Recent changes to U.S. laws, including the implementation of the Affordable Care Act (ACA) and the end of the Defense of Marriage Act (DOMA), may have improved access to health care for lesbian, gay, bisexual and transgender (LGBT) individuals, according to an issue brief released in January by the Henry J. Kaiser Family Foundation. The brief also highlighted the latest health and marriage data among LGBT individuals in the U.S.
According to the Kaiser brief, a 2012 Gallup poll estimates that 3.4% of Americans, or more than nine million people, identify as LGBT. Many LGBT individuals face daily struggles with stigma, discrimination, violence and even rejection by their own families or communities. In addition to these personal struggles, they may also face barriers such as inequality in the workplace and health insurance sectors, substandard health care or denial of insurance coverage.
There are no special circumstances or health issues that pertain only to the LGBT community. That being said, there has been research suggesting that major conditions such as HIV, mental illness and substance abuse are typically significant health concerns for some LGBT subgroups, as are sexual and physical violence. Moreover, a recent literature review found that self-identified LGBT individuals are more likely than heterosexuals to rate their health as poor, have more chronic conditions and have higher prevalence and earlier onset of disabilities. Overall, LGBT people report more asthma diagnoses, headaches, allergies, osteoarthritis, and gastrointestinal problems than heterosexual individuals, according to the brief.
One of the more prevalent health concerns for the community is HIV and sexually transmitted infections (STIs). Within the brief it states that in 2010, men who have sex with men (MSM), while representing an estimated 2% of the U.S. population, accounted for more than half (56%) of all people living with HIV in the U.S., and two-thirds (66%) of new HIV infections. In addition, STI rates are higher among LGBT groups than heterosexuals, and rates have been increasing for some infections.
Recent changes to national policy may help to reverse this trend, the brief suggests. The ACA alone will extend coverage to millions of uninsured persons through the expansion of Medicaid in some states, as well as the creation of new federally subsidized health insurance marketplaces. As of January 2014, individuals can no longer be denied insurance due to a pre-existing condition, such as HIV infection, mental illness or a transgender medical history. Additionally, new private plans are now required to cover recommended preventive services without cost sharing, which would include screenings for HIV, STIs, depression and substance use.
Discrimination, which has played a heavy part in denial of coverage in the past, ideally should no longer be an overwhelming issue. Section 1557 of the ACA prohibits discrimination based on sex, defined to include gender identity and sex stereotypes (but not sexual orientation), in any health program receiving federal funds. Separate federal regulations issued by the Department of Health and Human Services governing the health insurance marketplaces and plans offering the essential health benefits bar discrimination in insurance provisions based on sexual orientation and gender identity. (A separately released issue brief from Kaiser more deeply explores the impact of the ACA on health insurance coverage for HIV-infected people.)
The brief also states that, in addition to the ACA, the end of DOMA has afforded more LGBT individuals with access to health care, by extending access for some LGBT families to a range of benefits, including dependent health coverage and family and medical leave.
In summary, the Kaiser brief suggests that health care access and coverage may be looking much better for the majority of LGBT individuals. However, there is still much research to be done in regards to the outcomes of recent changes in policy. Although health insurance may be more available to individuals, it's unclear how affordable it will be in the long run, since the ACA fluctuates in price depending on the number of individuals enrolled in each specific health care plan.