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Federal Judge Vacates ACA Nondiscrimination Protections

In an Oct. 15 decision, a judge in the U.S. District Court for the Northern District of Texas vacated parts of Section 1557 of the Affordable Care Act (ACA), which prohibits discrimination based on race, color, national origin, sex, age, or disability.

In Franciscan Alliance v. Azar, plaintiffs argued that certain provisions of a 2016 final rule implementing Section 1557 violated the Administrative Procedures Act and the Religious Freedom Restoration Act. Specifically, the court struck down parts of the rule that explicitly prohibit discrimination based on gender identity and termination of pregnancy.

The decision follows a 2016 preliminary injunction that remanded the rule to the Department of Health and Human Services (HHS) for further review. In 2018, the judge reopened the lawsuit.

The court also allowed outside groups to intervene and defend the law. The ruling now can be appealed to the Fifth Circuit Court of Appeals.

Several other courts have heard similar cases and upheld the nondiscrimination protections on the basis of gender identity.

In June, HHS issued a proposed rule overhauling Section 1557, including the provisions at issue in this case. America’s Essential Hospitals submitted comments expressing concern that changes to nondiscrimination protections will decrease access and worsen outcomes for vulnerable patients.

Contact Senior Director of Policy Erin O’Malley at or 202.585.0127 with questions.


About the Author

Rachel Schwartz is a former policy associate at America's Essential Hospitals.

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