What is Section 1557 of the Patient Protection and Affordable Care Act?

Section 1557 of the Patient Protection and Affordable Care Act (ACA) is the primary anti-discrimination provision within the ACA. It prohibits discrimination in health programs or activities that receive federal financial assistance, are administered by an executive agency, or are established under Title I of the ACA.

Provisions of Section 1557

Protected classes

It extends protections against discrimination on the basis of:

• Race
• Color
• National origin
• Sex (including gender identity and sexual orientation, as clarified by the Biden administration's interpretation)
• Age
• Disability

See also: What are the 18 PHI identifiers?

Scope

• The law applies to any health program or activity that receives funding from the U.S. Department of Health and Human Services (HHS), such as Medicare and Medicaid, as well as entities created by the ACA, like the Health Insurance Marketplaces.

Specific protections

• Language access: Entities must take reasonable steps to ensure meaningful access to individuals with limited English proficiency (LEP), including providing translations or interpreter services.
• Accessibility for individuals with disabilities: Health programs must ensure that their services, facilities, and communications are accessible to people with disabilities.
• Sex discrimination: Protections include prohibitions against discrimination based on pregnancy, gender identity, and sex stereotyping.
• Enforcement: Individuals who believe they have been discriminated against can file a complaint with the HHS Office for Civil Rights (OCR). The law also allows private lawsuits in certain cases.

Intersection with other laws

Section 1557 incorporates existing civil rights laws, such as:

• Title VI of the Civil Rights Act of 1964 (race, color, national origin)
• Title IX of the Education Amendments of 1972 (sex)
• The Age Discrimination Act of 1975
• Section 504 of the Rehabilitation Act of 1973 (disability)

See also: HIPAA Compliant Email: The Definitive Guide

HHS and Section 1557

As part of its 2024 achievements, the HHs implemented Section 1557 of the Affordable Care Act to address “discrimination throughout HHS health programs and activities.” 

By enforcing Section 1557, HHS promotes equity in healthcare and helps address long-standing health disparities. The department’s efforts ensure that vulnerable populations have access to high-quality and nondiscriminatory healthcare services.

In the news: HHS Administration reflects on 2024 achievements and challenges