28 Yale J.L. & Feminism 243 (2016-2017)
Trans/Forming Healthcare Law: Litigating Antidiscrimination under the Affordable Care Act

handle is hein.journals/yjfem28 and id is 251 raw text is: 









Trans/Forming Healthcare Law: Litigating
Antidiscrimination Under the Affordable Care Act

Wyatt Foret



ABSTRACT: Although section 1557 of the Affordable Care Act outlaws sex
discrimination in healthcare, its statutory language does not by itself articulate
which actions may give rise to cognizable claims of discrimination. Further, the
final rule implementing section 1557 confirms the recent trend in which courts
recognize that anti-transgender discrimination is inherently discrimination on
the basis of sex. This Article stands at the crossroads of these two doctrinal
developments, and articulates what sorts of theories of discrimination are
cognizable for transgender plaintiffs under the Affordable Care Act. It does so
by looking to the text of the statute and final rule, as well as reasoning by analogy
from existing antidiscrimination law.


IN TRO D UCTION ................................................................................................ 244
I. T HE STATUS Q UO ......................................................................................... 245
II. THE ACA AND ILLEGAL DISCRIMINATION ................................................. 246
       A. The Mechanics of the ACA's Antidiscrimination Provision .......... 247
       B. Current Limitations of Section 1557 ............................................... 249
III. FRANCISCAN ALLIANCE V. BURWELL ...................................................... 251
IV. LEGAL THEORIES OF HEALTHCARE DISCRIMINATION ............................ 258
       A. Section 1557's Implied Cause of Action ........................................ 259
       B . D enial  of  C are  ................................................................................. 26 1
       C. Anti-Stereotyping and Constructive Denial of Care ....................... 262
       D . H ostile  Care  Environm ent .............................................................. 264
 C O N C LU SION   ................................................................................................... 269





    1  Many thanks to Professor Ellen Katz, Kate Gilbert, Katherine Klem, Nikita Mehta, Tamina
 Daruvala, Conor Ahem, Daniel Halainen, Sanya Kumar, Kelsey Gann, Kayla Oliver, Caroline Wilson,
 Leah Scaduto, Claudia Wack, Laura Hsu, Adrian Gonzalez, Aislinn Klos, Nicole Brambila, Yena Lee,
 and Catherine McCarthy for their helpful comments on this article.


Copyright © 2017 by the Yale Journal of Law and Feminism

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