Protecting Care for All — Gender-Affirming Care in Section 1557 and Beyond

This perspective examines the conflict between state level bans on gender affirming care (e.g., Florida’s Medicaid exclusion) and federal protections under Section 1557 of the Affordable Care Act, which prohibits sex-based discrimination including discrimination against transgender and nonbinary individuals. The article traces the shifting interpretations of Section 1557 across administrations, highlighting the Biden administration’s 2022 proposed rule to restore protections for gender-affirming care and ensure access to routine services (e.g., preventive screenings) for transgender patients. It critiques state laws that criminalize such care, noting their incompatibility with federal nondiscrimination mandates and their chilling effect on clinicians. The authors advocate for physician engagement, institutional compliance, and professional advocacy to safeguard transgender health access amid legal and religious exemptions.

This perspective examines the conflict between state level bans on gender affirming care (e.g., Florida’s Medicaid exclusion) and federal protections under Section 1557 of the Affordable Care Act, which prohibits sex-based discrimination including discrimination against transgender and nonbinary individuals. The article traces the shifting interpretations of Section 1557 across administrations, highlighting the Biden administration’s 2022 proposed rule to restore protections for gender-affirming care and ensure access to routine services (e.g., preventive screenings) for transgender patients. It critiques state laws that criminalize such care, noting their incompatibility with federal nondiscrimination mandates and their chilling effect on clinicians. The authors advocate for physician engagement, institutional compliance, and professional advocacy to safeguard transgender health access amid legal and religious exemptions.