clinical social work association

HHS Proposed Changes to Affordable Care Act | Section 1557 on Non-Discrimination | August, 2019

The Clinical Social Work Association strongly opposes the DHHS proposed Section 1557 rule change.  This revision would open the door to discrimination by healthcare providers and by insurers offering Marketplace plans. Discrimination and denying access to health care in our public health care system is unethical and harmful.

Ethical Treatment vs Prejudice

CSWA represents many of the 250,000 Licensed Clinical Social Workers (LCSWs) who provide mental health diagnosis, treatment, and other health related services through in the public and private sectors.  We adhere to a code of ethics that prohibits discrimination; indeed, a social worker would never turn away someone seeking health or mental health care. It is self-evident that all health professions practice within codes of ethics that prohibit discrimination and do no harm.

The DHHS proposed changes are in stark contrast to ethical practice.   Currently, Section 1557 regulations standardize the protections and processes that prohibit discrimination in health care for all vulnerable populations.  Further, current regulations recognize that intersectional discrimination can affect people who belong to multiple protected classes; for example, discrimination against an African-American woman could be based on race, sex, or both.  While DHHS maintains that it “is committed to ensuring the civil rights of all individuals who access or seek to access health programs or activities of covered entities,” the proposed changes, if finalized, would substantially scale back current protections against discriminatory practices, and create a climate friendly toward providers inclined to deny care based on stereotyping and generalized prejudice. 

Proposed Changes for Insurance Carriers

With regard to changes for insurance carriers, CSWA notes with dismay that the DHHS proposal would provide leeway for insurers to shape benefit designs with potential to disadvantaged vulnerable groups often targeted for discrimination by race, color, national origin, sex, age, and/or disability. While these rules would only apply to Marketplace plans, the change would have significant impact on the lives of the 20 million people covered by these plans and could be adopted by private plans. 

It is also of significant concern to CSWA that DHHS also wants to eliminate basic consumer protections by ending grievance procedure requirements and restricting the right to challenge violations of the right to access care in court.

Disability Discrimination

As to the question of relaxing protections currently provided to individuals with disabilities, we cannot see how the proposed exemptions are justified.  Surely an increase in the “undue hardship” exemptions for federally covered entities would seriously curtail access to healthcare for individuals who in their daily lives already face undue hardships due to their disabling conditions.

Recommendation 

CSWA urges that DHHS keep Section 1557 in place and protect the rights of vulnerable and/or disabled enrollees to health care through the Marketplace plans. To open the door for healthcare providers to refuse to provide healthcare services to certain groups and for insurers to develop policies that disadvantage such groups is unethical and would destroy civil and disability rights protections to specific patient populations.  

Thank you for this opportunity to provide input on the DHHS proposal to change non-discrimination regulations under ACA Section 1557.  We are available to respond to any questions.  Please contact us.