Center for American Progress

Updated Section 1557 of the Affordable Care Act Codifies Critical Protections for Marginalized Communities

Updated Section 1557 of the Affordable Care Act Codifies Critical Protections for Marginalized Communities

The landmark rule to update Section 1557 of the Affordable Care Act is a critical step forward for health equity.

People walk past a New York City hospital.
People walk past a New York City hospital covered in Pride colors on June 23, 2021. (Getty/Alexi Rosenfeld)

On April 26, 2024, the U.S. Department of Health and Human Services (HHS) finalized a landmark rule updating Section 1557 of the Affordable Care Act, which prohibits federally funded health programs and services from discriminating on the basis of race, color, national origin, age, disability, or sex. The new rule codifies nondiscrimination protections for LGBTQI+ people accessing health programs or activities that receive federal funds. Furthermore, it strengthens protections for other marginalized communities—including women, pregnant people, disabled people, people born outside of the United States, and those who don’t speak English as their primary language.

The rule was proposed by HHS in 2022, in part to update health care nondiscrimination protections to reflect the decision in Bostock v. Clayton County, which confirmed that LGBTQI+ people should be protected from discrimination. The proposed rule underwent an extensive public comment and review period. Now, nearly two years later, the rule has been finalized, and it will go into effect 60 days after publication.

Background on Bostock v. Clayton County

In June 2020, the U.S. Supreme Court released its decision in Bostock v. Clayton County, which combined three cases argued before the court concerning whether Title VII of the Civil Rights Act of 1964 extends its nondiscrimination protections to include a prohibition on discrimination based on sexual orientation and gender identity. Ultimately, the Supreme Court determined that it is “impossible to discriminate against a person for being homosexual or transgender without discriminating against that individual based on sex.” This decision meant that federal laws, such as Title VII, that prohibit discrimination based on sex also prohibit discrimination based on sexual orientation and gender identity. The ruling confirmed that the LGBTQI+ community is protected from discrimination anywhere discrimination based on sex is prohibited.

Not only do these updates strengthen people’s nondiscrimination protections when interacting with medical providers and facilities but also when seeking or using health care coverage. At a time when access to medical care and bodily autonomy is under attack, these updated protections are crucial.

Learn more about health care discrimination in the LGBTQI+ community

Who will be covered by these updated nondiscrimination protections?

The newly codified protections in 1557 apply to any health care program, service, or activity that receives federal funding. This means that those who see a provider who is under a Medicare agreement, seek care at a federally funded health care center, or use federally funded health insurance are all protected against health care discrimination. These protections are far-reaching:

  • Roughly 99 percent of all nonpediatric physicians and nearly all hospitals in the United States accept Medicare and bill services under Medicare participation agreements.
  • Approximately 1,400 health centers—with more than 15,000 service delivery sites across all 50 states, U.S. territories, and the District of Columbia—are funded by the federal Health Resources and Services Administration (HRSA) Health Center Program, providing care to approximately 30.5 million people.
  • In 2022, roughly 127 million people, or 38.5 percent of Americans, were covered by federally funded health insurance, such as TRICARE and Medicaid.

These protections are groundbreaking: Nearly all Americans will now be better protected from health care discrimination. This isn’t just a win for LGBTQI+ communities; it’s a win for anyone seeking health care.

What does the 1557 rule provide in addition to nondiscrimination protections?

Beyond nondiscrimination protections, the newly finalized rule will require covered entities to inform patients of the availability of language assistance services. These notices must be provided in English along with at least 15 other languages most commonly used in a respective service area. Providers will be required to give these notices and extend nondiscrimination protections even to patients seeking care remotely through telehealth.

Additionally, the final rule addresses the use of algorithms and other technology in clinical decision-making, banning discrimination against marginalized communities that might result from the use of patient tools. This includes tools that use generative artificial intelligence (AI).


The landmark rule to update Section 1557 of the Affordable Care Act is a critical step forward for health equity. Nearly everyone in the United States—including those in the LGBTQI+ community—now have better access to health care that is free from discrimination.

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Cait Smith

Director, LGBTQI+ Policy


LGBTQI+ Policy

The LGBTQI+ Policy team provides timely, strategic resources on policy issues affecting LGBTQI+ communities.

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