Thankful for Trans Health Progress

As we approach Thanksgiving, LGBTQ health advocates have a major reason to be thankful this year:  This year, the Department of Health and Human Services (HHS) released the final regulation implementing Section 1557 of the Affordable Care Act (ACA).  Section 1557 is the landmark anti-discrimination provision of the ACA, which for the first time protection from discrimination on the basis of sex in federal health programs..  This final regulation makes it clear that “sex” includes gender identity and sex stereotyping.  This ban on discrimination based on gender identity extends real, concrete protections to transgender and gender non-conforming people who report facing a variety of forms of discrimination in healthcare – from being unable to access insurance coverage, to outright refusals to provide care, to verbal and physical abuse at the hands of medical professionals.  

Under this new guidance, Section 1557 prohibits most insurers from discriminating on the basis of gender identity when providing health coverage and requires that providers treat individuals in a manner consistent with their gender identity, including in access to health care facilities.  Section 1557 applies to all health programs and activities, any part of which receives any Federal financial assistance—including but not limited to physicians, hospitals, pharmacies, community clinics and nursing facilities. The regulation also equips people who have experienced discrimination with a mechanism for reporting a claim and seeking justice.  This fact sheet outlines more information about how Section 1557 protects transgender and gender non-conforming people.  

While this regulation is truly transformational, it was a long time coming.  This regulation was finalized six years after the passage of the ACA in 2010.  When HHS released the draft final guidance last fall, HRC mobilized our members and supporters and delivered 13,398 public comments urging HHS to provide explicit protections for LGBTQ people in the final regulations.  Just as this did not come about overnight, we know that it will take time for policies and practices in healthcare settings to change to fully implement these non-discrimination protections.  Therefore, HRC has also been working hard to educate both consumers and providers, insurers and employers about the important protections that Section 1557 offers.

Shortly following the release of the new guidance, HRC Foundation worked with our partners to release an updated version of our guide, Creating Equal Access to Quality Health Care for Transgender Patients: Transgender-Affirming Hospital Policiesto provide guidance to hospitals and other healthcare facilities that are seeking to improve healthcare for transgender patients.  This guide includes information about the new Section 1557 guidance and includes model policies for hospitals to help them reduce bias and insensitivity, and address key issues such as confidentiality, room assignments, bathroom access, and admitting/registration procedures. In addition to the this guide, HRC has held webinars and made presentations at conferences where HRC has reached hundreds of health care providers and administrators with information about Section 1557 and the policies and practices they should be putting in place to reduce bias and discrimination.  

This week, HRC marks Transgender Week of Awareness, dedicated to the progress, continued challenges, and unfinished work in the fight for transgender equality. Throughout the week, HRC will dedicate each day to urgent and important issues facing the transgender community, including support for youth and families, workplace equality, access to life-saving and inclusive health care, and combatting violence against the transgender community. The week concludes with with Transgender Day of Remembrance on November 20 when the community comes together for vigils around the country to honor those lost in the past year. Learn more at