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Act Now to Protect Non-Discrimination Protections Under ACA Section 1557 



The Affordable Care Act’s Section 1557 prohibits discrimination based on race, color, national origin, sex, age and disability in health care programs. The law was the first to prohibit discrimination in health care based on sex. The regulations guiding Section 1557’s non-discrimination protections defined sex to include gender identity and sex stereotyping providing important protections for health care access for LGBTQ individuals. The U.S. Department of Health and Human Services is proposing significant revisions to the regulations implementing the non-discrimination protections that would affect LGBTQ people and people with HIV including by:

  • Eliminating the prohibition of discrimination based on gender identity and health insurance coverage protections for transgender individuals;
  • Eliminating prohibitions of nondiscriminatory benefit design that protect people with HIV or LGBTQ individuals;
  • Rolling back protections allowing individuals with limited English proficiency access to interpretation and translation services; and
  • Limiting the reach of the protections to only specific programs that receive federal funding and not applying the regulations to all programs administered by HHS.

HHS also proposes eliminating gender identity and sexual orientation protections from 10 other regulations related to Medicaid, private insurance, and education programs. If finalized, the changes proposed in the HHS rule would have significant harmful impacts on access to prevention and care services for women, people of color, LGBTQ individuals and those with HIV. The Kaiser Family Foundation’s Issue Brief HHS’s Proposed Changes to Non-Discrimination Regulations Under ACA Section 1557 offers a summary and analysis of the proposed rule.


Take Action:

The proposed rule to significantly narrow the scope of the non-discrimination provision of the ACA is open for comment until August 13, 2019 at 11:59 pm ET. Please consider weighing in to urge HHS to preserve protections that prohibit discrimination in health care based on race, color, national origin, sex, age, or disability.

Below are template comments. Please modify to reflect your experience caring for patients with HIV and LGBTQ patients. Email HIVMA Senior Policy and Advocacy Manager George Fistonich, with questions

To submit your comments, copy, cut and paste into this form.


Template Comments:

Re:  Section 1557 NPRM, RIN 0945-AA11

To Whom It May Concern:

I am an HIV clinician and am writing to share my concerns regarding the proposed rule on revisions to the Nondiscrimination in Health and Health Education Programs or Activities, Section 1557 of the ACA.

The ACA’s non-discrimination protections, Section 1557, are important to ensure that my patients with HIV and transgender patients can access necessary health care without discrimination. Without the protections guaranteed in the regulations, my patients could be denied care and treatment by other health care providers and by insurers, putting their health at risk and potentially having adverse consequences for the public health of their community. 

In February of this year, President Trump announced his administration’s goal to end the HIV epidemic in the United States within 10 years. The non-discrimination provisions of the ACA that help ensure people with HIV and transgender individuals can access care and treatment are critical to achieving the goals of the Ending the HIV Epidemic initiative. The initiative’s key strategies, including the expansion of Pre-Exposure Prophylaxis (PrEP) for people at higher risk for HIV and significantly increasing the number of people living with HIV who are in care and virally suppressed, will be compromised if this rule takes effect. Stigma and discrimination remain two of the biggest challenges to our national HIV response and without these non-discrimination protections, providers will be able to deny care to people with HIV or LGBTQ individuals while health insurers once again will be able to vary benefits in ways that discriminate against them and other vulnerable populations.   

I strongly urge you to consider how the proposed rule will negatively impact access to HIV prevention, care and treatment services for some of the populations at greatest risk for HIV and who are living with HIV. Please withdraw the proposed rule (Section 1557 NPRM, RIN 0945-AA11) that would rollback protections important to preventing discrimination in health care. Please feel free to contact me with questions regarding my comments.



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