Section 1557

Sec. 1557 of the Affordable Care Act provides important protections against discrimination in health care programs and activities based on race, color, national origin (including limited English proficiency and primary language), sex (including pregnancy status and related conditions, sexual orientation, gender identity, sex stereotypes, and sex characteristics, including intersex traits), age, and disability.

The National Health Law Program helped craft Sec. 1557 as part of our work on the Affordable Care Act and we have continued to work to effectively implement and enforce it since it was enacted. It is a crucial provision that prohibits discrimination in health programs and activities receiving federal financial assistance, health programs and activities administered by federal agencies, and ACA health insurance marketplaces and issuers that participate.

The Biden Administration’s final rule aimed at strengthening Sec. 1557 protections is expected this spring. We will provide analysis of the new rule once it is announced.

1557 Resources and Analysis

March 19, 2024
Medicaid and CHIP Reimbursement Models for Language Services: 2024 Update
Mara Youdelman
Access to language services, such as oral interpreting or written translation services, is critical to enhancing patients’ understanding of…
October 3, 2022
NHeLP Comments on Section 1557 Proposed Rule
Mara Youdelman, Wayne Turner, Elizabeth Edwards, Madeline Morcelle, Abigail Coursolle, Charly Gilfoil, Jennifer Lav, Skyler Rosellini, Alicia Emanuel, Cat Duffy, Catherine McKee, Fabiola Carrión, David Machledt, Héctor Hernández-Delgado, Dania Douglas, and Carly Myers
NHeLP submitted comments on the Department of Health and Human Services' Notice of Proposed Rulemaking to implement Section 1557…
August 15, 2022
Questions and Answers on the 2022 Proposed Rule Addressing Nondiscrimination Protections under the ACA’s Section 1557
Mara Youdelman, Wayne Turner, Abigail Coursolle, Elizabeth Edwards, Jennifer Lav, and Madeline Morcelle
In courts and through regulatory action, the Biden-Harris administration is vigorously working to address health equity. This includes strengthening…
November 2, 2021
Amicus brief from National Health Law Program in CVS v. Doe
Elizabeth Edwards and Wayne Turner
In CVS v. Doe, individuals living with HIV challenge a decision by their health insurers to require access to…
June 19, 2020
HHS Eliminates or Weakens Regulatory Protections Against Discrimination in Health Care
Wayne Turner, Mara Youdelman, and Madeline Morcelle
As part of its ongoing attacks on health care and civil rights, the Trump administration recently finalized drastic changes…
August 13, 2019
NHeLP comments on proposed rulemaking for Section 1557 – Nondiscrimination in Health and Health Education Programs or Activities
Wayne Turner, Jennifer Lav, and Mara Youdelman
Section 1557 of the Affordable Care Act provides important protections against discrimination in health care programs and activities based…
July 11, 2019
The Trump Administration’s Proposed Changes to Language Access in the Section 1557 Regulations
Mara Youdelman
Featuring presenters from the National Health Law Program and the Asian & Pacific Islander American Health Forum, this webinar…
June 12, 2019
Webinar: Trump’s Proposed Rollback of the ACA’s Nondiscrimination Protections
Candace Gibson, Wayne Turner, and Mara Youdelman
At the end of May the Trump administration released a proposed regulation that would undermine or eliminate key protections…
June 4, 2019
Protections for LGBTQ People with Behavioral Health Needs
Abigail Coursolle
Despite progress in breaking down discrimination against LGBTQ people seeking access to quality health care, the current administration and…
June 4, 2019
Q&A: Proposed Rollback of Nondiscrimination Protections Under the ACA’s Section 1557
Wayne Turner and Candace Gibson
In courts and through regulatory action, the administration is vigorously working to dismantle the Affordable Care Act (ACA). On…
March 16, 2018
Q&A Section 1557 of the Affordable Care Act: Protections for Transgender Individuals
Jennifer Lav
A recent federal court injunction has undermined the Affordable Care Act's provisions intended to end discrimination of transgender individuals…
May 16, 2016
Issue Brief: Highlights of the Section 1557 Final Rule
Jane Perkins, Wayne Turner, Mara Youdelman, and Elizabeth Edwards
This issue brief provides an initial analysis of the Department of Health and Human Services' final rule implementing §…
November 9, 2015
NHeLP Comment: Nondiscrimination in Health Programs and Activities NPRM
Mara Youdelman
NHeLP comments in response to the Notice of Proposed Rule Making to the Affordable Care Act's section 1557, Nondiscrimination…
May 28, 2014
NHeLP and The AIDS Institute Complaint to HHS Re HIV/AIDS Discrimination by FL
Jane Perkins and Wayne Turner
Complaint to the Office for Civil Rights at the U.S. Department of Health and Human Services (HHS OCR) requesting…
December 4, 2013
NHeLP Comments on Information Regarding Nondiscrimination – Section 1557
Mara Youdelman and dfitzgerald
Comment submitted to the HHS in response to the proposed rule issued on April 5, 2013 regarding standards for…
July 23, 2013
The ACA and Application of § 1557 and Title VI of the Civil Rights Act of 1964
Mara Youdelman
This memo analyzes how the nondiscrimination provision enacted as Sec. 1557 of the Patient Protection and Affordable Care Act…

