On June 28th, the US Supreme Court upheld President Obama’s Affordable Care Act.
“The decision by the United States Supreme Court is extremely good news for lesbian, gay, bisexual, and transgender (LGBT) Americans, regardless of where they live,” said MassEquality Executive Director Kara Suffredini. “This groundbreaking health care law holds sweeping reforms for LGBT people who face significant disparities in health and care from our nation’s broken health care system. The Court’s ruling to let this law stand means that the important work taking place to rectify those disparities will continue.”
Numerous surveys and studies, including an April 2011 report on LGBT health by the National Institute of Health have documented that LGBT people experience significant gaps in health and care. The Affordable Care Act has put many concrete changes in place to address these disparities, but three of them are particularly critical for LGBT Americans:
The ACA’s Patient’s Bill of Rights will end health insurance industry practices including lifetime limits on coverage and annual limits on coverage. These reforms are critical to those dealing with high medical costs associated with care for HIV and cancer, both of which impact LGBT people at rates higher than the general population. Nearly25% of transgender women are HIV positive. Gay and bisexual men are at least 44 times more likely than the general population to become HIV positive.
LGBT people also experience higher rates of cancer than the general population. The NIH report on LGBT Health definitively states that gay men experience higher rates of anal cancer; lesbian and bisexual women experience higher rates of breast cancer; transgender men experience higher rates of ovarian cancer; and transgender women experience higher rates of prostate cancer than the general population.
The ACA prioritizes building a culturally competent health care workforce by tripling the size of the National Health Service Corps which offers training in cultural competence in the care of LGBT patients. The Journal of the American Medical Association published a study in September 2011 showing that most medical schools spend a range of three to eight hours total over medical students’ entire school careers on health concerns related to lesbian, gay, bisexual, and transgender people. These health issues include higher rates of obesity, drug and alcohol abuse, HIV infection, and cancer than the general population. It is vital that health care providers are comfortable talking openly with LGBT people about what impacts their health.
The ACA permits the collection of demographic data related to health care disparities that will provide vital information to better understand—and eliminate—health care disparities experienced by LGBT people. A July 2009 report by the Massachusetts Department of Public Health found that transgender men and women have significantly worse health outcomes than heterosexual, gay, and lesbian residents of Massachusetts. And only 92.3 percent of transgender residents have access to health care, compared with 97 percent of all state residents. Meanwhile, 17.3 percent of transgender residents report that they do not have a personal doctor.
The 2009 DPH report also found that lesbian and gay adults in Massachusetts are more likely to report being in fair or poor health and being tense or worried as opposed to heterosexual residents; they are more likely to smoke, binge drink, and use illegal drugs than heterosexuals; and they are more likely over their lifetimes to have been victims of sexual assault than heterosexuals.
The Court ruled that implementation of the ACA’s expansion of public insurance coverage through Medicaid can be left up to individual states. Access to Medicaid by lower-income and poor Americans is a critical benefit for hundreds of thousands of LGBT Americans who are un- or underinsured thanks to workplace discrimination and who make lower incomes than they otherwise would because of employment discrimination. It is disappointing that this provision has been left up to individual states and it is vital that the work continues on a state-by-state basis to ensure that affordable and comprehensive health care coverage is accessible.
This provision will not impact LGBT residents of the Commonwealth, who have benefitted from the state’s landmark 2006 health care reform law, which expanded health insurance coverage to lower-income people so that nearly everyone in the Commonwealth now has access to health insurance coverage.
“It is clear that LGBT Americans are at a severe disadvantage when it comes to getting the care they need—and deserve,” said Suffredini. “Today’s decision revives much of the hope that the LGBT community has that the health care system will, at very long last, begin addressing their health care needs.”
