ACLU attorney Jay Kaplan of Michigan Consumers for Healthcare discuss the impact of recent rulings on LGBT people

How Obamacare Affects The Community

Impact Of Affordable Care Act and Medicaid Expansion Discussed, Federal Programs To Benefit Same-Sex Couples

By Crystal A. Proxmire

With the Affordable Care Act (aka Obamacare) soon to be fully implemented and recent changes in policy being approved by many federal agencies in the wake of June's historic U.S. Supreme Court decisions impacting LGBT people, there is a lot to consider when looking at what benefits are now available. On Sept. 21 Affirmations Community Center in Ferndale held a workshop with Ryan Sullivan of Michigan Consumers for Healthcare and attorney Jay Kaplan of the ACLU to help get the LGBT community up to speed.

Sullivan shared Obamacare basics, beginning with online marketplaces that go into effect Oct. 1. He also discussed the recent Medicaid expansion that was approved in Michigan, which will take effect in April 2014. The expansion covers low income individuals and families that didn't qualify previously. A simple video explains what everyone needs to know on YouTube at http://www.youtube.com/watch?v=JZkk6ueZt-U.

Many of the specific needs of LGBT people are now met by the Affordable Care Act. According to Sullivan, 1 in 3 LGBT people is currently uninsured. There are many health disparities in the community, including increased discrimination and violence, risk of homelessness, barriers to benefits like healthcare, marriage discrimination, lack of official data, lack of funding set aside for LGBT-specific research and outreach, and lack of medical professionals with experience in how to interact with LGBT patients.

Sullivan explained that community-based preventions programs would help many low income people and that preventative care would make a huge difference for all patients who took advantage of it. "A lot of things have not been done because there is no profit in it, but there is huge costs saving in it," he said. "The Affordable Care Act makes some of those things possible."

Many insurance plans discriminate against transgender people by having broad exclusions. Unfortunately this will still be the case with many private plans. However, plans that are through the Federal government will not discriminate according to Sullivan.

Legal Decisions Affecting Access To Care

Kaplan explained how the recent U.S. Supreme Court decisions and several federal mandates affect access to care for LGBT people.

"One of the key components of access to healthcare is access to marriage," Kaplan said. "The decision in the Windsor case in June did not strike down the entire Defense of Marriage Act, only part of it. They [The Supreme Court] did not strike down section two that says states do not have to recognize marriages performed in other states."

In Michigan there is a Constitutional Amendment, passed in 2004, that says the state only recognizes the union "between one man and one woman is marriage," or "similar unions for any purpose."

"We have one of the most broadly prohibitive statutes in the country," Kaplan said.

Because of this broad prohibition or "similar unions," legislatures and courts have restricted equal access by LGBT couples to other benefits. "Two years ago the Michigan legislature passed a law that made it illegal for public employers to provide benefits to same-sex partners," Kaplan said.

The ACLU sued over the constitutionality of that law, and Federal Judge Lawson entered a preliminary judgment that states it discriminates, but that is pending a final judgment. Kaplan said they have tried to work with Attorney General Schuette's office, but the state wants to have a full trial to argue the matter. It is expected to take place in April of next year. In the meantime, public employees that do have benefits can continue using them.

Benefits To Same-Sex Couples In All 50 States

One outcome of the recent U.S. Supreme Court cases is the Federal government will now provide benefits to people who have been legally married. However, Kaplan explains, it's still a patchwork quilt, because court cases have not yet defined exactly what that means.

Kaplan said there are more than 1,100 benefits associated with a legal civil marriage, but that some of those benefits are based on the "Place of Celebration," but other programs define marriage as based on your "Place of Domicile."

The Obama Administration has recently said that any programs they have authority over are going to change to make "Place of Celebration" the determining standard to qualify for federal benefits, although it is going to take time for them to go through every program and make those changes.

Some have been made already. The Department of Defense has extended spousal benefits to military personnel regardless of the state they live in. The Federal Government has also agreed to recognize legal spouses of employees regardless of what state they live in. And the IRS will allow same-sex married couples to file taxes jointly in all 50 states.

And just last week the Social Security Administration encouraged LGBT couples to apply for benefits in order to protect their filing date, stating they intend to change from being based on "place of domicile" to being based on "place of celebration."

As far as Medicaid goes, the law is not yet clear according to Kaplan. Medicaid is federally funded, but it is administered by the state. It should be clear soon how this will affect married couples in states like Michigan that refuse to recognize their unions.

The ACLU LGBT Project works to protect and obtain equal rights for residents in Michigan. Check out their website at http://www.aclumich.org/courts/lgbt-project for the latest information. The official source for information on the Affordable Care Act is http://www.healthcare.gov.

The Affordable Care Act has ten key provisions that help the LGBT community:

1. Data collection

2. Patient's Bill of Rights

3. Public coverage expansion through Medicaid

4. Private coverage expansion through the exchanges

5. Preventative care, especially for women

6. Information resources at www.healthcare.gov

7. Healthcare workforce

8. HIV/AIDS care

9. Nondiscrimination protections

10. Community-based prevention programs

The official source for information on the Affordable Care Act is https://www.healthcare.gov/.


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