Health care has long been a frustrating catch-22 in the LGBT community, perhaps most notably for low income people living with HIV who don’t qualify for Medicaid in most states because they don’t have full-blown AIDS.
That, despite the fact that it would make sense to cover them because with with right drugs and care, their HIV might not advance to the devastating illness at all—and a greater taxpayer expense of treating AIDS could be avoided.
Not anymore under Obamacare.
The new federal health insurance rules that go into effect Jan. 1 will fix that loophole in many states and bring other real benefits for the LGBT community, which has disproportionately high rates of uninsured people, especially among low-income and transgender people.
The national Out2Enroll campaign launches on Friday—which is also National Coming Out Day—to spread the word and urge LGBT people to sign up for Obamacare coverage.
The Affordable Health Care Act has several provisions that will allow more LGBT people to gain medical coverage not only by making private plans more affordable, but also by eliminating key barriers to enrollment in Medicaid, the federal medical insurance program for low income people.
Currently, LGBT people in most states do not qualify for Medicaid because they do not have children or an AIDS diagnosis. In states that are expanding Medicaid under the Affordable Health Care Act, those exclusions will be eliminated.
That could mean health coverage for up to 386,500 LGBT people, according to research by the Center for American Progress, a progressive public policy think tank in Washington D.C. and another sponsor of Out2Enroll.
However, the Center also estimated that the decision by some states not to expand Medicaid will leave an estimated 280,900 LGBT people who cannot afford to buy private insurance without access to any coverage.
Obamacare offers a chance to buy affordable private health policies for same-sex partners who cannot enroll in their partner’s employer-based plan.
“Partner coverage is really challenging for people. Now they have an affordable option,” said Laura Durso, director of LGBT research and communication for the Center for American Progress.
Half of respondents in a recent Center for American Progress survey reported difficulty in signing up same-sex partners in their job-based health insurance.
Participants can choose from four levels of plans. Each plan is required to offer a core package of ten broad categories of medical services with differing monthly premiums and deductibles. Importantly for the LGBT community, non-discrimination provisions in the law will prohibit insurers from witholding benefits or charging higher premiums based on gender identity or health conditions such as HIV/AIDS or cancer.
LGBT people will be eligible for all services that non-LGBT people receive under any plan. Those include prescription drugs, reproductive health care and mental health services, including substance abuse treatment. LGBT people tend to have higher rates of depression and anxiety, making behavioral health parity a key concern, Durso said.
However, states can decide the specific services that are included in those 10 broad categories. It is not yet known how many states will cover services such as gender reassignment surgery, hormone therapy, and fertility treatments and procedures, but if they are covered, LGBT people will be eligible to receive them due to the non-discrimination clause.
“We don’t have completely clear picture yet of what is covered and not covered from state to state,” Durso said.
Activists urge people to check what services are covered in their state. Likewise, people with HIV/AIDS who receive services through federal Ryan White programs or state AIDS drug assistance programs should check with their case managers to determine which plan will best meet their needs.
Out2Enroll sponsors say transgender people are another key target for the campaign. Many transgender people are uninsured because they are not formally employed and face discrimination in getting health care. Besides medical treatments for sex reassignment, they also have a dire need for mental health services due to high rates of depression and suicide.
With the slogan “Be Out. Be Healthy. Get Covered,” Out2Enroll will continue over the coming months via a website, social media and events in areas where surveys have found high rates of LGBT uninsured, such as Florida and Texas.
“We want to make sure our community has a voice and a place to go to answer questions,” Durso said.