September 23, 2019

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Prohibiting Discrimination in Health Care Coverage with the ACA

11/10/2015

Everyone’s heard about the Affordable Care Act (ACA) and how it has improved access to equitable health care. But did you know that the same law also contains a powerful tool to combat discrimination?


Section 1557 of the ACA prohibits discrimination in health care coverage and care based on race, color, national origin, sex, age, or disability in a range of health programs. The federal Department of Health & Human Services (HHS) has requested comments on its proposed new federal regulations, and Legal Voice was proud to join with its sister organizations in The Alliance: State Advocates for Women’s Rights & Gender Equality in filing these comments.


A key reason the ACA is such a game-changer is its promise to end discriminatory practices that affect women’s access to comprehensive health care. The required coverage of a range of women’s preventive care services, for example, ensures that carriers don’t exclude services that most women need and, without insurance, often could not afford.


We applaud HHS’s clarifications that further the ACA’s nondiscrimination provisions, such as:

  • Including broad definitions of what health programs and activities are covered, so that, for example, if a health insurer has plans on the Exchange or receives Medicare Part D payments for any of its plans, then all of the plans it sells are covered by Section 1557;
     

  • Ensuring that sex discrimination includes discrimination on the basis of pregnancy, false pregnancy, termination of pregnancy or recovery therefrom, childbirth or related medical conditions, sex stereotyping, or gender identity. It may seem self-evident that all of these categories are based on sex, but many of these interpretations were secured only after long battles in the courts.

We’ve also asked HHS to avoid exclusions—such as religious exemptions and the employment discrimination exemption—that minimize the reach of the ACA’s civil rights protections. And while we commend HHS for including strong and clear statements that discrimination based on gender identity, gender expression, gender transition, or transgender status is sex discrimination, the rule is less clear that discrimination based on sexual orientation is also prohibited. Numerous courts have recognized that sexual orientation discrimination is also prohibited, because it is based on sex stereotyping, so we have urged HHS to clarify this in the final rule.

 

The ACA was a critical step in ensuring all persons, regardless of their gender, can access the protections that everyone deserves. Rest assured that we will keep speaking up at each step of the way to make sure that these protections are not diluted.
 

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- Read comments from The Alliance

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