Since 2016, the Department of Health and Human Services (HHS) has explicitly interpreted the word "sex" in the nondiscrimination provisions of the Affordable Care Act (Section 1557) to recognize and include transgender people, entitling them to the same services to which everyone else is entitled, although a federal court injunction on Dec. 31, 2016 prevented HHS from enforcing its nondiscrimination rule. Under the Trump administration, HHS lawyers began working on permanently reversing the rule, and on May 24, 2019, the proposed reversal was formally announced. On October 15, 2019, federal judge Reed O’Connor vacated the nondiscrimination rule, saying that it violated the Religious Freedom Restoration Act. His ruling meant that federally-funded healthcare insurers and providers may deny treatment or coverage based on sex, gender identity or termination of pregnancy, even if the services are medically necessary. On November 1, 2019, HHS announced that, effective immediately, recipients of taxpayer-funded grants from HHS are permitted to discriminate on the basis of sexual orientation and gender identity, as it will no longer enforce the 2016 rule known as 81 F.R. 89393. This change affects "HIV and STI prevention programs, opioid programs, youth homelessness services, health professional training, substance use recovery programs, and many other life-saving services," according to the National Center for Transgender Equality. In April 2020, HHS acknowledged that the pending rule to replace Section 1557 (which was then under review by the Justice Department) followed the federal court order that "vacated the gender identity provisions" of Section 1557. The replacement rule was revealed on June 12, 2020.
