Today as part of an ongoing attack on the most marginalized, the Trump Administration is proposing dangerous and far reaching changes to regulations implementing the Health Care Rights Law, Section 1557 of the Affordable Care Act, which prohibits discrimination in healthcare. The proposal attempts to eliminate the rights of LGBTQ people. It also rolls back protections for limited English proficient (LEP) older adults, and attempts to radically limit the way that victims of any type of discrimination can seek redress under the law. By gutting the only federal law designed to protect against discrimination in health care, the move is a cruel, extremist, and transparent political attack on LGBTQ older adults, LEP seniors, and others who frequently face discrimination in accessing care.
The ACA’s Health Care Rights provision is a landmark civil rights law that prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in federal health programs and activities. The law includes affirmative protections for consumers and obligations on insurers and providers, as well as a new avenue for older adults and others to enforce their rights.
The proposed changes to the Health Care Rights Law will be particularly harmful for transgender older adults – one in five of whom report being refused care because of their gender status. This discrimination, which compounds over a lifetime, contributes to poorer health outcomes among transgender older adults, with one in three reporting poor physical health. By deleting references to protections based on gender identity, sexual orientation, and sex stereotyping across federal healthcare regulations, the Trump Administration’s proposal is saying transgender older adults and LGBTQ people more broadly do not have the right to receive the care they need and be treated with dignity.
In the same proposed rulemaking, the Trump Administration is also rolling back language access protections for LEP older adults by eliminating the requirement that healthcare providers affirmatively distribute notices of non-discrimination and include translated taglines in significant communications to consumers. These requirements, key to enforcing Title VI of the Civil Rights Act, are critical to assist LEP communities to better understand their rights and access care.
Finally, if gutting key provisions of the existing regulations were not enough, the proposed rulemaking takes aim at the Health Care Rights Law’s enforcement structure, which would make it significantly more difficult to bring particular discrimination claims under the law.
To be clear, this proposed rule is part of a larger, strategic attack on the lives of LGBTQ and LEP older adults. The Department of Health and Human Services Office for Civil Rights (OCR), the same agency tasked with enforcing Section 1557, recently released a final “Conscience Rights” rule that allows providers to discriminate against transgender older adults and others on religious and moral grounds and changed the OCR mission statement to emphasize conscience and religious freedom. Meanwhile, the Department of Homeland Security’s proposed “public charge” rule would make it nearly impossible for LEP older immigrants to enter the U.S. or become permanent residents if they are not wealthy and use or might need Medicaid or help paying for Medicare, food or housing.
Upon the proposed rule being published in the Federal Register, a 60-day public comment period will begin. In the coming weeks, Justice in Aging will provide resources, including template comments, to help advocates fight back. Now is the time to tell the Trump Administration that the lives, rights, and dignity of LGBTQ older adults, LEP seniors, and people with disabilities matter and to protect the Health Care Rights Law.