplishes some badass stuff.

What’s Section 1557 all about?

Section 1557 of the ACA is a federal law that protects you from discrimination on the basis of race, color, national origin, age, disability, and sex. That includes protections for people who have been pregnant, who have limited English proficiency, or who don’t conform to traditional gender identities.

Section 1557 applies to all programs that receive federal funding, including a lot of clinics, hospitals, insurance programs, all of Medicare and Medicaid, and more. It prohibits:

Discrimination on the basis of gender. Before, it was legal for a woman to be charged 1.5 times the rate a guy of the same age paid for insurance. Also, pregnancy was considered a ‘pre-existing condition,’ meaning some insurance companies could refuse to sell you insurance if you were pregnant. (Whaaa…?) Now all of that is illegal. Section 1557 and other parts of the ACA protect you from discrimination based on gender, pregnancy and pregnancy-related conditions, or marital status.

Discrimination on the basis of gender identity. Back in 2010, a study found that 28% of transgender and gender non-conforming folks had been harassed in a medical setting, and 19% had been denied care on the basis of their identity. Under the ACA, harassment is illegal and folks who transition from the gender they were assigned at birth cannot be denied medically necessary procedures. For example, someone who transitions from female to male cannot be denied ovarian cancer screening if it is deemed medically necessary. And while the new rule doesn’t require that insurance companies cover treatments for gender transitions, it also disallows them from saying “Nope, we won’t cover any medical services relating to gender transition.” Sound confusing? Here’s how the Human Rights Campaign explains it.

Discrimination on the basis of sexual orientation. While the law doesn’t specifically mention sexual orientation, its prohibition of sex-based discrimination includes a ban on ‘sex-stereotyping’. That means you can’t be treated differently because you don’t conform to stereotypical expressions of masculinity and femininity, which includes sexual orientation. Here’s an in-depth look at LGBT protections in Section 1557 of the ACA.

Discrimination on the basis of ability. Before the ACA, insurance companies could say “Nah, we won’t cover you because of your disability” or “We’ll cover you, but won’t help pay for health care related to your disability.” It made buying insurance really hard for some folks with disabilities. Now, most insurance plans need to offer you coverage for your disability. Section 1557 goes further—if your disability means that you and your provider can’t communicate effectively, they need give you some options, like the use of a sign-language interpreter. The Department of Health and Human Services (HHS) breaks down Section 1557’s communications protections here, and you can find more information about health care for people with disabilities on HealthCare.gov.

Discrimination on the basis of limited English proficiency. The law makes sure people with limited ability to read, write, or speak English have “meaningful access” to health services. In many cases that will mean making written or oral translation available—and “using low-quality video remote interpreting services or relying on unqualified staff, translators when providing language assistance services” won’t cut it. Health care providers are also required to post a notice that explains the individual rights and communication services they offer for people with limited English proficiency.

Sweet. So how’s this all gonna’ happen?

Making rules is one thing—enforcing them is another. So how will the government make sure the rules laid out in Section 1557 are followed?

Complaints of discrimination filed by individuals are a big way that this law is enforced, so if you believe you have been discriminated against, it’s important to speak up about it. You can file a complaint with the Office of Civil Rights (OCR) at HHS—they have an online portal that walks you through the complaint, question by question.

There have already been several successful investigations and resolutions where the OCR was able to help people fight discrimination. For example, a male-to-female trans woman in Colorado was denied mammogram coverage by a local clinic. When she filed a claim with the OCR, they investigated her case, traced her clinic’s funding to the Center for Disease Control (CDC), and changed the CDC’s grant-making policy to include coverage of mammograms for male-to-female trans women who had taken or were taking hormones. Just goes to show that filing a complaint may do more than resolve your own issue—your claim may have a ripple effect that helps others get better access to health care too. Win-win!

If you want to talk through an incident with someone before you file a complaint, or if you’d like assistance filing, you can contact the National Women’s Law Center at (202) 588-5180 or info@nwlc.org, the Transgender Law Center via their Get Help page, or the OCR via their toll-free help line (800) 368-1019 or (800) 537-7697 (TDD).