Section 1557 is the key nondiscrimination provision of the Affordable Care Act (ACA). It prohibits discrimination in health programs and activities receiving federal financial assistance, health programs and activities administered by the executive branch, as well as entities created under the ACA, including the Marketplaces and health plans sold through the Marketplaces. Section 1557 protects against discrimination on the basis of race, color, national origin (including language access), sex, age, and disability, and does so by building on existing civil rights laws. It is the first federal law to ban sex discrimination in health care.

Under the Obama administration, the U.S. Department of Health and Human Services (HHS) underwent an extensive, 6-year process to develop regulations for enforcing Section 1557. The Final Rule that it issued in 2016 provides that discrimination on the basis of sex includes discrimination on the basis of pregnancy, false pregnancy, termination of pregnancy, or recovery therefrom, childbirth or related medical conditions, sex stereotyping and gender identity. This was a major victory for LGBTQ people.

Unfortunately, the Trump administration is trying to roll back this victory by replacing the 2016 rule with a new one that would take away the explicit protections for our community. NCLR submitted comments opposing this harmful policy change.

In January of 2018, the U.S. Department of Health & Human Services (HHS) issued a proposed federal regulation that would allow widespread discrimination in health care delivery in the name of religious liberty. The rule would allow health care providers to refuse to treat someone if their refusal is based on a religious reason. NCLR submitted extensive comments opposing the rule, which was nevertheless issued in final form in May of 2019. A number of organizations and state and local governments sued HHS to prevent the rule from going into effect. NCLR filed amicus briefs in the litigation challenging the rule. The rule was struck down in court. The Trump Administration has appealed the orders vacating the rule.

NCLR partners with the NCAA in the Common Ground Initiative to increase dialogue at conservative religious colleges about how LGBTQ inclusion and respect for religion can operate together to create safer, healthier, and more inclusive environments for student athletes—and by extension for all students.

NCLR, along with other national LGBTQ organizations, is part of a State Policy Working Group that addresses proposed state legislation affecting LGBTQ people across the country. The group works to support local advocates in advancing bills to protect LGBTQ people from discrimination in employment, housing, public accommodations, healthcare, and other areas, and to allow transgender and nonbinary people to obtain gender marker changes on identity documents.

The group also works to stop the dozens of hostile anti-LGBTQ bills introduced in state legislatures every year. Among the proposed laws that have been successfully defeated are bills that would permit discrimination against same-sex couples who marry, create broad religious exemptions to existing civil rights protections, allow religiously-affiliated child welfare agencies to refuse to place children with same-sex couples, prohibit transgender people from using restrooms and other facilities based on their gender identity, and deprive transgender youth of access to gender-affirming medical care and participation in school sports based on their gender identity.

NCLR is a member of the Federal AIDS Policy Partnership (FAPP), which is a national coalition of more than 120 local, regional, and national organizations advocating for federal funding, legislation and policy to end the HIV epidemic in the United States, and is active in the Structural Interventions Working Group.

URGENT ACTION: Tell Your Senators to Vote for the Equality Act!

The Equality Act (H.R. 5) would prohibit discrimination based on an individual’s sexual orientation or gender identity in employment, housing, credit, education, public accommodations (things like restaurants, hotels, and theaters), and jury service. It would also prohibit discrimination based on sex, sexual orientation, and gender identity in programs receiving federal funding. The bill was passed by the House of Representatives in the last Congress in May 2019 with a bipartisan vote of 236 to 173 but was blocked from consideration in the Senate by then-Majority Leader Mitch McConnell. The bill was reintroduced by Rep. David Cicilline (RI-1) and Sen. Jeff Merkley (OR) in the 117th Session of the United States Congress on February 18, 2021. A vote is expected in the House shortly, with action following soon after in the Senate.

NCLR has played a leading role in drafting the Equality Act and working for its eventual passage. We have partnered with Black and Pink and others to educate Congress and the public on the Act’s potential to reform the U.S. criminal legal system for LGBTQ people and people of color.

Currently, only 22 states have non-discrimination protections that fully protect LGBTQ individuals. According to the Center for American Progress, more than 1 in 3 LGBTQ Americans have reported facing some form of discrimination within the past year, with the number increasing to 3 in 5 for transgender individuals. This discrimination often causes substantial harm to the psychological and economic wellbeing of the LGBTQ community and creates undue difficulties for many LGBTQ people in accessing medically necessary healthcare – most dramatically for the transgender population and people of color.

The most recent polling from the nonpartisan Public Religion Research Institute (PRRI) shows that more than 80 percent of all Americans (including a majority of Democrats, Independents, and Republicans) support comprehensive nondiscrimination protections that include LGBTQ individuals. FiveThirtyEight has also similarly found that President Biden’s executive order mandating that federal agencies implement the Supreme Court’s ruling in Bostock v. Clayton County in nondiscrimination policies was the most popular of his early executive actions, with the support of an overwhelming 83% of Americans.

More than 600 national, state, and local organizations have signed on to urge the swift passage of the Equality Act, in addition to a broad coalition of faith-based groups and 335 major corporations, showing the breadth of support the legislation has maintained since its passage in the House in 2019. NCLR is a member of the Freedom and Opportunity for All coalition (along with 16 other partner organizations) advocating for the urgent passage of the Equality Act.