Attorney General Bonta Leads 20 Attorneys General in Support of Increased Health Care Protections for Marginalized Communities

OAKLAND — California Attorney General Rob Bonta led 20 attorneys general in filing a multistate amicus brief in States of Texas and Montana v. Becerra et al., opposing the State of Texas and Montana’s motion for a temporary restraining order, preliminary injunction, and stay of agency action against the Biden administration’s 2024 Final Rule implementing Section 1557 of the Patient Protection and Affordable Care Act (ACA), which strengthens protections against discrimination in health care for protected groups and individuals. In the amicus brief, the coalition supports the final rule’s inclusion of sexual orientation and gender identity as forms of sex discrimination and stresses the importance of upholding the nondiscrimination protections of Section 1557 to ensure equitable access to health care for all individuals.

“While some seek to undermine vital health care protections for our most vulnerable patient populations, the Biden administration’s final rule ensures equal and uninterrupted access to health care for all free from discrimination,” said Attorney General Bonta. “We urge the court to consider the serious physical, emotional, and psychological harms stemming from health care discrimination against underserved communities already facing significant barriers in our nation’s health care system. At the California Department of Justice, we will continue to use every tool at our disposal to safeguard the health care rights of all.” 

Section 1557 of the ACA prohibits all health programs and activities receiving federal financial assistance from discriminating against individuals on the basis of race, color, national origin, sex, age, or disability. On June 19, 2020, the Trump administration issued a rule implementing Section 1557, severely narrowing the scope of a 2016 Obama rule by eliminating prohibitions preventing health insurers from discriminating against vulnerable populations, including LGBTQ+ individuals, individuals with limited English proficiency, and women, as well as other protected classes. In response, the Biden administration issued the final rule in April 2024, restoring protections weakened by the previous administration, reducing language access barriers, and expanding accessibility, among other safeguards.

In the amicus brief, the coalition defends the final rule against these challenges, arguing that:

• The amici states’ experience ensuring equitable access to health care for transgender individuals confirms the important benefits of the rule.
• Serious harm would be inflicted on transgender individuals by denying them medically necessary care that protects their physical, emotional, and psychological health.
• The rule's definition of discrimination "on the basis of sex" as including discrimination based on sexual orientation and gender identity is consistent with the statutory text, congressional intent, and Supreme Court precedent.

In filing the amicus brief, Attorney General Bonta was joined by the attorneys general of Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Nevada, New Jersey, New York, Oregon, Pennsylvania, Rhode Island, Vermont, Washington, and the District of Columbia.

A copy of the amicus brief can be found here.