The Supreme Court's landmark ruling today upholding the Patient Protection and Affordable Care Act (ACA) is a huge win for millions, including lesbian, gay, bisexual, and transgender (LGBT) people and our families. The National Gay and Lesbian Task Force has been a strong advocate for the health-reform law, and this ruling will help ensure that LGBT people and others have access to affordable health-insurance coverage. The ACA has already helped millions throughout the country, and we are thrilled that this ruling will allow the ACA to continue to make a positive difference in people's lives.
While this ruling is a major victory, the Supreme Court did limit a key provision that would have expanded coverage to low-income people through the federal Medicaid program. The high court held that the government is limited in its ability to withhold Medicaid funds from states that fail to comply with the expansion of Medicaid that the law requires. The federal government may, however, use new federal funding as an incentive for states to comply.
This setback will limit the ability to get health-care coverage to those of us who are economically vulnerable. We must continue to press for reform to address this inequity in our health-care system. LGBT people, people of color, and the economically disadvantaged confront multiple barriers to care and are disproportionately affected by poor health outcomes. We are all hampered by systemic, costly discrimination that refuses to recognize our needs or our families.
LGBT people -- particularly LGBT people of color -- are in desperate need of affirmative, comprehensive, and affordable health care, and the Affordable Care Act is an important step to address those needs. According to "Injustice at Every Turn: A Report of the National Transgender Discrimination Survey," a groundbreaking report conducted by the National Gay and Lesbian Task Force and the National Center for Transgender Equality, transgender and gender-nonconforming people systematically lack access to adequate health care because of dire poverty, unemployment, and widespread discrimination in nearly every facet of their lives. "Injustice at Every Turn" found that 19 percent of transgender and gender-nonconforming people said they lack access to any type of health insurance, with 31 percent of black respondents and 36 percent of immigrant respondents reporting that they are uninsured. An astounding half of the respondents reported having to teach their medical providers about basic transgender health care, and the transgender community reports over four times the national average of HIV infection (2.64 percent compared with 0.6 percent), with Latino transgender people experiencing a 10-percent HIV-infection rate and black transgender people a 24-percent infection rate.
Limited access to affordable health-insurance coverage is often linked to poverty and employment, and this is especially true for the transgender community. For most people in the United States, health-insurance coverage is attained through employer-sponsored health plans, yet "Injustice at Every Turn" found that the unemployment rate among transgender and gender-nonconforming people is twice the national average and four times as high for transgender people of color. The high rate of unemployment contributes to the fact that transgender people are four times more likely than their peers to live on a household income of less than $10,000 per year, and 19 percent reported having been homeless at some point in their lives.
The Supreme Court's ruling reaffirms that LGBT people in America should look forward to the implementation of many parts of the Affordable Care Act that were upheld today and that will continue to have a huge impact on the LGBT community. Just some of those provisions include:
- A federal ban on sex-based discrimination in the health-care system for the first time. Because a number of federal agency and court decisions have found that sex-based discrimination includes discrimination on the basis of gender identity and sex-stereotyping, this could have a broad impact on all LGBT people, particularly transgender people.
- State insurance exchanges. States will set up insurance-exchange programs, which are accessible, online programs that give consumers the opportunity to compare insurance coverage and costs and then pick the plan that is best for them. Under federal rules these plans cannot discriminate on the basis of sexual orientation or gender identity.
- Coverage for children under age 26. The ACA requires insurance companies to offer coverage for children under age 26 through a parent's insurance plan. For many young people, especially young LGBT people, this may be their only access to health-insurance coverage.
- Accessible insurance search tools for same-sex couples. Same-sex couples seeking health coverage that is inclusive of domestic partners can now search for such policies at healthcare.gov.
- Improved LGBT-inclusive health data collection. The federal government has begun the process of developing and adding sexual orientation and gender identity questions to national health surveys, to help better understand LGBT health disparities.
- Insurance for adults and youth with preexisting conditions. In 2014 the ACA will prohibit discrimination against adults who have preexisting conditions (the ACA already banned preexisting condition exclusions for children in 2010). This will significantly impact transgender people and people with HIV/AIDS, who are often denied coverage on this basis.
- Increased access to lifesaving preventive care. The ACA will now prohibit insurance companies from charging co-pays on lifesaving preventative services, including mammograms, tobacco-use interventions, cholesterol and high-blood-pressure screening, and testing for sexually transmitted infections (STIs), including HIV/AIDS.
Despite these advances, however, there is still much left to be done. Until all members of our community are given access to affordable and safe health care, advocates should not and cannot stop pushing for full coverage for those that need it most, LGBT or not. It is literally a matter of life or death.
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