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LGBT community eyes PPACA’s anti-discrimination provisions

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Equal access to Obamacare for all Americans – including lesbians, gays, bisexuals and transgenders.

It’s a tall order, but ensuring it happens is now part of the mission at the U.S. Health and Human Services Office for Civil Rights. The agency is a nearly $40 million operation that historically has investigated discrimination charges against hospitals and other providers in cases that typically involved the disabled or minorities.

By year’s end, if not before, the OCR will detail just how it plans to go about doing its new job of helping LGBT Americans gain equal access to the benefits outlined in the Patient Protection and Affordable Care Act (PPACA).

Once it does, one of the more important battles in the fight for LGBT rights in the United States will have been won, at least on paper.

“Significantly, this is the first time that sex discrimination in health care is prohibited by a national civil rights law,” HHS noted in its budget paperwork in early April.

PPACA is unequivocal on this point, promising health care regardless of race, color, national origin, disability, age or gender.

“Health is an LGBT equality issue,” said Kellan Baker, associate director for LGBT research and communications at the Center for American Progress. “If we don’t have our health, we don’t have anything. I would say that the ACA and the changes at HHS are some of the most significant opportunities for LGBT equality that we have seen in a long time.”

Hashing out just how to make it all work will be top of mind for the OCR in coming months. There will be a series of “listening sessions” before the final rules are crafted.

Equal rights are of keen interest to many Americans, but among those “listening” most intently are those in the LGBT community. Employers, insurers and the benefits community at large are paying close attention, too.

As advocates will point out, 51 percent of small business offer coverage to same-sex partners of employees, and more than 60 percent of Fortune 500 companies do the same. PPACA promotes the expansion of these practices and authorizes the coming insurance exchanges to offer coverage that includes same-sex couples and their children.

The health system’s problems can be especially pronounced in the LGBT community, advocates say, and discrimination that’s based on real or perceived sexual orientation or gender identity is commonplace.

Access to health care services, including preventive care such as cancer screenings, are a huge part of the problem.

According to a 2011 report from the Center for American Progress, gay men and lesbians experience elevated rates of certain cancers, including breast cancer, melanoma, and non-Hodgkin’s lymphoma, because of the difficulty they have in accessing health care. Also, lesbian and bisexual women are at greater risk than heterosexual women for chronic diseases linked to smoking and obesity.

The Center for American Progress is a left-leaning group, leaving it open to attack by skeptics. But its statistics about the health of the LGBT community are viewed as reliable as anyone else’s, albeit incomplete.  

The problem with LGBT health statistics in general is that, while there are more than 9 million Americans who identify as LGBT, federal and state governments have not routinely collected data on people’s sexual orientation or gender identity.

That started to change in January of this year, when the federal government began to collect sexual orientation on its most important health assessment tool, the National Health Interview Survey. But there’s a long way to go before enough of this data is collected, and doing so won’t be easy.

Based on the numbers that are available, the National Academy of Sciences, in a report released in 2011, agreed that gay and transgender people often face “barriers to equitable health care” and receive substandard care when they seek it.

“Fearing discrimination and prejudice,” it said, “many lesbian, gay, bisexual and transgender people refrain from disclosing their sexual orientation or gender identity to researchers and health care providers.”

In addition, its report said, many doctors lack the necessary training. “Medical schools teach very little about sexuality in general and little or nothing about the unique aspects of lesbian, gay and bisexual health,” it said.

PPACA will mean not only new nondiscrimination protections but, perhaps most critically, coverage for many in the LGBT community as a result of the expansion of Medicaid.

The law ended annual and lifetime coverage limits, eliminated pre-existing condition exclusions and closed the “donut hole” in prescription drug coverage under Medicare Part D. 

But historically, obtaining health insurance has been tougher for the LGBT population. Mainly, that’s because those in the community, faced with persistent workplace discrimination and harassment, have been more likely to lose or quit their jobs, to be employed in lower-wage jobs with no benefits, or to not be hired in the first place, according to advocates.

Also, many workplaces still do not provide health insurance benefits for the same-sex domestic partners of their employees.

All of this explains why the LGBT community has been a big supporter of Obamacare.

Looking ahead, the HHS Office of Civil Rights is now responsible for enforcing Section 1557, the nondiscrimination provision in the Affordable Care Act.

To help it do that job, the office sought $42.2 million in funding for 2014, an increase of $1.2 million.

Hopes are high that the money comes through, but apprehension is running high, too.

In part, that’s because as states finalize the details of benefit plans and packages expected to be sold on the coming insurance exchanges, or marketplaces, the question is just how much variation might be seen between plans.

One big variable already identified clearly: While many of those with HIV live in the nearly 30 states that have either already opted for Medicaid expansion under PPACA or are in the process of doing so, there are many more who live in states still sitting on the sidelines.

And then there’s the concern shared by all — whether the exchanges will be up and running in October.

“That’s not a long time from now and we’re talking about millions of people who will need help figuring out how to enroll themselves and their families. It’s a real complicated challenge,” Baker said.

It’s a sentiment that helps explains another concern running through Baker’s head: 

“We really are looking forward to seeing some strong implementation of Section 1557 of the law.”

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