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How LGBT People Benefit Under the Affordable Care Act

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Over the holidays last year, my partner and I traveled back to my family's home for Christmas. It was the first real opportunity I had to spend time with my entire extended family since I got back into the movement working for the National Gay and Lesbian Task Force.

With a title like "project director," my job can sometimes sound a little less than stimulating, so nobody asks what I do anymore, and I can avoid politically charged conversations. Ironically, when I'm at work I sometimes feel like the most conservative person in the office, but my family sees me as the "wild-eyed lefty with harebrained ideas." I'm neither, in my humble opinion. And they aren't really the reserved, frosty people I sometimes describe them as when stretching the truth for a good story. Sometimes we meet eye-to-eye, and, to my surprise, that's what happened on Christmas morning.

After the nieces and nephews had opened their presents and were running around with lots of noise-making toys (some provided by me), we were sitting around the kitchen table drinking coffee. An extended family member brought up "that health care reform law." Uh-oh, I thought. But then she started telling an anecdote I didn't expect.

A friend's son had graduated from college but couldn't find a job, and he had no health insurance because he had no job. Yet the friend was able to put her son back on her health insurance because of the new health care reform law. My relative hadn't realized this was a change in the law, and she was happy to learn about it.

There are lots of things that people don't know or understand about the health care reform law, known as the Affordable Care Act (ACA). When I was working for a member of Congress during the ACA debates, I fielded lots of calls with questions about what would happen if the measure passed. Will I be able to keep my current health plan? Will I be able to get health insurance more easily even though I have a preexisting condition? Are you really going to ration health care and create death panels?

At the time we couldn't answer most of these questions, because the law hadn't been passed. The exception was the whole rationing-of-care and death-panels thing. That line doesn't even deserve a thoughtful response, so enough said. But now the ACA has passed and it's being implemented as I write.

Most of the changes happening under ACA benefit the general population, but because of the many disparities that lesbian, gay, bisexual, and transgender (LGBT) people and their families face -- in employment, societal misunderstanding or discrimination, and health -- the changes will greatly benefit LGBT lives. Here's just a short list:

  • State Insurance Exchanges: In the state insurance exchanges (think of a plane ticket search site, but for health insurance instead), which will be available in each state, there is a clear and unequivocal rule that you can't discriminate against LGBT people and their families.
  • Insurance for young people: If you have a dependent under the age of 26, or are one yourself, you can add or keep that person on your current health insurance plan. This is especially helpful for young people who are unemployed or underemployed and do not receive health insurance from an employer.
  • Insurance for people with preexisting conditions: A number of provisions in ACA benefit people, at any stage of life, with a "preexisting condition." Because of the law, children 18 and under can't be denied coverage by an insurer. Beginning in 2014, the same will be true for all adults. In the meantime, the Obama administration has implemented the Pre-Existing Condition Insurance Plan program for hard-to-insure adults.
  • Federal assistance for low-income individuals and families: The law greatly expands eligibility for Medicaid, ensuring that more low-income people from all segments of society can access the benefits of Medicaid health insurance coverage.
  • Increased coverage by community health centers: Like the old political adage, health care is often local. Doctors, nurses, and other health care providers living and working in your own community have the best perspective on your health care needs. Under the ACA, community health centers are getting an infusion of much-needed funding to expand coverage and to open in new, and needed, locations.
  • Making insurance premiums go to health care, not salaries and bonuses: One of the most remarkable changes to health insurance coverage under the ACA has nothing to do with you, your doctor, or the health facility you visit. The law says that, for the first time, health insurers must spend most of the premium you pay on actual health care, not on salaries, administration fees, or bonuses. Insurance companies and brokers argued that the commissions earned from selling a health insurance plan should be counted as delivery of health care. The Obama administration, rightfully, said no to this idea. Health insurers must now spend 80 percent (85 percent for larger companies) of your premium on your health care. If they don't, you're owed a refund.
  • Information on domestic partner insurance benefits: Small employers and individuals can now search for insurance plans that offer domestic partner benefits by using tools available at http://finder.healthcare.gov and following the prompts to search insurance plans by state.

These changes to health insurance aren't the be-all and end-all to improving health care for LGBT people and their families. But they do make a good dent in the barriers we face. Increasing access to health insurance, which is the primary way we pay for health care services in this country, is a major and important accomplishment.

The Affordable Care Act does much to increase the rates at which LGBT people and their families, indeed all Americans, are covered for the basics of health care to the catastrophes. There's more work to be done, especially for transgender people, who still find their needs excluded from most insurance plans. But we should take a moment to reflect on the positive step forward that ACA is for LGBT people and their families.

To find out more about the ACA or how to use any of the tools discussed above, visit the government's health care reform website at healthcare.gov.

On March 22, the National Gay and Lesbian Task Force and the Center for American Progress are hosting a free webinar featuring HHS personnel to help ensure LGBT people and their families make the most of health care reform. Register here.