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A memo signed in April 2011 by President Obama that bans hospitals from discriminating against gay men and lesbians went into effect on Tuesday.

The order prohibits hospitals that accept federal funding from Medicare and Medicaid, the government’s elderly and poor health care programs, from discriminating on the basis of a variety of characteristics, including sexual orientation and gender identity. It also prevents hospitals from denying visitation rights to the partners of gay men and lesbians, and requires officials to honor patients’ wishes of who can make medical decisions on their behalf.