People with disabilities often face stigma and discrimination in health care settings and services. Additionally, they face barriers when it comes to accessing affordable and quality health care – with discriminatory practices such as inaccessible facilities and equipment, failure to provide interpreters or auxiliary aids, and discriminatory benefit designs that exclude people with disabilities from coverage, forcing them to pay much higher costs, or unnecessarily restricts services to segregated settings instead of providing them in the community. Section 1557 protects against disability discrimination in health care more broadly than just insurance, ensuring that a wide array of health care entities provide non-discriminatory coverage and care. This blog, adapted from our Section 1557 Q&A issue brief, explores some of the ways people with disabilities experience discrimination in health care settings, and provides advocates information on how the proposed changes to Section 1557 would help ameliorate those inequities.
The 2022 Proposed Rule promotes equal access to health care by addressing effective communication; physical accessibility;benefit design; treatment of companions to people with disabilities and companions with disabilities; the right to receive services in integrated, community settings; and the use of clinical algorithms resulting in biased decisions.
The 2022 Proposed Rule includes three clarifications of particular significance to people with disabilities:
First, the proposed rule establishes clear standards for Section 1557 procedures, including standards for requesting effective communication and reasonable modifications, and how people can file a complaint about discrimination.
Second, it recognizes that Section 1557 prohibits discriminatory benefit design, including that covered entities are obligated under Section 1557, like they are under other nondiscrimination provisions, to provide services in the most integrated setting appropriate to the needs of individuals with disabilities.
And third, the 2022 Proposed Rule addresses the role of technology in providing equitable care, and includes protections regarding access in telehealth services and health related information and communication technology, including mobile apps. While the 2022 Proposed Rule should be strengthened to ensure it provides qualified communication access and access to technology, and to ensure it prevents discrimination through the use of algorithms, the proposed rule includes important protections for people with disabilities.
The Biden Administration has proposed changes that would strengthen Sec. 1557 protections and is accepting public comments through October 3, 2022.
Here are some additional resources that might be useful:
- Questions and Answers on the 2022 Proposed Rule Addressing Nondiscrimination Protections under the ACA’s Section 1557, our overview of the ways Section 1557 impacts various individuals, especially those who live at the intersection of multiple identities.
- Blog: What is Section 1557? An Introduction
- Blog: How the Proposed Changes to Section 1557 Affect Individuals with Limited English proficiency (LEP)
- Blog: How Changes to Section 1557 will Improve Health Care for LGBTQI+ People
- Blog: How Changes to Section 1557 will Impact Health Care for People with Disabilities
- Blog: How the Proposed Section 1557 Rule Addresses Discrimination Based on Sex Stereotypes
- Blog: How Proposed Changes to Section 1557 Strengthen Protections Related to Pregnancy or Related Conditions, Including Abortion.
