While much of the news coverage of the Affordable Care Act (ACA) has focused on the bipartisan bickering and controversy surrounding its passage and subsequent attempts to repeal it or challenge it in court, the benefits for the health of the nation are generally overlooked. In particular, there has been little focus on the ACA's benefits for people who are lesbian, gay, bisexual or transgender (LGBT).
Recent data show that there are about 9 million LGBT people in the United States, accounting for roughly 3.5 percent of all Americans. Thanks to research at The Fenway Institute and elsewhere, we know that there are several specific health disparities that affect our community. LGBT people smoke at rates 70-percent higher than the general population. Gay and bisexual men, especially those from communities of color, are disproportionately affected by HIV/AIDS, accounting for roughly half of the 1.2 million Americans living with the virus and 66 percent of new infections in 2010. Transgender women have the highest prevalence of HIV of all population groups. Lesbians and transgender people are less likely to access preventive health care. LGBT youth have an elevated risk for homelessness, suicide attempts, and depression, and sexual minority youth report higher rates of substance use than heterosexual youth.
Lack of access to health care has been a major contributing factor to LGBT health disparities. Research has found that lesbians and transgender people are less likely to have health insurance. Thousands of same-sex partners in dozens of states were stripped of employer-provided health insurance when anti-gay family measures were enacted outlawing public-sector domestic partner benefits. Private insurance companies have historically discriminated against gay men and same-sex couples, and many deny coverage for preexisting medical conditions like HIV. One quarter of people with HIV are currently uninsured. This includes many gay and bisexual men and transgender women. Medicaid currently does not provide coverage for single individuals or families without dependent children, which is why the Medicaid expansion to all earning up to 133-percent of the federal poverty level is so important.
The Affordable Care Act will improve access to health care for LGBT people in five important ways:
- Nondiscrimination protections: Public and private health insurers are prohibited from discriminating on the basis of sexual orientation, gender identity or HIV status.
- Insurance market reforms: The Patient's Bill of Rights phases out annual and lifetime limits on coverage, ends preexisting condition exclusions, and ends arbitrary rescission of insurance coverage. These protections are especially important for transgender people and people living with HIV/AIDS.
- Prevention and wellness: Certain preventive services particularly important to LGBT people will soon be covered by insurance as Essential Health Benefits, including HIV testing, depression screening, and tobacco use screening.
- New coverage options: Subsidies will allow millions of working-class people, including LGBT people, to afford to buy health insurance for the first time.
- Data collection: The ACA authorizes the Secretary of Health and Human Services to expand the collection of sexual orientation and gender identity data on national health surveys that help us better understand LGBT health and prioritize spending and research priorities.
Thanks to the Affordable Care Act, partnered LGBT people in the 38 states that don't recognize same-sex relationships will have more affordable insurance options. Screening for HIV and sexually transmitted infections should become more accessible, routine and widespread. Health insurers won't be able to drop coverage just because someone is transgender or attracted to a person of the same sex. Low-income, uninsured LGBT people in the states that go along with Medicaid expansion will be able to access Medicaid coverage for the first time. And our community's unique health care needs will be documented by the federal government so that we can better understand and address them.
The Affordable Care Act is not going to solve all the problems plaguing the American health care system. It has gaps. For example, the ACA protects transgender people against discrimination in health care, but not lesbian, gay and bisexual people. A sexual orientation nondiscrimination regulation is needed. But the ACA represents a huge step toward addressing inequities in health insurance coverage and connecting millions of Americans, including LGBT Americans, to the health care they and their families need to live healthier, happier lives.
Follow Sean Cahill, Ph.D. on Twitter: www.twitter.com/FenwayHealth