LGBT community and people with HIV have much to lose in health debate

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All Americans have benefitted from the expansion of healthcare access under the Affordable Care Act (ACA). Sharp annual increases in healthcare costs have been tamed, at least for the last few years.

More than 20 million individuals now have health insurance who didn’t have it before, either because they couldn’t afford it or because they had a pre-existing health condition and were denied coverage.

{mosads}The Kaiser Family Foundation analyzed data from multiple government sources and found that the rate of white non-Hispanic Americans age 0-64 without insurance has been cut from 12 percent in 2013, before key ACA provisions kicked in, to 7 percent in 2015. Among Black Americans the amount of people without insurance dropped from 19 percent to 11 percent, while among Latinos it dropped from 30 percent to 21 percent, and among Asians from 14 percent to 7 percent.


A 2014 Gallup study found that lesbian, gay, bisexual and transgender (LGBT) Americans were more likely to report being uninsured than non-LGBT Americans. Between mid-2013 and early 2015, however, the percentage of LGB adults without health insurance decreased from 22 percent to 11 percent, which is a larger decrease than in the non-LGB adult population.

People with HIV and other chronic diseases have also disproportionately benefitted from the ACA. The U.S. Centers for Disease Control and Prevention and the Kaiser Family Foundation estimate that the percentage of people living with HIV who lacked any kind of health insurance coverage was 22 percent in 2012 and dropped to 15 percent in 2014, following implementation of key elements of healthcare reform. The percentage of PLWH on Medicaid increased from 36 percent in 2012 to 42 percent in 2014. The ACA, and Medicaid expansion in particular, have been very important to covering the healthcare costs and needs of PLWH.

As Congress and the Trump Administration debate what will be included in a new, national healthcare insurance plan, it will be important to include provisions that ensure broad access to healthcare insurance for LGBT people and people living with HIV. The most significant of these provisions are preserving the right to insurance coverage for preexisting conditions, the elimination of lifetime and annual spending limits on health insurance coverage, and continuing the Medicaid expansion.

The 2010 Affordable Care Act implemented broad reforms of the nation’s healthcare system, such as prohibiting health insurers from denying coverage to people with pre-existing health conditions, including HIV. It also greatly expanded access to health insurance for low-income people by permitting states to cover more residents through Medicaid, an insurance program funded jointly by the federal government and states that covers low-income people and those in need, including children and people with disabilities.

Thirty-one states have expanded eligibility for people living with HIV who have not received an AIDS diagnosis, and for low-income individuals without dependent children.

Other essential healthcare provisions for LGBT people and those living with HIV include:

  • Prohibiting anti-LGBT discrimination in healthcare treatment and access

  • Encouraging sexual orientation and gender identity data collection in clinical settings

  • Encouraging cultural competency training to provide affirming care to LGBT patients

It is also critical that access is guaranteed to essential health benefits such as prescription drugs, mental health and substance use treatment, and preventive services such as testing for HIV and other sexually-transmitted infections. LGBT people and people with HIV suffer from higher rates of depression, anxiety, and suicidality.

They also use tobacco, alcohol and other substances at higher rates than the general population. These disparities in health and health outcomes cannot be addressed without access to preventive services delivered by culturally competent healthcare clinicians.

Our healthcare system has made great progress toward better meeting the needs of all Americans, including vulnerable populations. In recent years we have more forcefully challenged racial/ethnic and LGBT health disparities, and new HIV diagnoses are down by 19 percent thanks in part to more people with HIV being in care, on treatment, and virally suppressed. We can’t take our foot off the gas pedal now if we are to achieve health equity and improve health outcomes for all Americans.

Sean Cahill, PhD is Director of Health Policy Research for The Fenway Institute at Fenway Health.

The views of contributors are their own and are not the views of The Hill.

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