HHS takes next step in advancing health equity through the Affordable Care Act

Proposed rule implements new protections against sex discrimination; enhances language assistance; protects individuals with disabilities; and extends to insurers participating in Health Insurance Marketplaces

Earlier this month, the Department of Health and Human Services (HHS), Office for Civil Rights (OCR), issued a proposed rule to advance health equity and reduce disparities in health care.  The proposed rule, Nondiscrimination in Health Programs and Activities, will assist some of the populations that have been most vulnerable to discrimination and will help provide those populations equal access to health care and health coverage.  We are distributing this notice widely to ensure we receive public comment from all interested stakeholders during the comment period, which is open until November 9, 2015. 

Section 1557 of the Affordable Care Act (ACA) extended civil rights protections banning sex discrimination, including gender identity, to health programs and activities.  Previously, civil rights laws enforced by OCR barred discrimination based only on race, color, national origin, disability, or age. The proposed rule also extends all civil rights obligations to the Health Insurance Marketplaces (including all plans of issuers participating in the Marketplace) and all health programs and activities funded or operated by HHS, and clarifies the standards HHS applies in implementing Section 1557 across all bases of discrimination.

The proposed rule includes a number of new protections. Among them:

• Women must be treated equally with men in the health care they receive.  Other provisions of the ACA bar certain types of sex discrimination in insurance, for example by prohibiting women from being charged more than men for coverage.  Under Section 1557, women are protected from discrimination not only in the health coverage they obtain but in the health services they seek from providers. 

• Individuals may not be subject to discrimination based on gender identity. For example, some insurance policies have historically contained categorical exclusions on coverage of all care related to gender transition.  Those categorical exclusions are prohibited under the proposed rule.  Individuals must also be treated consistent with their gender identity, including in access to facilities.

• The rule bolsters language assistance for people with limited English proficiency, so that individuals are able to communicate more effectively with their health care providers to, for example, describe their symptoms and understand the treatment they have been prescribed.  The proposed rule provides clear guidance on the requirements of the law with regard to provision of language services, such as oral interpreters and written translations. 

• For individuals with disabilities, the rule contains requirements for the provision of auxiliary aids and services, including alternative formats and sign language interpreters, and the accessibility of programs offered through electronic and information technology.   

The proposed rule requests comments in a number of areas including whether the final rule should extend to non-discrimination on the basis of sexual orientation and whether it should include an exemption for religious organizations and what the scope of any such exemption should be.  Nothing in the proposed rule would affect the application of existing protections for religious beliefs and practices, such as provider conscience laws and the regulations issued under the ACA related to preventive health services.

The proposed rule is on OCR’s website, along with a fact sheet and Frequently Asked Questions that are translated into 15 languages: www.hhs.gov/ocr/civilrights/understanding/section1557/index.html.

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