Living and Wellness LGBT Guide to Health Care in the US By Health Care Reform, March 28, 2015 With the passage of the Affordable Care Act (ACA), more Americans have access to affordable health insurance than ever before; however, certain populations in the United States face additional issues accessing and using health care. One such population is the lesbian, gay, bisexual, and transgender (LGBT) community. Health Issues in the LGBT Community The LGBT community has similar health issues to non-LGBT Americans; however, discomfort with public perception, poor treatment by health professionals, and other barriers can prevent community members from receiving the health care they need. The LGBT community has a higher instance of some illnesses. The HIV epidemic continues to disproportionately affect gay and bisexual men. Lesbians and bisexual women report poorer overall health and higher rates of asthma, headaches, allergies, and other issues. LGBT individuals are more likely to face violence – the FBI reports that one in five hate crimes in 2011 were due to sexual orientation bias. LGBT individuals, particularly those within the bisexual community, have a higher instance of being victims of sexual violence. Mental health continues to be a serious concern among the LGBT community. Stigmas and prejudices against sexual and gender minorities have a dramatic effect on LGBT Americans, especially among youths. Parental rejection of LGBT youths can increase the likelihood that they will suffer from depression, use drugs, engage in risky sexual behavior, or attempt suicide. Improvements in Access to Health Care for LGBT Individuals LGBT access to health care is shaped by a number of factors, including: Federal and state laws affecting health insurance Compensation and benefits Marriage laws The passage of the Affordable Care Act in 2010 and the overturn of the Defense of Marriage Act (DOMA) in 2013 improved access to care in the LGBT community. In addition, states and private organizations have moved to expand non-discrimination policies to include LGBT individuals. The ACA improved access to health insurance for LGBT individuals and families in the same way it assisted all Americans. Health insurance is available for the uninsured through state marketplaces, and financial assistance is available based on income level. Medicaid eligibility is also expanding in many states, which helps lower-income Americans of any orientation or gender. Unfortunately, bias and discrimination in health care is a reality for many LGBT individuals. The elimination of the pre-existing condition exclusion was a major help, as carriers can no longer use this to eliminate care for existing physical and mental health needs. Additionally, the state marketplaces cannot discriminate based on sexual orientation or gender identity. Eight states have non-discrimination policies along with the federal law. Legislative Impact on Health Care for LGBT Americans The DOMA ruling had a major impact on access to health care in the LGBT community. In the 35 states plus D.C. that legalized gay marriage, a married same-sex partner can be added as a dependent on individual and group health coverage the way heterosexual spouses can be. Health insurance issuers cannot discriminate against same-sex spouses in employer insurance. Due to the Employee Retirement Income Security Act (ERISA), which governs benefits of private employers throughout the U.S., same-sex couples enjoy the same health benefits of spouses of the opposite sex. However, because ERISA does not impact those who work for state or local governments or a church, some employers still have discretion over what insurance plans they offer to staff. The DOMA and marriage rulings also had a major impact on LGBT individuals’ ability to access care for their families and same-sex partners. Visiting loved ones in the hospital was often denied to same-sex families, but in 2011, government regulations outlawed this discrimination. Regulations in process may require medical providers to recognize a same-sex spouse as a patient representative in discussing care. The changes of the ACA and the overturning of DOMA have a positive impact on LGBT access to care. Over time, it’s hopeful that this increased access and reduced discrimination will be beneficial to overall quality of health in the LGBT community.