Which of the following would be considered permissible under Section 1557?
Permissible actions are non-discriminatory ones: recruiting a diverse workforce, community-based marketing that does not target or exclude by protected class, and providing auxiliary aids such as large-print or braille materials and interpreters. Refusing an applicant by race or charging women higher copays is prohibited.
The answer
Under Section 1557 of the Affordable Care Act, the actions that are permissible are the ones that do not discriminate on the basis of a protected characteristic, and especially those that promote equal access. Typical permissible examples on this exam include:
- Recruiting a diverse workforce or conducting community-based marketing that reaches broad populations without targeting or excluding people by a protected class, and
- Providing auxiliary aids and services to people with disabilities or limited English proficiency, such as large-print or braille documents, qualified sign-language interpreters, and language-assistance services.
Section 1557 is the ACA's nondiscrimination provision. It prohibits discrimination in health programs and activities that receive federal financial assistance on the basis of race, color, national origin, sex, age, or disability. Anything that treats people equally, or actively removes barriers for protected groups, is permissible; anything that denies, limits, or charges more because of a protected characteristic is not.
Why the other options are wrong
The distractors are all forms of prohibited discrimination:
- Refusing to accept an application because of the person's race is direct race discrimination, prohibited.
- Charging women higher copays or premiums than men for the same service is sex discrimination, prohibited (Section 1557 was a major driver of ending sex-based rating).
- Denying coverage or services because of national origin or disability, or failing to provide meaningful language access, likewise violates the law.
- Marketing designed to discourage or exclude sicker or older enrollees is prohibited discriminatory marketing.
Each of these singles out a protected class for worse treatment, which is exactly what Section 1557 forbids. The permissible answer, by contrast, is the option describing equal treatment or the provision of accommodations.
The bigger picture
The way to reason through any Section 1557 scenario is to ask two questions: Does the action treat someone worse because of a protected characteristic (race, color, national origin, sex, age, disability)? If yes, it is prohibited. Does it instead provide equal access or a needed accommodation? If so, it is permissible, in fact often required. Providing auxiliary aids for disabled patients and language assistance for those with limited English proficiency are not just allowed; the law affirmatively requires covered entities to offer them. That is why an option about supplying braille, large print, or interpreters is the safest "permissible" choice, while any option that refuses, limits, or up-charges based on who the person is falls on the prohibited side.
| Recruiting a diverse workforce | Permissible | Promotes equal access; no protected class harmed |
| Providing braille / large-print materials | Permissible (required) | Auxiliary aid for disability access |
| Offering interpreters / language assistance | Permissible (required) | Meaningful access for limited-English patients |
| Refusing an application because of race | Prohibited | Race discrimination |
| Charging women higher copays than men | Prohibited | Sex discrimination |
| Marketing that discourages sick or older enrollees | Prohibited | Discriminatory targeting by age/health |
Frequently asked
What does Section 1557 prohibit?
Section 1557 prohibits discrimination in health programs and activities receiving federal financial assistance on the basis of race, color, national origin, sex, age, or disability. This includes denying services, limiting coverage, or charging more because of a protected characteristic.
Who is covered by Section 1557?
It applies to health programs and activities that receive federal financial assistance, health programs administered by HHS, and the health insurance marketplaces. Covered entities include most hospitals, clinics, insurers, and providers that accept federal funds such as Medicare or Medicaid.
What are the protected classes under Section 1557?
The protected bases are race, color, national origin, sex, age, and disability. These mirror longstanding civil-rights statutes (Title VI, Title IX, the Age Act, and Section 504) that Section 1557 incorporates into the health-care context.
Is charging different copays by sex allowed?
No. Charging women higher copays or premiums than men for the same service is sex discrimination and is prohibited under Section 1557. Ending sex-based differences in cost-sharing and rating was one of the provision's central effects.
What auxiliary aids does Section 1557 require?
Covered entities must provide appropriate auxiliary aids and services for people with disabilities, such as braille, large-print materials, and qualified sign-language interpreters, as well as language-assistance services like qualified interpreters and translated materials for people with limited English proficiency.