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Opposition to Section 1557 of Patient Protection and Affordable Care Act

Publication date: 
Tuesday, August 13, 2019

Topics: Health, LGBTQ+, Immigrants, and Women


Description of Position

On behalf of Philanthropy California, we express our strong opposition to the proposed regulatory rule regarding Section 1557 of the Patient Protection and Affordable Care Act published in the Federal Register on June 14, 2019. This proposed rule threatens the health and wellbeing of lesbian, gay, bisexual, and transgender people, as well as immigrants, women, and ultimately all Americans. We urge the rule to be withdrawn in its entirety and that the existing patient protections remain in effect.

This proposed rule would substantially limit federal protections against gender identity and sexual orientation discrimination in healthcare. Additionally, this proposed rule would weaken protections that provide access to language services for patients with limited English proficiency (LEP). Under this rule, healthcare providers could legally discriminate against and deny care to patients who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) and limit accessibility to care for immigrant patients without fear of repercussion.

Philanthropy California is an alliance of Northern California, Southern California, and San Diego Grantmakers with a collective membership of more than 600 foundations, corporate giving programs, and philanthropists. In 2017, foundations gave approximately $10 billion to over 14,000 nonprofits in the state in support of a variety of issues and initiatives. As the voice of California’s philanthropic community, we collaborate statewide to provide a forum for exchanging ideas, sharing knowledge, and leveraging our efforts for greater impact in service of communities across the state. 



In 2016, Section 1557 was wisely added to clarify existing law that discrimination against LGBTQ persons in healthcare settings and in insurance benefits coverage is unlawful. Judicial precedent has long classified discrimination on the basis of sexual orientation and gender identity as sex discrimination. Over 1.6 million LGBTQ adults in California – over 5 percent of the state’s population – now benefit from the anti-discrimination protections afforded by Section 1557.

Section 1557 also provides important protections for patients with limited English proficiency. In California alone, 6.8 million individuals, or 27 percent of the LEP population nationally, have received better access to healthcare because of Section 1557. The proposed rule change would sow confusion among healthcare workers and insurance companies and give the impression that discrimination on the basis of sexual orientation, gender identity, or English proficiency is permissible.

The proposed changes to Section 1557 regulations threaten to take away critical rights and protections previously afforded to LGBTQ and LEP patients and, in doing so, will make it more challenging and more costly for those seeking medical care. Foundations across California have made significant investments to promote the health and well-being of LGBTQ and immigrant communities through supporting increased access to healthcare and critical supports and services. The proposed changes to Section 1557 regulations would undo years of work by the philanthropy to support healthy, thriving communities for all Californians. Moreover, if access to health care is restricted for LGBTQ and LEP patients, more individuals and families will be forced to delay preventative care and rely increasingly on emergency medical services. Such a shift will cause health care costs to skyrocket across California and place significant burdens on government and the nonprofit sector.


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