Trump Administration Kills Trans Protections in Affordable Care Act

The U.S. Department of Health and Human Services Friday announced changes to the Affordable Care Act that reverse protections for transgender people added by the Obama administration in December 2016. The previous changes to Section 1557 of the ACA had defined gender as “one’s internal sense of gender, which may be male, female, neither, or a combination of male and female.” Today’s announcement signaled a return to the original text of the law.

“Today’s rule attempts to gut the robust nondiscrimination protections under the Health Care Rights Law, Section 1557 of the Affordable Care Act (ACA),” Winnie Stachelberg, executive vice president for external affairs at the Center for American Progress, said in a written statement. “This move by the administration to undermine anti-discrimination protections in health care for LGBTQ people, women, people with limited English proficiency, people with disabilities, and others, including those who face multiple forms of discrimination, is unconscionable at any time.”

Section 1557 of the ACA made it illegal to discriminate due to “race, color, national origin, sex, age or disability in certain health programs and activities.” The Obama administration had sought to strengthen those protections with the refined definition, but was met with immediate opposition in the courts, which ultimately agreed with the Trump administration’s interpretation of the law. The current administration had issued a proposed rule changing that interpretation in May 2019, and today’s move finalizes that rule.

“HHS respects the dignity of every human being, and as we have shown in our response to the pandemic, we vigorously protect and enforce the civil rights of all to the fullest extent permitted by our laws as passed by Congress,” Roger Severino, director of the Office for Civil Rights at HHS, said in a statement announcing the decision. “We are unwavering in our commitment to enforcing civil rights in healthcare.”

Experts were quick to express concern, though.

Lynn Dawson, associate director of HIV policy at the Kaiser Family Foundation, told NPR that changes will be felt beyond basic health care issues. She says insurance companies might be able to raise premium prices for LGBTQ+ people, and trans patients might find limited remedies through the legal system.

“Because of limited access to litigation, I think that it’s fair to state that the ramifications [of this rule] could be pretty significant,” she lamented.


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