What is Section 1557? An Introduction

What is Section 1557? An Introduction

Health care access is under attack. Between the recent Supreme Court decision on abortion rights, the proliferation of anti-trans and other regressive policies at the state-level, and the profound health inequities revealed by the COVID-19 pandemic, millions of people continue to encounter a health care system that is stacked against them. 

While there is no quick fix for all the problems in our health care system, the Biden administration has taken a giant step towards restoring and strengthening civil rights protections for people in many health-related programs and activities that receive funding from the federal government or are run by the Department of Health and Human Services (HHS).

Section 1557, known by some as the “Health Care Rights Law,” is the main nondiscrimination provision of the Affordable Care Act (ACA). It prohibits discrimination in health care based on factors like race, ethnicity, language, age, disability, and sex – including pregnancy, sexual orientation, and gender identity. 

 The Biden administration has just proposed changes to the regulations implementing Section 1557 that would restore and strengthen nondiscrimination protections and improve access to care for millions of people. 

If these proposed changes are ultimately adopted, they will promote health equity of Black, Indigenous, and people of color, and increase access to unbiased coverage and care for those historically underserved because of race, ethnicity, language, age, disability, and sex.

The National Health Law Program helped craft Section 1557 as part of our work on the Affordable Care Act and we have continued to work on it after President Obama signed the Affordable Care Act into law. We want to see robust implementation and enforcement of its protections. Discrimination has no place in health care, and it’s critical that the Biden administration move forward with these protections to secure access to care, free from any discrimination or prejudice. 

The National Health Law Program and our coalition of partners are reviewing the proposed changes and will publish additional analysis and resources. We will also provide individuals and organizations a chance to participate in the “public comment” process to help ensure that everyone can access the care they need.

While we are still reviewing the proposed rule, we wanted to provide a topline overview of the ways Section 1557 impacts various individuals, especially those who live at the intersection of multiple identities.

Language Access

A key component of Section 1557 is strengthening protections for people with limited English proficiency (LEP) by restoring and expanding requirements for language services. Language access services, which are essential for people with limited English proficiency, facilitate communication between those who do not speak the same language, especially in health care settings. Federal law, including Section 1557, requires health care entities help limited English proficient individuals access health care and participate in federal health programs. This can include providing oral interpreting and written translated documents.


Section 1557 was the first federal law to prohibit health care discrimination on the basis of sex. This protection covers sex assigned at birth, gender identity (including gender expression and sex characteristics, such as intersex characteristics), sexual orientation, pregnancy status (including childbirth, miscarriage, and abortion), and related conditions.


The Biden Administration proposes changes to strengthen protections for LGBTQI+ people, especially transgender people. These protections include the right to health care free from prejudice and discrimination, specifically when it comes to gender affirming care and hormonal replacement therapy (HRT). Section 1557 also bans “discriminatory benefit design.” 

Reproductive and Sexual Health 

Section 1557 impacts different areas of reproductive and sexual health care. Beyond gender affirming care, Section 1557 also protects patients from dismissals due to gender-based stereotyping, refusal of care over having had an abortion, and discrimination based on HIV-preventing pre-exposure prophylaxis (PrEP) for HIV-negative patients who choose to be intimately partnered with someone who is HIV-positive.


While the ACA bans insurers from rejecting coverage on the grounds of a pre-existing condition, Sec. 1557 protects those with pre-existing conditions from discriminatory pricing, including co-pays, prescription tiering, and coverage limits.

Learn more about our Section 1557 work and access additional resources here: healthlaw.org/section-1557/

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