LGBT+ People’s Health and Experiences Accessing Care

Key Takeaways

Understanding the health care needs and experiences of LGBT+ people in the United States is important for addressing barriers and facilitating access to care and coverage. We analyzed nationally representative data from a new KFF survey to compare the experiences of self-identified LGBT+ adults to their non-LGBT+ counterparts. Key findings include the following:

• The demographics of the LGBT+ community differ in some ways from that of their non-LGBT+ counterparts, differences that may have implications for health needs and access. Specifically, LGBT+ adults are younger, lower income, and less likely to be married.
• LGBT+ people more commonly report being in fair or poor health than non-LGBT+ people, despite being a younger population, and report higher rates of ongoing health conditions and disability or chronic disease.
• While LGBT+ people are as likely to have a usual source of care and regular provider, and use similar sites of care as their non-LGBT+ counterparts, they were more likely to report a range of negative provider experiences, including being blamed for health problems or having their concerns dismissed. At the same time, LGBT+ people were more likely to discuss certain health and social issues with their providers than non-LGBT+ people.
• LGBT+ people also more commonly report that they or a household family member has had problems paying medical bills in the past 12 months than non-LGBT+ people, and as for non-LGBT+ people, this is a challenge that sometimes impacts their ability to afford basic necessities.
• LGBT+ people’s utilization of health services compared to non-LGBT+ people varies considerably by service type. For example, LGBT+ women were less likely to report having had a recent mammogram or ever had gynecological exam than non-LGBT+ women but LGBT+ people were more likely to report having received other preventive screenings, including for sexual health.
• In some cases, LGBT+ people faced more challenging COVID-related circumstances than non-LGBT+ people, including a higher share of LGBT+ people seeking mental health care because of the pandemic.
• Smaller, but still substantial, shares of LGBT+ women report ever being pregnant compared to non-LGBT+ women, and majorities reported giving birth, though miscarriage was also a common experience.

Introduction

Understanding the health care needs and experiences of the more than 11 million LGBT people in the United States is important for addressing barriers and facilitating access to care and coverage. Studies have found that LGBT+ people experience certain health and access to care challenges at higher rates than their non-LGBT+ peers. Recognizing this, the National Institutes of Health (NIH) has identified sexual and gender minorities as a “health disparity population” to encourage and support research in this area. Health disparities among LGBT+ people can vary across the population and can intersect with factors beyond sexual orientation and gender identity to include race/ethnicity, class, nationality, and age, among other aspects of identity.

Despite some significant progress in researching these issues over the last decade, a recent study found that most population-based research still does not include measures of sexual orientation and gender identity, limiting the ability of policymakers, policy implementers, and researchers to assess national trends, disparities, and identify needed interventions. We sought to add to the knowledge base in this area by analyzing newly available, nationally representative data from the 2020 KFF Women’s Health Survey to compare the experiences of self-identified LGBT+ adults to their non-LGBT+ counterparts.

The survey included measures of sexual orientation and gender identity, as well as other demographic characteristics, and asked about a range of issues from general well-being to experiences engaging in the health system, HIV, reproductive health care, and the impact of COVID-19. The survey, conducted between November and December 17, 2020, included a nationally representative sample of 4,805 people ages 18-64 using an online probability-based panel, including 492 LGBT+¹ people and oversampled lesbian and bisexual women.² (A breakdown of sample size by LGBT+ group is available in the appendix.) Data are representative of people who self-identified as ‘female’ or ‘male’ (regardless of sex assigned at birth) and two separate survey questionnaires were designed for these two gender groups. While we aimed to be as inclusive as possible, we were not able to obtain a large enough sample to support a separate questionnaire focused on non-binary or gender-fluid people. In addition, small sample size limits our ability to report representative estimates of experiences among transgender people.