The U.S. government has revised the Affordable Care Act, allowing healthcare providers to discriminate based on gender identity. The change, finalized by the Department of Health and Human Services under President Donald Trump, alters Section 1557, which previously protected patients from discrimination in healthcare. The rule, set to take effect in August, redefines “sex” as male or female based on biology, removing language that included gender identity from the 2016 Obama-era interpretation.
The 2016 HHS rule under President Barack Obama clarified that “sex” in the Affordable Care Act included gender identity, defined as an individual’s internal sense of gender. This interpretation aimed to prevent discrimination against transgender and nonbinary people. The new 2020 rule removes this definition, returning to a biological interpretation of “sex” as male or female. HHS officials argue this change reduces regulatory costs, citing $2.9 billion in savings over five years by avoiding multilingual materials.
Transgender rights advocates have condemned the move as a step toward eroding healthcare access. Mara Keisling, executive director of the National Center for Transgender Equality, called the rule “hateful and cruel,” stating it would hinder transgender individuals from receiving care to live “happy, healthy, and productive lives.” Activists warn that the policy could worsen existing barriers, such as stigma and discrimination, which already contribute to healthcare disparities.
Data from the Williams Institute estimates that 1.4 million U.S. adults identify as transgender, though the actual number may be higher. Research published in 2017 highlights that transgender individuals often avoid healthcare due to discrimination. The World Health Organization has noted that transphobia increases health risks unrelated to gender, emphasizing the need for “gender-affirmative healthcare” to address these gaps, which involves improving well-being for transgender individuals.
HHS officials argue the rule simplifies compliance.
Critics stress that removing protections risks deepening inequities.
The policy shifts the burden of addressing discrimination onto patients, who may struggle to seek redress without legal support. For transgender individuals, who already face higher rates of mental health challenges and barriers to care, the change could exacerbate existing vulnerabilities.
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