Finding ways to communicate directly with and provide tailored services to lesbian, gay, bisexual, and transgender (LGBT) individuals has been a challenge for managed care organizations, but experts say breaking barriers is imperative. Research indicates that many LGBT patients have had negative experiences with healthcare providers, and that has caused many to stay out of the system.
“LGBT individuals are very likely to have experienced stigma and discrimination in medical settings and as such are often less likely to go to a doctor,” says Julia Applegate, MA, director of the Institute for LGBTQ Health Equity at Equitas Health, a healthcare system known for serving the LGBT community. “LGBT individuals are also disproportionately low-income, which means accessing insurance is often financially impossible.”
In October 2016, the National Institute on Minority Health and Health Disparities (NIMHD) designated sexual and gender minorities (SGM), including LGBT populations, as a health disparity population in order to increase healthcare research.
“Stigmatization, hate-violence, and discrimination are still major barriers to the health and well-being of SGM populations,” said Eliseo J. Pérez-Stable, MD, director of NIMHD, in a statement. “Research shows that sexual and gender minorities who live in communities with high levels of anti-SGM prejudice die sooner—12 years on average—than those living in more accepting communities.”
High uninsured rate
It is difficult to measure how many LGBT individuals have healthcare coverage. The most accurate account comes from married lesbian and gay couples, and people who self-report to studies and polls. A 2014 Gallup poll found that more than 24% of LGBT adults were uninsured prior to the ACA and 17.6% were uninsured after provisions that required coverage took effect. Nearly 30% of LGBT adults reported not having a personal doctor (compared to 21% of non-LGBT adults). The poll also found that 29% of LGBT women reported that they were struggling to afford healthcare or medicine after the ACA.
“Even with the progress that's been made to date, LGBT people remain disproportionately unlikely to be uninsured relative to the general population. So, there's more work to do,” says Katie Keith, JD, MPH, member of the steering committee for Out2Enroll, an initiative launched by the Center for American Progress in 2013 to provide LGBT individuals with unbiased and accurate health reform information. “LGBT consumers are looking for insurance companies and plans that do not discriminate on the basis of sexual orientation or gender identity. This means, for instance, offering plans with family coverage for same-sex couples, making in vitro fertilization equally available to heterosexual and same-sex couples, and including fully transgender-inclusive coverage.”