Prior to the passage of the ACA, no federal law provided comprehensive protection against sex discrimination in health care. However, proposed rule Section 1557 in the Affordable Care Act is the first federal law to prohibit sex discrimination in health care and also implements prohibitions against discrimination based on race, color, age, and disability. The rule specifically establishes prohibition on gender discrimination including discrimination related to gender transition. The rule also includes requirements for effective communication for individuals with disabilities and language assistance for those with limited English proficiency. This rule will ensure equal access to health care to in order to advance wellness, prevention, and improved access to health care services. The scope of this section protects individuals from discrimination by any hospitals, clinics, employers or insurance companies that receive federal funding and also extends discrimination protection to individuals in any program or activity created under the ACA, including state health insurance exchanges or any federal health program such as Medicare, Medicaid or CHIP. This rule will be enforced by The Department of Health and Human Services Office for Civil Rights (OCR) who also has jurisdiction to oversee and investigate violations and compliances for Section 1557. However, the implications of including an exemption for religious organizations are unknown as the rule would not affect the existing protections for religious beliefs and practices.