What Healthcare Reform Means for LGBT Communities

by Crystal A. Proxmire

The biggest challenge with healthcare reform is the abundance of rumor and misinformation that is out there. That's why Michigan Consumers for Healthcare and the Center for American Progress are traveling around the state explaining the law to various target communities, including LGBT residents.

Kellan Baker of the Center for American Progress was part of a Feb. 11 outreach held at Oakland University. His presentation outlined many provisions of "Obama Care," a term that the administration is re-claiming as Baker said, "because after all he does care."

Baker explained "almost all individuals must have coverage by January 2014. The way a health insurance system works is if you want it when you're sick you have to pay for it when you're well. Too few people are paying into the system right now." He said there are 1.2 million uninsured in Michigan residents and 50 million across the U.S.

LGBT people face health a number of discrepancies, which the administration acknowledges. They face less coverage, less benefits for partners, no legal protection for employment, increased discrimination, violence, poverty and homelessness. There are many plans that exclude transgender health services. There is also a lack of data, which would inform a basis for funding and targeted services. And there is a problem with health care providers who are not culturally competent in dealing with LGBT clients.

There are ten provisions of the Healthcare Act, which are particularly important to LGBT people.

1. Data Collection

"If there is no data, and you can't show a problem, then there is no problem," Baker said. In 2011 the Department of Health and Human Services announced a LGBT Data Progressive Plan that includes sexual orientation and sexual identity be included in patient forms and surveys.

2. Patient Bill of Rights

The Patient Bill of Rights ends lifetime limits on insurance. It ends rejection based on pre-existing conditions. It ends arbitrary withdrawal of insurance coverage. And it gives rebates if executives spend too much on overhead costs and executive salaries at insurance agencies.

3. Public Coverage Expansion

Medicaid has been reformed and will be setting Medicaid coverage for all individuals making $15,000 or less for individuals and $31,000 for a family of four. Previously it was only available to those who had children or were disabled.

4. Private Coverage Expansion

The Act allows for Federal subsidies for people in the $15,000 - $45,000 income range. Plans cannot discriminate against people based on sexual orientation. The coverage must meet ten requirements: Essential Health Benefits plans must include coverage within the following 10 categories:

1. Ambulatory patient services (for example, walk-in services at community health centers)

2. Emergency services

3. Hospitalization

4. Maternity and newborn care

5. Mental health and substance use disorder services, including behavioral health treatment

6. Prescription drugs

7. Rehabilitative and habilitative services and devices

8. Laboratory services

9. Preventive and wellness services and chronic disease management

10.Pediatric services, including oral and vision care

5. Preventative Care

Health insurance plans are now mandated to cover preventative care, HIV/STD testing, depression screenings, vaccinations, tobacco use screening and cholesterol screenings. The Women's Health Amendment covers contraception and violence screening.

6. Information Services

The bill establishes http://www.healthcare.gov, a website where people can shop for coverage and compare rates. They can even search for health plans that offer domestic partner benefits.

7. Health Care Workforce

Obamacare provides $11 billion to support new community health centers, which will increase access to "essential community providers," including those who use Ryan White HIV and AIDS funding.

The Affordable Care Act also triples the size of the National Health Service Corps, a group that gets specific LGBT competency training.


A big change is the elimination of "medical disability" as the requirement for Medicaid. Previously someone would have to be debilitating ill to qualify for medical care. With Obamacare a person can begin treatment early in their diagnosis, which greatly impacts patient life expectancy. The act also prohibits exclusion based on pre-existing conditions such as HIV/AIDS. The creation of electronic health records system will also streamline the process of understanding a patient and their medical history.

9. Nondiscrimination Protections

The Civil Rights Act, the Americans with Disabilities Act, Age Discrimination Act and Title IX are all tools the government can use to protect LGBT Americans. These include HIV/AIDS status and sex. Baker explained that the Department of Health and Human Services is interpreting these broadly to include LGBT people in sex discrimination cases.

10. Community-Based Prevention

The act has allocated $15 billion in prevention and public health grants, with some granting money going to projects with LGBT communities as a priority population. Baker noted that for every $1 spent on prevention you save $5 in terms of healthcare spending down the road.

11. Marketplaces

Another key thing to know about the new law is the Healthcare Marketplace. In Michigan the marketplace is a partnership between the State and the Federal government where qualified health care plans will be offered. Despite Michigan's ban on marriage recognition, some private health care plans can offer domestic partner benefits.

The marketplace is expected to launch in October 2013, giving residents three months to find insurance to comply with the insurance requirement.

To learn more visit http://www.consumersforhealthcare.org.

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