Health and Access to Care and Coverage for Lesbian, Gay, Bisexual, and Transgender Individuals in the U.S.
Lesbian, gay, bisexual, and transgender (LGBT) individuals often face challenges and barriers to accessing needed health services and, as a result, can experience worse health outcomes. These challenges can include stigma, discrimination, violence, and rejection by families and communities, as well as other barriers, such as inequality in the workplace and health insurance sectors, the provision of substandard care, and outright denial of care because of an individual’s sexual orientation or gender identity.1,2,3
While sexual and gender minorities have many of the same health concerns as the general population, they experience certain health challenges at higher rates, and also face several unique health challenges. In particular, research suggests that some subgroups of the LGBT community have more chronic conditions as well as higher prevalence and earlier onset of disabilities than heterosexuals. Other major health concerns include HIV/AIDS, mental illness, substance use, and sexual and physical violence. In addition to the higher rates of illness and health challenges, some LGBT individuals are more likely to experience challenges obtaining care. Barriers include gaps in coverage, cost-related hurdles, and poor treatment from health care providers.
Several recent changes within the legal and policy landscape serve to increase access to care and insurance for LGBT individuals and their families. Most notably the implementation of the Affordable Care Act (ACA) and the Supreme Court’s overturning of a major portion of the Defense of Marriage Act (DOMA), as well as recent steps taken by the Obama Administration to promote equal treatment of LGBT people and same-sex couples in the nation’s health care system have reshaped policy affecting LGBT individuals and their families. The ACA expands access to health insurance coverage for millions, including LGBT individuals, and includes specific protections related to sexual orientation and gender identity. The Supreme Court ruling on DOMA resulted in federal recognition of same-sex marriages for the first time, which also serves to provide new health insurance coverage options. In addition, President Obama’s administration has undertaken a variety of other initiatives to improve the health and well-being of LGBT individuals, families, and communities.4
This issue brief provides an overview of what is known about LGBT health status, coverage, and access in the United States, and reviews the implications of the ACA, the overturning of DOMA, and other recent policy developments for LGBT individuals and their families going forward.
The authors thank Kellan Baker of the Center for American Progress and Sean Cahill of the Fenway Institute for their thoughtful review and comments.