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LGBT People And Those Living With HIV Have Disproportionately Benefitted From ACA, Have Much At Stake In Reform Debate 

Friday Mar 10, 2017
LGBT People And Those Living With HIV Have Disproportionately Benefitted From ACA, Have Much At Stake In Reform Debate 

On March 7, The Fenway Institute of Fenway Health released a policy brief outlining the essential elements of a revised national health insurance strategy to ensure that LGBT people and people living with HIV have broad access to health insurance and culturally competent care. LGBT people and people living with HIV have disproportionately benefitted from the Affordable Care Act's expansion of health insurance coverage.

"As Congress and the Trump Administration debate what will be included in a new, national health care insurance plan, it will be important to include provisions that ensure broad access to health care insurance for LGBT people and people living with HIV," said Sean Cahill, PhD, Director of Health Policy Research for The Fenway Institute at Fenway Health. "The most significant of these provisions are preserving the right to insurance coverage for preexisting conditions, continuing the ban on lifetime and annual spending limits on health insurance coverage, and continuing the Medicaid expansion." 

The 2010 Affordable Care Act implemented broad reforms of the nation's health care system, such as prohibiting health insurers from denying coverage to people with pre-existing health conditions, including HIV. It also greatly expanded access to health insurance for low-income people by permitting states to cover more residents through Medicaid, an insurance program funded jointly by the federal government and states that covers low-income people and those in need, including children and people with disabilities. The ACA also allowed for immediate coverage of those living with HIV via Medicaid without first requiring a diagnosis of AIDS.

Key provisions to expand access to private and public health insurance were implemented in 2013. Since then, the rate of uninsurance among lesbian, gay, and bisexual people (LGB) decreased from 21.7 percent to 11.1 percent, which is larger than the decrease in uninsurance among the non-LGB population. 


  (Source:fenwayhealth.org)

The percentage of people living with HIV who lacked any health insurance coverage was 22 percent in 2012 and dropped to 15 percent in 2014, following implementation of key elements of health care reform. The percentage of people with HIV on Medicaid increased from 36 percent in 2012 to 42 percent in 2014, according to an analysis by the Centers for Disease Control and Prevention and the Kaiser Family Foundation.

Other essential health care provisions for LGBT people and those living with HIV outlined in the policy brief titled, "Essential Elements of a Revised National Health Care Policy for LGBT People and People Living with HIV," include:

  • Expanding eligibility criteria for Medicaid
  • Prohibiting anti-LGBT discrimination in health care treatment and access
  • Encouraging sexual orientation and gender identity data collection in clinical settings
  • Encouraging cultural competency training to provide affirming care to LGBT patients

    "It is also critical that access is guaranteed to essential health benefits such as prescription drugs, mental health and substance use treatment, and preventive services such as testing for HIV and other sexually-transmitted infections," Cahill added. "LGBT people suffer from higher rates of depression, anxiety, and suicidality. They also use tobacco, alcohol and other substances at higher rates than the general population. These disparities in health and health outcomes cannot be addressed without access to preventive services delivered by cultural competent health care clinicians."

    The policy brief, "Essential Elements of a Revised National Health Care Policy for LGBT People and People Living with HIV," can be read here.


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