Obamacare Enrollment for LGBTs

Despite significant social, political, and legal gains in the last few decades, lesbian, gay, bisexual and transgender Americans have long lagged behind their straight and cisgender counterparts when it comes to physical and mental health.

Due to factors ranging from increased risk of violence and homelessness to the decreased likelihood of having adult children or other family members to assist with health care late in life, LGBT people are disproportionately affected by tobacco and drug use, HIV, depression and suicide, other mental illness and even cancer.

Hoping to utilize the implementation of the Affordable Care Act to close the "health care gap," the National LGBT Health Education Center at The Fenway Institute has partnered with the Center for American Progress to release a guide detailing best practices for health care providers to increase LGBT enrollment in health insurance under the ACA as well as improving overall health.

The guide, titled "Optimizing LGBT Health Under the Affordable Care Act: Strategies for Health Centers," details five areas in which the ACA can help LGBT Americans better access health care, including data collection, nondiscrimination protections, prevention and wellness, insurance market reforms, and new coverage options.

Experts have long been aware that LGBT individuals are disproportionately likely to face a variety of health issues and have reduced access to care, but quantifying the problem has been difficult, because so little hard information is available. Under the ACA, the Department of Health and Human Services will be required to collect information on sexual orientation and gender identity on federal population health studies. This data should help HHS identify specific areas of concern related to the LGBT health care gap so as to begin working on solutions.

The ACA will also implement nondiscrimination requirements to prevent insurers from refusing to cover individuals because they are lesbian, gay, bisexual, or transgender, or from offering benefits that discriminate based on sex, gender identity, sexual orientation, or preexisting health condition. Individuals who experience discrimination from their insurers, or while trying to enroll in coverage, can file a complaint with their Marketplace or with the Department of Health and Human Services' Office of Civil Rights (although the OCR's web site does not currently list sexual orientation or gender identity in its categories for which a discrimination complaint may be filed).

In particular, being transgender can no longer be considered a preexisting condition and grounds for refusing or revoking coverage, although insurance plans are still not required to cover transition-related care. The end of preexisting condition exclusions will also be a boon for individuals living with HIV/AIDS, a population that disproportionately includes LGBT people, and particularly LGBT people of color. Additionally, people who have had gender transitions will no longer be able to have their coverage revoked on the basis of fraud or intentional misrepresentation, and they cannot be denied preventative screenings appropriate to their anatomy, regardless of the gender listed on their insurance plan.

The Affordable Care Act designates prevention as an "essential health benefit," and requires most insurance plans to cover many preventative services and screenings with no co-pay. This will impact LGBT individuals in a range of ways that may help close the health care gap. For instance, data from the California Health Institute Study indicated in 2009 that LGBT adults were more likely to be diagnosed with cancer, and less likely to get cancer screenings such as mammograms. Making these services, as well as STD and HIV tests, mental health care screenings, and other preventative care available for low or no cost should help alleviate disparities in LGBT health outcomes.

ACA Lets LGBT Couples Receive Family Subsidies

Lack of recognition for same-sex relationships and families has been a long-standing barrier to accessing healthcare for LGBT individuals. Under the Affordable Care Act, married same-sex couples will be able to receive health insurance marketplace subsidies as a family, regardless of whether the state they live in recognizes their marriage, and Healthcare.gov has a filter that allows couples to search for plans in their area that offer same-sex domestic partner benefits.

Another common obstacle to obtaining health care for LGBT individuals is the fear -- or reality -- of encountering insensitivity and discrimination in a health care setting. Along with detailing specific ways in which the ACA benefits the LGBT community, the guide offers suggestions for health centers hoping to improve outreach to LGBT individuals. These tips include offering free or low-cost services that address those individuals' specific health needs, such as counseling services, HIV and STD testing, and hormone therapy; developing and displaying comprehensive nondiscrimination policies; and training staff to deal with LGBT individuals and their particular needs in a sensitive and culturally competent manner. If implemented on a broad scale, these guidelines could make health centers more welcoming and result in more LGBT people enrolling in and using health coverage, leading to better health outcomes overall.

A recent study by the Center for American Progress indicated that low-income LGBT people, particularly transgender people, were likely to be uninsured and to feel "stressed, frustrated, worried, and overwhelmed" by the prospect of shopping for health coverage. Understanding the benefits and subsidies available, and having access to knowledgeable, culturally competent insurers and health care providers, is crucial to obtaining better health outcomes for LGBT individuals. More detailed explanations, and help enrolling in coverage, can be found at out2enroll.org. The ACA takes key steps toward closing the health care gap, but it is up to individuals and communities to continue working toward a healthier future for all Americans.