The Trump Administration Wants to Roll Back Health Care Protections for the Most Marginalized

Section 1557, or the “Final Rule” of the Affordable Care Act (ACA), sometimes referred to as the Title IX of the landmark law, prohibits discrimination based on race, color, national origin, sex, age and disability in health programs receiving federal financial assistance—and the Department of Health and Human Services (HHS) is intent on dismantling it.

(Larissa Puro / Creative Commons)

New proposed revisions to the ACA from HHS include stripping Section 1557 of its protection of termination of pregnancy, allowing insurance providers to seek blanket religious exemptions from covering the procedure. Using “religious freedom” as a cover for discrimination, this revision would extend the Trump administration’s attacks on women’s reproductive rights, which have included expanding such exemptions for birth control coverage. The proposed rules change also lowers standards for language assistance provided to people with limited English proficiency and hearing aids given to people with disabilities, citing the cost of printing notice pamphlets, notices and brochures.

These new plans from HHS put women, people with limited English proficiency and those with disabilities at risk—and most dangerously, they would extend the administration’s efforts to block trans and non-binary people from Title IX protections.

The ACA was one of the first federal laws to interpret the “discrimination on the basis of sex” as including gender identity, with an original goal of ensuring that the 780,000 trans Americans living in states without anti-discrimination laws have access to routine coverage and hormonal therapies, but HHS’ proposed changes would instead embolden providers who wish to discriminate.

Many transgender people already avoid receiving medical care out of fear: In a study cited by the Human Rights Campaign, over 70 percent of transgender people said they have been victims of discrimination during medical exams and appointments

The Trump Administration wants Section 1557 to apply only to a biological definition of sex—upholding a decision made in a continuing 2016 Indiana case that argued “the Department had adopted an erroneous interpretation of ‘sex,’” according to a Federal Register notice published in June.

LGBTQ+ and health care advocates warn this policy change could have even more dire consequences. “Should President Trump and his administration follow through with this new rule,” GLAAD said in a statement announcing its submission of a formal comment on the proposed rules change, “blood will be on their hands.”

The American Medical Association (AMA) agreed. “Section 1557’s protections assist some of the populations that have been most vulnerable to discrimination,” AMA CEO Dr. James Madara said in a statement, “such as lesbian, gay, bisexual, and transgender individuals and those suffering from mental illness, including substance use disorders, and help provide those populations equal access to health care and health coverage… The AMA stands behind Section 1557’s gender identity protections and opposes any modifications to the rule that would jeopardize the health and wellbeing of vulnerable populations.”

“No matter what the Trump Administration does,” the National Center for Trans Equality wrote in its formal comment, “the Health Care Rights Law is the law of the land, and most courts have said it protects transgender people. Only Congress has the power to change the law by repealing the ACA.”

Take Action! The comment period for the change ends on August 31. Make your voice heard now by submitting an official comment.


Rachel Kennedy is an Editorial Intern at Ms. and Associate Opinion Editor for The Daily Princetonian. A Bostonian by birth and a feminist by choice, she hopes to empower women by sharing their stories. She is particularly interested in covering maternal healthcare, women activists, pop culture, and politics. Rachel currently studies History, Journalism, and African American studies at Princeton University.