A woman in New Jersey was denied insurance coverage for an annual mammogram despite her plan’s typical coverage for such services. The reason: she’s transgender and her plan denies any coverage related to sex reassignment. She filed a lawsuit and eventually gained access to the coverage afforded to other women after battling the denial of care for two years.
A man in Connecticut was denied the care he sought for a routine procedure by two separate doctors’ offices. The reason: he’s transgender and was asking for a hysterectomy. One doctor deemed the procedure medically unnecessary and the other office would not provide services to transgender patients.
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) people face mountains of barriers in obtaining health care—whether from insurers, employers, or providers. According to the Institute of Medicine, LGBTQ people are more likely, on average, to be without health insurance than the general population, with one in ten reporting being refused medical care outright because of sexual orientation and/or identity. According to a 2010 survey, nearly 30 percent of transgender and gender nonconforming people postponed medical care when they were sick or injured due to concerns about discrimination.
Moreover, people with multiple marginalized identities—in particular queer people of color—face greater discrimination. Nearly one-third of all transgender people of color report being uninsured. And upwards of 24 percent of transgender people of color report being refused medical care because of provider and insurer bias.
But there’s now an opportunity to change these statistics.
HHS recently announced that employers, insurers and providers cannot deny health insurance coverage or benefits based on “gender identity or failure to conform to stereotypical notions of masculinity or femininity.” We believe the rollout of Health Insurance Exchanges stand as an opportunity to level this playing field through decreasing gaps in coverage and ensuring all consumers—including LGBTQ people—have awareness of and access to the care they need.
In fact, there are victories tied to work on Exchanges already worth celebrating. In Colorado, consumer health advocates and LGBTQ advocates successfully partnered to complete an environmental needs assessment to identify current coverage limitations. In Maryland, that same type of partnership has resulted in the state including sexual orientation and identity on their patient satisfaction forms for a new health care program for low-income people. New York has taken this opportunity to ensure their Exchange has an LGBTQ workgroup, with other workgroups standing as allies when advocating for consumer-friendly Exchange principles.
As Exchange development moves along, we’ll also begin to see consumers use Navigators—individuals trained to support Exchange enrollment. By engaging with LGBTQ advocates now, consumer health advocates can help ensure states contract with LGBTQ-friendly non-profits to support consumer access by recognizing disparities, and approaching enrollment with true cultural competency.
Consumer health advocates and LGBTQ advocates are partnering to advance equitable health care through increased access to coverage, public education and consumer engagement, and data collection, by:
1. Increasing Access to Coverage:
- Working with Departments of Insurance and Exchange staff to build strong Exchanges that follow non-discrimination guidelines, and ensuring individuals are not denied access to Exchange coverage on the basis of sexual orientation or gender identity
2. Engaging in Enrollment Opportunities:
- Ensuring state-selected Essential Health Benefit benchmark plans avoid transgender exclusions
- Identifying LGBTQ community-based organizations (CBOs), and even more specifically, LGBTQ Community of Color CBOs, to serve as Assisters and Navigators in the Exchange enrollment process
- Ensuring Navigators and Assistors are trained in LGBTQ cultural competency; Ensuring LGBTQ-friendly language on enrollment forms, such as asking for ‘Adult 1’ and ‘Adult 2’ , and ‘Partner’ to recognize varied types of families
3. Promoting Public Education:
- Developing listening tours to identify health needs from the LGBTQ community throughout Exchange implementation
- Highlighting the ‘Best Practices’ of those employers who have eliminated transgender exclusions, and who provide domestic partner benefits;
- Encouraging comprehensive voluntary data collection –including sexual orientation, gender identity, and relationship status —on enrollment forms and patient satisfaction surveys.