Imagine your doctor prescribing a medication that’s vital to your health, and then finding out your insurance company won’t cover it – and now you can’t afford it.
Recent headlines highlighted an example of this very scenario: an insurance company refused to cover the cost of pre-exposure prophylaxis (PrEP), a treatment regimen that is more than 90 percent effective in preventing HIV-negative individuals from contracting HIV. The insurance company stated in a letter that it denied coverage due to the individual’s “high-risk homosexual behavior.” This is an illustration of just one of the many ways the LGBTQ community faces pervasive discrimination and stigma when it comes to health care. As we observe National Gay Men’s HIV/AIDS Awareness Day on September 27, we are reminded not only of the HIV epidemic that still deeply affects members of the LGBTQ community, but of the importance of access to quality, culturally-competent health care.
LGBTQ individuals face challenges that begin with simply gaining access to health insurance coverage – compared to heterosexuals, LGBT individuals have significantly higher rates of uninsurance. The implementation of the Affordable Care Act (ACA) and Medicaid expansion greatly extended health insurance coverage, but this expanded access is being threatened as recent proposals, such as the Graham-Cassidy bill, threaten to gut Medicaid and repeal the ACA.
Health care providers often deny care as well. According a Lambda Legal survey, almost 8 percent of LGBT respondents reported that they had been denied needed health care outright. Over a quarter of all transgender and gender-nonconforming respondents – almost 27 percent – reported being denied care, and 19 percent of respondents living with HIV reported the same thing.
Even when LGBTQ individuals do receive health services, it’s often inadequate care. Throughout four years of medical school, students receive, on average, just five hours of training on LGBTQ-specific health issues. This is insufficient to educate providers on how to meet the needs of this community. A 2014 Kaiser Family Foundation survey of gay and bisexual men in the U.S. found that 15 percent of them had received poor treatment from a medical professional as a result of their sexual orientation, and 30 percent did not feel comfortable discussing their sexual behaviors with a health care provider.
Additionally, the Human Rights Campaign found that 28 percent of trans individuals surveyed had been harassed in a doctor’s office. LGBTQ youth face these issues as well. Their increased exposure to bullying and stigma may make them less likely to disclose their sexuality to providers and understand how their sexual activity could put them at risk for HIV and STIs.
These negative experiences coupled with rampant stigma in society may make the LGBTQ community less likely to seek care. Regularly visiting a provider means fewer emergency room visits and hospitalizations – the most expensive form of health care delivery. Avoiding health care services also severely hampers our progress in the fight against HIV—an epidemic that has a disproportionate impact on members of the LGBTQ community, especially young men of color who have sex with men and transgender women. Preventing just one new HIV infection can save as much as half a million dollars in estimated lifetime medical costs and taxpayer dollars. If current diagnosis rates continue, half of gay black men and a quarter of gay Latino men will be diagnosed with HIV during their lifetimes. Transgender women are 49 times more likely to be living with HIV than the general population.
It’s imperative that within the health care field we hire, promote, train, and retain LGBTQ staff and people of color. Peer workforce development and educational programs can equip LGBTQ individuals with the ability to connect others to health care and navigate the health care system. Professionals at Amida Care, New York’s largest Medicaid special needs health plan, provide access to respectful, high-quality, culturally competent care, including gender-affirming services, HIV treatment, behavioral health care, and supportive services such as housing referrals and employment programs. These types of holistic, integrated services are essential to quality care.
The LGBTQ community faces numerous barriers that prevent them from accessing essential care. Addressing this issue begins with ensuring that providers are trained to create a more welcoming environment and provide care for the specific needs of this community. When people in the LGBTQ community avoid care, their individual health suffers, public health suffers, and health care becomes more costly. Equitable health care for the LGBTQ community is good for everyone.