Public Comment

Section 1557 of the ACA: Public Comment

Nondiscrimination in health and health education programs or activities
October 2022

In July 2022, the U.S. Department of Health and Human Services proposed changes to its rules regarding nondiscrimination in health care. The changes clarify that under Section 1557 of the Affordable Care Act and other laws, discrimination on the basis of sexual orientation, gender identity, sex stereotyping, and sex characteristics is prohibited.

Public Comment


Section 1557 of the Affordable Care Act bans discrimination based on race, color, national origin, age, disability, or sex in federally funded health care. As proposed, this rule would make explicit that the law prohibits discrimination based on sex stereotypes, sex characteristics, sexual orientation, gender identity, and pregnancy, and would additionally bar insurers from denying or limiting access to coverage based on gender identity. The regulations would also remove broad religious exemptions added to the 2020 version of the regulation and instead follow existing federal laws permitting religious-based exceptions.


An estimated 13 million people in the U.S. ages 13+ identify as LGBT. Approximately 1.6 million of those individuals are transgender. Research shows that LGBT people often face barriers when attempting to access health care, including discrimination by health care providers and denials of coverage for gender-affirming care. In many states, LGBT people are not protected from discrimination based on their sexual orientation or gender identity in health care settings.


Scholars present extensive research detailing discrimination experienced by LGBT people when accessing health care. They also provide research on the health disparities LGBT people face compared to non-LGBT people and the negative effects of persistent stigma and discrimination on the health and well-being of LGBT people. Scholars identify some of the positive impacts the proposed rule could have and provide recommendations to ensure the maximum impact of the regulations.

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Section 1557 of the ACA: Public Comment