ASAN Opposes Unjust Changes to ACA Regulations

Words Affordable Care Act ACA written on a paper.

June 12th, 2020

The Autistic Self Advocacy Network strongly opposes a final regulation that would undermine  basic health care protections for LGBTQ people and people with disabilities. The new rule changes regulations implementing Section 1557 of the Affordable Care Act (ACA). In the midst of a pandemic and on the fourth anniversary of the Pulse shooting, the Trump Administration is trying to make it easier to discriminate against people who need health care.

The ACA prohibits most health care providers from discriminating on the basis of “race, color, national origin, sex, age, or disability,” including health insurers and government-managed programs such as the ACA Marketplaces. Importantly, the old regulations included gender identity, prenancy, and whether or not someone has had an abortion, under the definition of sex discrimination. The old regulations also said that all health care programs or activities must provide “meaningful access” to people who do not speak English fluently, including for users of Augmentative and Assistive Communication (AAC). This access includes clear notices on what your health care rights are in your native language. 

These are important protections that help make sure that people who are LGBTQ, people who don’t speak English as their first language, and people with disabilities are able to access health care and avoid discrimination. But by issuing a new final rule, the Trump administration has reversed this progress. The final rule eliminates protections against discrimination on the basis of gender identity and termination of pregnancy. This would allow healthcare providers to refuse to treat transgender people and other LGBTQ people, as well as people who have had an abortion. The final rule also includes exemptions that allow a provider to refuse to perform a specific procedure if it conflicts with their religious beliefs. To make matters worse, the final rule also exempts many types of health insurance plans entirely from the ACA’s non-discrimination provisions. Health insurance companies would be able to discriminate against people again if that person’s specific health insurance plan isn’t funded by money from the federal government. 

These changes would severely harm many people with disabilities. Many of us are LGBTQ and rely on government-funded insurance programs like Medicaid to provide the long term services and supports (LTSS) that are vital for our self-determination, health, and independence. Finding an alternative provider for the LTSS and medical services we need is already incredibly difficult for many people with disabilities—let alone LGTBQ people with disabilities. If our providers are allowed to discriminate against us, it may be impossible to get the services we need. Even if our providers don’t discriminate, our health insurance plans would be allowed to create discriminatory benefit designs, which could force us to pay more money for treatments. And, health care providers and insurers would no longer have to include notices with each document they send stating that auxiliary aids and services are available to people with disabilities and that services are available in a person’s native language. Without such assurances, people with disabilities who use AAC or  who speak English as a second language may not have any way of knowing whether or not they can successfully access services. 

The ACA provides critical protections to health care consumers, especially people with disabilities. ASAN urges HHS to rescind and revise this unjust rule and do its job—upholding the right of all people to access high quality health care. For more information on ASAN’s positions with respect to health care and the ACA, please contact Sam Crane, our Legal Director, at

The Autistic Self Advocacy Network is a 501(c)(3) nonprofit organization run by and for autistic people. ASAN was created to serve as a national grassroots disability rights organization for the autistic community run by and for autistic Americans, advocating for systems change and ensuring that the voices of autistic people are heard in policy debates and the halls of power. Our staff work to educate communities, support self-advocacy in all its forms, and improve public perceptions of autism. ASAN’s members and supporters include autistic adults and youth, cross-disability advocates, and non-autistic family members, professionals, educators, and friends.