Nondiscrimination Under the Affordable Care Act

Abstract

The Affordable Care Act (ACA) includes expansive consumer protections on nondiscrimination. Prior to the ACA, federal and state law included some nondiscrimination protections, but most have had only a limited effect in ensuring that coverage meets the needs of all consumers. Through its broad incorporation of new standards, the ACA is designed to address this gap by prohibiting discrimination based on health status, disability, age, race, gender, and sexual orientation, among other factors. Yet, there are significant questions about how new nondiscrimination requirements are being implemented in practice. This report explores how stakeholders are grappling with these new protections as insurers design and market new products, regulators review and approve products, and consumers look to obtain coverage that best meets their needs.

Our findings suggest that new nondiscrimination standards have not significantly changed the way that state regulators or insurers approach benefit design and that regulators face practical limitations in trying to implement these requirements. Further, some regulators may not be willing to assume a much broader role in defining discriminatory benefit design without clearer federal standards. In light of such limitations, ensuring that the ACA’s nondiscrimination standards are met likely requires ongoing monitoring of consumer complaints, the development of new infrastructure such as tracking systems, robust grievance and appeals processes, and clarification of federal requirements.