Repairing Disparities in LGBTQ+ Healthcare-The HSB Blog 6/28/22



OurTake:


With investment in the public and private sphere into programs such as the Affordable Care Act, Medicare/Medicaid, and the adoption of services such as Folx Health’s or Plume’s digital care offerings, the lesbian, gay, bisexual, transgender, queer and others (LGBTQ+) community is being empowered with the healthcare tools they need for healthy lives that begin to address historic disparities in healthcare access and outcomes. LGBTQ+ insurance coverage and healthcare discrimination are two significant issues faced by this community which have seen major improvements over the past several years (although this may come under threat with the recent Supreme Court decision overturning Roe v. Wade).


Many legislative and court victories have established or upheld a variety of new benefits and protections over the past two decades. Although many of these disparities still persist and more effort will be required from public and private stakeholders to properly deal with these issues, cultural attitudes towards the LGBTQ+ community appear to be changing and broad awareness and support of celebrations such as Pride Month seem to indicate a more promising future.


Key Takeaways:


  • 8% of the general population identify as LGBTQ+ according to U.S. Census data.

  • About 20% of LGB and transgender adults respectively lack insurance coverage vs. 12% of the general population according to Jurnal of Public Health Management and Practice

  • Almost 32% of lesbian, gay, or bisexual individuals and 38% of transgender individuals have been diagnosed with a depressive disorder compared to only 16% of the general population according to a New York State Department of Health study.

  • 16% of all LGBTQ+ adults reported experiencing healthcare discrimination according to a 2019 study published in the Health Services Research journal.


The Problem:


The LGBTQ+ community has long been neglected with regard to the availability of culturally competent healthcare. Struggles persist in achieving widespread coverage sensitive to the unique needs of this group delivered in a non-threatening and non-discriminatory manner. For example, data from an article published in the journal of Public Health Management and Practice indicates that LGBTQ+ suffer from greater health insurance coverage issues than the general population, with 17% of LGBTQ+ adults lacking any kind of coverage compared with 12% of the general population.


This disparity is even more apparent among LGBTQ+ adults of color and transgender adults at 23% and 22% without coverage, respectively. Additionally, the prevalence afforded states’ rights in the U.S. policy-making on a national level is disjointed allowing many states to make their own laws that have led to more than half of all U.S. states having no protections for LGBTQ+ inclusive insurance policies. Many more are left with inadequate protections against discrimination based on sexual orientation, gender identity, or both according to a national map of LGBTQ+ healthcare laws and policies by the Movement Advancement Project.


Access to insurance coverage and sexual or identity-based discrimination are undoubtedly the paramount concerns that the LGBTQ+ community faces in trying to ensure they receive proper health care and efforts must be taken to address this. Increased investment in health insurance programs such as the Affordable Care Act, Medicare, or other digital health tools from the private sector has made large strides in helping to address coverage issues. Moreover, new legislation must be passed guaranteeing protections to this already vulnerable community that has faced a long history of oppression and inadequate care.


The Backdrop:


At least 20 million American adults self-identified as LGBTQ+ in 2021, representing nearly 8% of the general population according to U.S. Census data. These numbers have seen considerable increases as more people have gained the confidence to come out publicly as American society has become more accepting of LGBTQ+ individuals, and policies guaranteeing their civil rights have been codified into law. However, many challenges still remain for this community.


The overall state of LGBTQ+ health and availability of healthcare in America is still very poor compared to the general population. For example, a 2020 survey conducted by the NYS Department of Health found that nearly 31.7% of lesbian, gay, or bisexual individuals and 37.8% of transgender individuals have been diagnosed with a depressive disorder compared to only 16% of the general population. The study also reported that these same individuals also noted dramatically higher rates of self-reported mental illness, with the study finding that these same individuals reported rates of self-reported mental illness that were almost double the rate of the general population (24%).


