New Rule Banning Discrimination Will Promote Health Equity

No one should ever have to worry that they will be discriminated against when seeking the medical care they need. To paraphrase Dr. Martin Luther King, it is one of the “most shocking and inhumane” of injustices. Thanks to new regulations released by the Obama administration last month, the right to receive health care without discrimination is stronger than ever before.

Health justice and health equity advocates across the nation celebrated the long-awaited release of the regulations implementing Section 1557 of the Affordable Care Act. Section 1557 prohibits discrimination by health plans, health facilities, and health care programs.

The new regulations provide consumers and advocates with important tools to help reduce health care disparities and advance health equity.

New rules represent progress toward ensuring access to health care without discrimination

While this nation’s longstanding civil rights laws prohibit some forms of discrimination—such as discrimination based on race, sex, and national origin—the new rules build on these protections by applying them to health care.

The rules clarify that there are specific types of discrimination in health care that need attention, such as:

• Eliminating discrimination based on sex and gender identity
• Ensuring meaningful access for people with limited-English speaking proficiency
• Enabling equal access for people with disabilities

What entities are subject to the new requirements?

The rules apply to health insurers, health facilities, and health care programs that:

• Receive financial assistance from the U.S. Department of Health and Human Services (HHS) (including Medicare, Medicaid, federal grants, etc.)
• Are administered by HHS
• Are administered through the health insurance marketplaces

The rules apply to health insurers that participate in the health insurance marketplaces (such as healthcare.gov or a state-based marketplace), those that participate in the Medicaid or Medicare programs, and those that receive other federal funds, such as community health centers and public health programs.

Additionally, if an insurance company receives federal funds for some of its products, the rules apply to all plans and policies sold by the company. Because most health insurance companies do participate in one of the federal programs, most health plans will have to follow the new rules.

What are some of the important new provisions that protect people from discrimination in health care?

• Health insurers cannot deny, cancel, limit, or refuse to issue polices based on race, color, national origin, sex, age, or disability. They cannot market their products in a way that would lead to these types of discrimination.
• Insurers cannot design their benefit packages in a way that would discriminate. For example, they cannot have a benefit to treat eating disorders for men but not women, and they can’t decide to cover a type of surgery for all adults except those with disabilities if people with a disability would also benefit from the surgery.
• People cannot be denied health care or health coverage based on sex or gender identity. They cannot be denied medically appropriate services that the plan covers for other people due to their gender identity.
• Health plans cannot issue blanket exclusions for health care services related to gender transitions.
• People with limited English proficiency and people with disabilities have a right to communication assistance, and health care programs and insurers covered by this rule must post notices about this and include taglines in the top 15 languages spoken in the country.
• People with disabilities must be provided auxiliary aids or interpreters as needed to communicate with the health care plan.
• People with disabilities must be given equal access to health facilities and programs.

Our companion blog explains the steps people can take if they believe they’ve been a victim of discrimination.