“The Affordable Care Act may represent the strongest foundation we have ever created to begin closing LGBT health disparities.”
— Secretary of Health and Human Services Kathleen Sebelius
The Affordable Care Act is the most significant reform of the U.S. health system since the creation of Medicare and Medicaid in the 1960s. The law’s impact will be especially profound for lesbian, gay, bisexual, and transgender people, who are poorly served by many parts of our current system.
In a recent speech at the first-ever White House LGBT Health Conference, Health and Human Services Secretary Kathleen Sebelius noted, “When this Administration took office, the health care system wasn’t working for a lot of Americans. But it was especially broken for LGBT Americans. ... that wasn’t right. All Americans, regardless of where they live or their age, sex, race, sexual orientation, or gender identity, have a basic right to get the care they need.”
Here are the top 10 ways the Affordable Care Act benefits gay and transgender Americans.
1. Data collection to better understand LGBT health disparities
According to Section 4302 of the Affordable Care Act, the secretary of health and human services may collect any demographic data that she or he believes to be important for understanding and addressing health disparities. In June 2011 Secretary Sebelius announced a plan for including sexual orientation and gender identity in national data collection efforts starting in 2013, in addition to the law’s required categories of race, ethnicity, primary language, sex, and disability status.
2. Patient’s Bill of Rights to end insurance company abuses
The new patient’s Bill of Rights in the Affordable Care Act outlaws many of the insurance industry’s worst abuses. For instance, it ended lifetime limits on coverage in 2010 and will phase out annual limits on coverage by 2014, both of which are particularly important for people with conditions such as HIV or cancer. As of 2014 it also prohibits insurance companies from denying coverage on the basis of a pre-existing condition such as HIV or a transgender medical history and from arbitrarily canceling a sick person’s coverage.
3. Expansion of public insurance coverage
The Affordable Care Act sets a new national threshold for Medicaid eligibility. Starting in 2014 every adult under age 65 who makes less than $15,000 per year will be eligible for Medicaid coverage regardless of which state he or she lives in. This group of newly eligible Medicaid beneficiaries will include many gay and transgender people and their families, since widespread discrimination in the workplace and in relationship recognition means that gay and transgender people are disproportionately likely to make less than $15,000 per year and to be uninsured. The new national eligibility threshold also eliminates the disability requirement for Medicaid coverage for people living with HIV.
4. Expansion of private insurance coverage
The law also requires every state to put in place a health insurance exchange starting in 2014. The exchanges will offer subsidies that make it possible for small employers and individuals who make between $15,000 and $43,000 per year to purchase affordable private coverage. Exchanges may not discriminate on the basis of sexual orientation or gender identity in any of their activities, and all exchange plans must offer comprehensive benefits across 10 essential health benefit categories, including prescription drugs, hospital stays, and mental and behavioral health services.
5. Coverage of preventive care
Under the Affordable Care Act all Medicare beneficiaries receive free annual checkups, and insurance companies may not charge copays or other fees for preventive services that are recommended by the U.S. Preventive Services Task Force. Of particular importance for gay and transgender people, these services include HIV and other sexually transmitted infection testing, depression screening, vaccinations, tobacco-use screening, and cholesterol and high blood pressure screening. The law’s Women’s Health Amendment also requires insurers to cover comprehensive preventive services for women, including contraception, intimate-partner violence screening, and annual well-woman visits.
6. Easy-to-find information about health care reform and you
This website (also in Spanish), which was one of the consumer-friendly reforms the Affordable Care Act required, is the one-stop shop the Department of Health and Human Services maintains for all things related to health care reform. The site offers a wide range of information about the law, including a Health Plan Finder tool that allows consumers shopping for coverage to compare plan details such as cost-sharing and benefit design in order to choose the option that best meets their needs. Same-sex couples, many of whom do not have access to health insurance through their own or their partner’s employer, can use a built-in filter to find plans offering coverage for domestic partners.
7. A diverse and culturally competent health care workforce
The Affordable Care Act prioritizes building a culturally competent and diverse health care workforce with a particular focus on primary care providers. The law triples the size of the National Health Service Corps, which places newly trained health care providers in underserved areas around the country, and the Department of Health and Human Services is offering LGBT cultural-competence training to corps members. What’s more, a new $11 billion fund supports new community health centers and expansion of existing centers, and the law requires the exchanges to ensure access to “essential community providers,” including community health centers that have expertise providing care to underserved populations such as the gay and transgender community.
8. Services for people living with HIV or AIDS
A major aspect of the Affordable Care Act is making prescription drugs more affordable, which will help people living with HIV or AIDS afford the medications they need. The law phases out the Medicare Part D “donut hole” by 2020 and requires pharmaceutical companies to provide a 50 percent discount on brand-name drugs in the donut hole. It also allows ADAP, or the AIDS Drug Assistance Program, contributions to count toward Medicare Part D’s True Out of Pocket Spending Limit, which will help people with HIV move out of the donut hole more quickly. To connect people living with HIV to health coverage and services, the law prohibits insurers from using pre-existing condition exclusions and charging higher premiums based on health status starting in 2014, removes the requirement that people with HIV have to wait for an AIDS diagnosis before they can qualify for Medicaid coverage, and promotes patient-centered medical homes in which providers work together as a team to coordinate high-quality and timely care for people with chronic conditions.
9. Nondiscrimination protections
Section 1557 of the Affordable Care Act extends federal nondiscrimination protections to the health care system for the first time. These protections include the Americans with Disabilities Act and the Rehabilitation Act, which protect individuals living with HIV or AIDS, and Title IX of the education amendments of 1972, which offer protections on the basis of sex. A national trend in case law interprets Title IX to include gender identity and sex stereotyping, though not sexual orientation. The Equal Opportunity Employment policies at several federal agencies, including the Department of Health and Human Services, also include gender identity under sex protections.
10. Community-based prevention programs
According to the National Prevention Strategy, which was created under the Affordable Care Act, “all Americans should have the opportunity to live long, healthy, independent, and productive lives, regardless of their … sexual orientation or gender identity; geographic location; or other characteristics.” To support this goal the law created a $15 billion Prevention and Public Health Fund that will fund new public health initiatives such as the Community Transformation Grants program at the Centers for Disease Control and Prevention. In 2011, $102 million was awarded to 59 communities and states to fight leading causes of illness and death for more than 115 million people, and several of these grantees included the gay and transgender population as a priority population.
Despite the media storm of misinformation and vicious partisan politics surrounding the Affordable Care Act, many of the law’s reforms are already making a difference in the lives of gay and transgender Americans—and many more benefits are still to come. The initial rollout of Affordable Care Act reforms before 2014 is just a starting point for a long-term process of turning our “sick care” system into a true health system that provides all Americans with the opportunity to build healthy lives, families, and communities. We should all be fighting to protect it.
Kellan Baker is a Health Policy Analyst at the Center for American Progress.