Additionally, LGBTQ+ youth are well documented to have higher rates of substance abuse than do heterosexual youth, and the LGBTQ+ community has long been targeted by tobacco industry advertising and marketing, with higher rates of tobacco usage as well in comparison to their cisgender, heterosexual peers. There is a clear need for quality and affordable healthcare among the LGBTQ+ community that necessitates further attention and investment in order to address these disparities.


Interpersonal discrimination is something that any LGBTQ+ adult will know well, and this problem remains ever-present even while seeking healthcare. 18% of LGBTQ+ adults reported having avoided healthcare due to anticipation of discrimination, along with 22% of transgender adults, while 16% of all LGBTQ+ adults reported actually experiencing discrimination in their healthcare visits according to a 2019 study by the Health Services Research journal.

Nevertheless, changing societal attitudes toward LGBTQ+ individuals and recent legislation guaranteeing certain civil rights to these individuals have led to a brighter outlook for the future. A larger part of America is arguably more accepting of LGBTQ+ individuals than ever, and significant resources are being devoted to ensuring continued improvement in the quality of their care from both the public and private sectors. Investment into government-led health insurance programs like the Affordable Care Act and Medicare has indeed led to the expansion of health insurance benefits to cover thousands more of LGBTQ+ Americans. Given recent court rulings relating to qualifying for these programs as well as the Federal recognition of gay marriage, many protections are now codified into law marking significant headway being made in combating discrimination in healthcare.


Implications:


Recent research into the impacts that increased public and private investment has had on LGBTQ+ healthcare coverage and health outcomes is promising. Affordable Care Act enrollment has been successful in reducing the number of uninsured LGBTQ+individuals. For example, the uninsured rate for LGBTQ+ individuals declined from 34% for low- and middle-income LGBTQ+ adults in 2013 to 26% in 2014 in just the first year of ACA adoption, according to Health Affairs. Similarly, large reductions were seen in states that chose to expand Medicaid coverage, along with substantial improvements in healthcare access. Affordable health insurance options such as these allow the most vulnerable to secure the coverage they need. Guaranteed protection in these public insurance policies can help LGBTQ+ families get the same full family coverage that heterosexual couples are eligible for, including explicit protections on the basis of gender identity and sex stereotypes according to Section 1557 of the Patient Protection and Affordable Care Act. The Office for Civil Rights at the Department of Health and Human Services has also committed itself to investigating and resolve complaints of discrimination regarding LGBTQ+ health care in line with the Biden administration’s commitment to ensuring LGBTQ+ patients can access health care services without fear of discrimination.

The private sector is also heavily involved in helping to address these historic disparities, primarily through the deployment of digital technologies and funding of startups dedicated to addressing the needs of the LGBTQ+ community, healthtech has focused on making healthcare more accessible and ensuring it is delivered in a more culturally competent way.


For example, Folx Health, a startup offering virtual care to LGBTQ+ patients, received more than $25 million in Series A financing in February 2021 allowing them to expand access to their tools so that employers can now offer services such as virtual primary care and telehealth. In addition, Folx offers hormone replacement therapy for transgender employees, and PrEP which helps fight against the risk of HIV transmitted through sex. Including such services in an employee health plan is a significant step forward for normalizing the inclusion of LGBTQ+ health benefits in employer-sponsored health insurance plans.


There are many more companies that offer similar services and could be of immense help to LGBTQ+ individuals in need of accessible and affordable care. Plume, offers a service transgender people can access directly from their phones that allows them to connect with experienced healthcare providers to get hormone replacement therapy services, if medically appropriate, from the comfort of their homes. By reducing the stigma associated with LGBTQ+ specific health issues and making these benefits available through employer-sponsored benefit plans, companies like Folx and Plume will help make this a benefit for all plans. As such, expanding health insurance benefits to include the previously marginalized LGBTQ+ community can go a long way toward addressing LGBTQ+ health disparities, improving mental health, fighting discrimination in healthcare, and improving the attitudes of some caregivers.


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