May 23, 2023
Where Are We With LGBTQI+ Inclusive Health Data? One Year After President Biden’s LGBTQI+ Equity EO
Naomi G. Goldberg
Why is improved LGBTQI+ inclusion in federal data, including surveys and administrative forms, so important for the health and…
September 27, 2022
How Proposed Changes to Section 1557 Strengthen Protections Related to Pregnancy or Related Conditions, Including Abortion
Madeline Morcelle
Sexism is deeply entrenched in every facet of our society, including the U.S. health care system. One of its…
September 27, 2022
How the Proposed Section 1557 Rule Addresses Discrimination Based on Sex Stereotypes
Madeline Morcelle
Sex stereotypes are stereotypical ideas about masculinity or femininity, such as expectations about how people should represent or communicate…
September 27, 2022
How Changes to Section 1557 will Impact Health Care for People with Disabilities
Jennifer Lav, Elizabeth Edwards, and Georgesula Ziama
People with disabilities often face stigma and discrimination in health care settings and services. Additionally, they face barriers when…
September 15, 2022
How Changes to Section 1557 will Improve Health Care for LGBTQI+ People
Skyler Rosellini, Charly Gilfoil, and Abigail Coursolle
Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, and plus people have historically faced discrimination in health care settings. Their health…
September 13, 2022
How the Proposed Changes to Section 1557 Affect Individuals with Limited English proficiency (LEP)
Mara Youdelman and Georgesula Ziama
Millions of people in the United States speak a language other than English and those with limited English proficiency…
August 15, 2022
What is Section 1557? An Introduction
Georgesula Ziama
Health care access is under attack. Between the recent Supreme Court decision on abortion rights, the proliferation of anti-trans…
September 8, 2020
NHeLP is a friend of the court in case involving the implementation of the ACA’s Non-Discrimination Provision
Elizabeth Edwards, Abigail Coursolle, and Cathren Cohen
Last week, the National Health Law Program (NHeLP) filed an amicus brief, signed by ten other health and civil…
August 6, 2020
Como se dice “discrimination” en Espanol?
Mara Youdelman
I’ve worked in Washington DC for over 20 years and I still have a hard time following all that…
August 6, 2020
Health Insurers Should Be Wary of Trump Regulatory Rollback
Wayne Turner
Confusion. Uncertainty. Such is the entirely predictable result of the Trump administration’s latest ignominy. In a final rule published…
August 6, 2020
Trump Administration’s Regulatory Rollback of Health Care Nondiscrimination Protections Incites Reproductive Health Injustice
Madeline Morcelle
Sex discrimination is deeply entrenched in our health care system. In recent years, it has manifested as obstetric violence,…
August 6, 2020
Trump Administration Rolls Back Important Health Care Protections for People with Disabilities and Chronic Health Conditions
Dania Douglas
On June 24, 2020, the Trump Administration announced it would roll back regulatory provisions protecting against discrimination in health…
May 28, 2019
Administration’s Proposed Regulation Change to ACA’s Nondiscrimination Provision Would Rollback Civil and Health Rights Progress
Elizabeth G. Taylor
Opening the door to discrimination in our health care system is no way to ensure equal access to vital…
November 2, 2017
The Law Is Not in Trump’s Court: Kyler Prescott’s Case and Sec. 1557 of the Affordable Care Act
Wayne Turner and Candace Gibson
Two years ago, the world lost Kyler Prescott. Kyler was a 14 year-old, transgender boy who battled against depression,…
September 28, 2017
Anti-discrimination Protections for Health Care of LGBTQ People Under Attack
Kimberly Lewis
*Editor's Note: This piece was updated in October following recent action by U.S. Attorney General Jeff Sessions.Over the past…

Meet the Legal and Policy Experts working on Section 1557