Section 1557 and Beyond: True Civil Rights Are Coming to Health Care at Long Last

healthcare diversityI just watched the movie “All the Way,” an extraordinary account of LBJ’s first year in office and the passage of the Civil Rights Act of 1964. While that law was groundbreaking, many are surprised to learn it did relatively little to end discrimination in health care. The definition of “public accommodation” in the law was very limited and did not include hospitals or other health care settings. The only way to impact discrimination in hospitals through the law was not an affirmative obligation to protect civil liberties but the more distant threat that federal funding could be removed from private hospitals failing to treat patients equally.

Not until the passage of the Americans with Disabilities Act in 1990 were health care services formally added to the definition of “public accommodation,” although Professor Sara Rosenbaum notes that it was little remarked upon at the time, perhaps because many just assumed that a hospital was a public accommodation.

Finally, with the passage of the Affordable Care Act in 2010, discrimination in health care was addressed comprehensively in federal law. Section 1557 of the law prohibits discrimination on the basis of race, color, national origin, sex, age or disability in the broad range of HHS programs as well as by issuers offering insurance through the ACA Exchanges.

Unfortunately, the regulations implementing Section 1557 weren’t finalized until just last month on May 13, 2016. For those of us who have been in the trenches fighting against health disparities, this was an interminably long time, but it represents a huge step forward in this fight.

And, then, like Christmas in July (or, really, June), CMS released proposed rules this week that would require that hospitals that accept Medicaid or Medicare dollars must proactively establish policies to prohibit discrimination.

In a news cycle filled with far too much hate, these important strides toward equality in treatment are a welcome respite that I wanted to highlight.

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