This blog is part of a series that will highlight how structural racism in the health care system negatively affects the health of individuals of color. Community Catalyst is committed to exposing and dismantling policies, practices and attitudes that routinely produce cumulative and chronic adverse outcomes for people of color in the health system.
While LGBT Pride celebrations are in full force, LGBT people continue to remain deeply concerned about federal attempts to curtail health access, equal rights and non-discrimination protections that are moving forward on many different fronts. Repealing the Affordable Care Act would remove rules that protect LGBT people from discrimination in health care settings. LGBT immigrants in particular fear the Trump Administration’s plans to deport millions and restrict health services, and Congressional leaders are introducing legislation to restrict health care access to immigrants.
As social justice advocates challenge the administration on immigration, health and equality, it is important to understand the communities tangled within systems of oppression – racism, homophobia, transphobia, xenophobia – to ensure advocacy strategies are inclusive of and responsive to the needs of the most vulnerable. When discussing how health policies impact LGBT people, we assume all LGBT people are citizens. When we implement strategies to conduct outreach to immigrant communities, we forget that there are immigrants who identify as LGBT. LGBT immigrants have unique experiences due to their immigration status, sexual orientation and gender identity. Health advocacy strategies and policies must reflect these experiences to promote health equity and reduce health disparities for LGBT immigrants.
The US is home to approximately 904,000 LGBT immigrants. Nearly one-third (267,000) are undocumented. While the uninsured rate for LGBT people has dropped under the ACA, LGBT immigrants are largely restricted from accessing health coverage and continue to have one of the highest uninsured rates.
LGBT immigrants, like LGBT people overall, are at risk for negative health outcomes such as alcoholism, depression and cancer due to stigma and stress associated with discrimination. HIV is also a growing epidemic within immigrant communities. Mental health issues are also common due to constant fear of being deported and detained. Trans immigrants, for example, are mistreated and discriminated in detention centers with no access to appropriate health services. Plus, President Trump’s Muslim ban has threatened the lives of LGBT and HIV-positive refugees seeking asylum who are stuck in regions that criminalize homosexuality. President Trump recently announced he would keep the Deferred Action for Childhood Arrivals (DACA) program, but 36,000 LGBT DACA recipients still fear he will abolish it over time and trigger their deportation.
The intersecting systems of oppression behind the exclusion of LGBT immigrants from health coverage deepens negative health outcomes. LGBT immigrants have little to no options for accessing prevention services. While states such as California and New York have enacted coverage expansions for young low-income immigrants, undocumented and “DACAmented” LGBT immigrants are excluded from purchasing ACA plans and enrolling into Medicaid or CHIP. LGBT mixed status families in states that have not adopted the Legal Immigrant Children’s Health Improvement Act (ICHIA) must wait five-years before being eligible to enroll. Homophobia and transphobia within the health care system also keeps LGBT immigrants from accessing health services and widens health disparities. Trans immigrants have reportedly been refused care by their providers due to their gender identity.
Advocates could take following steps to undo the systems of oppression facing LGBT immigrants.
- Promote LGBT cultural competency training for health care-related students and professionals to eliminate discrimination in health care settings.
- Collaborate with and support LGBT and immigrant rights organizations.
- Support campaigns that aim to protect the privacy of immigrants access health services.
- Join efforts to expand health coverage opportunities for undocumented and DACAmented LGBT immigrants.
- Build meaningful relationships with state and local groups to foster community dialogue and raise awareness about LGBT-specific issues.
As LGBT immigrant communities continue to live in fear amidst leaked executive orders and anti-immigrant rhetoric, it will be critically important for advocates to use an intersectional lens to engage community members experiencing multiple levels of discrimination who are at most risk of losing any access to health coverage and care.