After Pride: The Fight for LGBTQ+ Health Equity Isn’t Over

As Pride Month comes to a close, healthcare leaders across the U.S. are reflecting on both the strides made and the challenges that remain in achieving health equity for LGBTQ+ communities.

This year, political shifts at the federal level have heightened concerns, prompting providers, payers and employers to reassess their commitment to inclusive, affirming care.

Health equity for LGBTQ+ individuals is not only a matter of justice—it’s essential for improving population health, protecting mental well-being, and lowering the long-term costs of care across systems.

Policy changes at the federal level have added new urgency.

According to a KFF analysis, the Trump administration has overruled multiple executive orders designed to protect LGBTQ+ rights, including those addressing nondiscrimination in healthcare and education. The White House Gender Policy Council was also dissolved.

The analysis also noted that in May, the HHS released a report questioning the evidence behind pediatric gender-affirming care, and CMS followed with letters to select hospitals requesting data on these services.

The most recent punch to the gut in June is the administration’s initiative to pull the plug on the suicide hotline for LGBTQ+ youth.

Although these moves have been presented as efforts to monitor quality and spending, many see these moves as a calculated step toward restricting care.

This federal activity mirrors the escalating state-level legislation.

As of June 2025, more than 30 states have passed laws banning or restricting gender-affirming care for minors.

In addition, over 540 anti-LGBTQ+ bills have been introduced nationwide—pressuring providers and threatening access.

Within this changing landscape, healthcare leaders are working to close long-standing equity gaps.

Karen Schulte, president of Medicare for SCAN Health Plan, stressed that fear of discrimination continues to prevent LGBTQ+ older adults from seeking care.

Schulte

“One of the most pressing and concerning challenges facing LGBTQ+ seniors today is that roughly 20% report that they have avoided medical care due to fear of discrimination. And this fear isn’t something they imagine. It is based on a long history of being marginalized and not feeling safe or understood in healthcare settings.”

To help address this, SCAN launched SCAN Affirm in 2023—the first Medicare Advantage plan specifically designed for LGBTQ+ older adults, Schulte said.

“While many of this population’s healthcare needs mirror those of other seniors,” Schulte said, “LGBTQ+ individuals often face heightened challenges, such as greater social isolation and limited family caregiving support.”

The plan offers a network of affirming providers, aiming to reduce discrimination and improve engagement in care.

Employers are also being called to act.

Bea Capistrant, vice president of research at Morgan Health, highlighted worsening mental health outcomes among lesbian, gay and bisexual employees, as found in the organization’s systemwide Quality and Outcomes report on employer-sponsored insurance.

Capistrant

She shared that these groups “continue to shoulder a higher mental health burden. More of these individuals experienced depression (from 30% to 37%) as well as serious psychological distress (from 18% to 29%) year-over-year.”

The report revealed that among those who reported having a major depressive episode in the prior year, they had a significant decline in the share of those receiving treatment—from 74% to 54%.

Capistrant added that employers can help by digging deeper into benefits data.

“Understanding where disparities—and gaps in care—may exist is central,” she said. “With those insights, employers will have the opportunity to design more relevant benefits for their employees, such as increased access to behavioral health specialists or family planning support.”

On the ground, community health centers are adjusting to protect care access.

Chris Viveiros, director of communications at Fenway Health, reflected on the last six months in the healthcare landscape.

Viveiros

“In the last six months, we’ve faced dual pressures: increasing political threats to LGBTQ+ healthcare—particularly care for transgender people—and financial constraints that challenge the sustainability of community health centers,” Viveiros said. “This is creating additional stress for a population that already faces challenges accessing the high-quality, culturally competent care that we need and deserve.”

To become part of the solution in this area, Fenway is expanding telehealth and redesigning how patients engage with care.

“This flexible, patient-centered approach is designed to protect access, promote sustainability, and support the longevity of affirming care,” Viveiros said. “It’s a way of honoring our commitment to LGBTQ+ communities while adapting to the realities of today’s healthcare landscape.”

Scout, M.A., Ph.D., executive director of the National LGBTQI+ Cancer Network, highlighted the broader erosion of protections.

Scout, M.A., Ph.D.

“Unfortunately, this year has been more regression on LGBTQ+ health than any year previous. All the federal surveillance has been terminated. 100% of NIH research funding on this topic has been terminated,” Scout said. “Major healthcare agencies are being required to attest they will do no ‘DEI’ work, which is now broadly defined as anything to close gaps for underserved populations.”

Scout also noted persistent structural blind spots.

“I feel like the healthcare industry has more blind spots than not for LGBTQ+ patients. The biggest being that data collection on an underserved population is optional,” he said. “That means we can’t use EHR datasets to track quality indicators for us, we can’t get disease outcome differentials for us, we can’t even figure out patient satisfaction.”

While many institutions are pushing forward, others are facing constraints.

At UPMC, federal guidance has limited the ability to offer certain gender-affirming services.

A spokesperson stated, “UPMC remains steadfast in our commitment to providing exceptional care for all patients. As we continue to monitor executive branch memos, directives, and other guidance from the federal government, these actions have made it abundantly clear that our clinicians can no longer provide certain types of gender-affirming care without risk of criminal prosecution.”

The system continues to provide behavioral health support and other care within the bounds of the law.

Still, many in the field remain committed to progress.

“Pride Month is a meaningful reminder of why we launched SCAN Affirm,” shared Schulte. “Advancing equity in aging includes meeting the unique needs of LGBTQ+ seniors.”

Viveiros added that despite decades of progress, challenges of federal and state governments restricting access to healthcare to these groups, “(attacking) LGBTQ+ and racial justice progress and eliminating protections for transgender and non-binary people across the U.S.” still loom.

However, he remains hopeful.

“LGBTQ+ people have always fought back,” he said. “We have always found ways to thrive, to build community, and to love openly—even when the world said we couldn’t.”

Scout echoed that statement and said, “This year I’m more grateful than ever for all organizations that are continuing to support our communities when we need it the most.”

As Pride Month closes, the fight for LGBTQ+ health equity continues—with urgency, with innovation and with collective resolve.