As issues surrounding healthcare and insurance continue to evolve, members of LGBTQ+ communities may begin to see improvements in a long history of under-treatment and poor treatment. LGBTQ+ Americans have faced a long struggle to get the right healthcare. This struggle intersects with issues such as the training and cultural competency of health professionals and a history of stigma and discrimination against these communities.
While that may be starting to change, there is still a long road ahead. Until there are stronger legislative protections in place and increased training for healthcare professionals, many LGBTQ+ people remain wary.
- There is a long history of LGBTQ+ mistreatment when it comes to healthcare.
- It wasn't until 1987 that the American Psychiatric Association stopped classifying homosexuality as an illness.
- LGBTQ+ people struggle with finding healthcare professionals who understand their specific needs.
- LGBTQ+ people are more likely to put off seeing a doctor than the general population for fear of discrimination/mistreatment.
- The Equality Act, which was passed by the U.S. House of Representatives in early 2021, would put legislation in place to help protect LGBTQ+ healthcare rights; it still needs Senate approval.
LGBTQ+ Healthcare History
Examining the history of the treatment of homosexuality in healthcare illustrates the difficulties members of LGBTQ+ communities have faced in seeking care. Until quite recently homosexuality was considered a mental illness or deviant behavior. That meant that, rather than getting access to medical care, anyone who was found to be homosexual risked being either thrown in jail or into a mental asylum, to be subjected to so-called “treatment” or “rehabilitation” that could include not just psychological treatments such as painful aversion therapy, but also hormonal castration and lobotomy.
As late as 1968, the American Psychiatric Association (APA) listed homosexuality as a mental disorder in its Diagnostic and Statistical Manual of Mental Disorders (DSM). It wasn’t until 1973 that the designation was officially removed from the APA’s DSM. And it wasn’t until 1987 that the APA stopped using “homosexuality” as a diagnosis.
Transgender people weren't alluded to in the DSM until 1980 when "transsexualism" first appeared there. In 1994, the APA replaced "transsexualism" with "gender identity disorder." In the latest DSM, the APA eliminated "gender identity disorder," replacing it with "gender dysphoria" to shift the focus to the mental and physical distress felt by many transgender people.
Even as legal rights for the LGBTQ+ community have expanded, many struggle to find healthcare providers who can competently address their specific issues and concerns. Getting insurance coverage for these issues can also be difficult. Many LGBTQ+ people still face discrimination and may not seek treatment for fear of being mistreated or denied care.
That stress raises the likelihood of depression and anxiety. The 2015 U.S. Transgender Survey showed that some 40% of transgender people attempted suicide in their lifetime. That same survey found that nearly a quarter of transgender people hadn’t sought out medical care over the past year for fear of mistreatment.
As laws continue to evolve and healthcare professionals get the proper training, things are slowly starting to change. In the meantime, it’s important to address the multitude of issues facing the LGBTQ+ community right now.
LGBTQ+ Healthcare: Breaking Down Barriers
Many members of the LGBTQ+ community are hesitant to seek medical care, leaving them at greater risk of depression, anxiety, and a slew of diseases, including cancer and heart disease. One survey showed that more than half of those who identify as LGB said they’d been discriminated against, while nearly 27% of transgender respondents said they were outright denied care.
Even when they had the access to healthcare, 10% of LGBT people said they had been subjected to harsh or abusive language, while others (11%) said there were even some healthcare professionals who refused to even touch them.
These are alarming statistics, but there are organizations working to change that. HealthSherpa, a platform aimed at simplifying the Affordable Care Act enrollment process, put together a list of 20 LGBTQ+ healthcare resources to help ease the stress and anxiety of seeking proper healthcare.
Where to start? First, it’s important to find a doctor who is LGBTQ+ friendly and educated in the specific issues affecting those in LGBTQ+ communities. One of the best (and easiest) ways is through a referral from someone who has already been through the experience. The Gay and Lesbian Medical Association also offers a healthcare provider list that may be useful.
It’s important to be comfortable with whomever you choose. If it’s unclear whether the doctor you chose is well versed in treating the LGBTQ+ community, it’s something to ask when making the initial appointment. For healthcare providers, it’s equally important to be sensitive to LGBTQ+ patients’ needs and feelings, including training staff who interact with patients at every step of the process, starting with scheduling.
Here are a few things members of the LGBTQ+ community should consider:
- Be ready to come out to your doctor. It’s important for your doctor to understand your gender identity and sexual orientation in order to be able to address your specific health needs and risks.
- Be ready with a list of questions specific to your gender identity and sexual orientation. Everyone has different needs at different times. For example, some transgender people may want to discuss hormone therapy and surgery, while other members of the LGBTQ+ community may be more focused on sexual health or mental health issues.
- Mental and physical health. The LGBTQ+ community often faces higher instances of substance abuse, depression and anxiety, and obesity than the general population. Being able to discuss these issues will allow your healthcare provider to give you the right help and advice.
- Sexual and reproductive health. It’s important to be screened for HIV and STDs, alongside prostate, testicular, breast, cervical, and colon cancer if these tests apply to you. Early detection is key to successful treatment. In addition to tests, immunizations for Hepatitis A/B may be necessary as well as for HPV. These are all things that should be discussed with your healthcare provider during your appointment(s).
Insurance Protections for LGBTQ+ People
As the medical field plays catch up, what’s next for LGBTQ+ healthcare rights? Most important: passing legislation that protects the LGBTQ+ community from discrimination.
In addition to healthcare coverage, healthcare insurance is another fraught issue for the LGBTQ+ community. Gaps in coverage mean some members of the LGBTQ+ community may not have access to the care they need. Cost is another major factor, with some studies showing nearly half of LGBT people going without care because they couldn't afford it.
Currently, only 16 states, plus Puerto Rico and Washington, D.C. ,have laws explicitly prohibiting health insurance discrimination based on sexual orientation and gender identity. Put another way: only 42% of the LGBTQ+ population in the United States lives in states that ban health insurance discrimination based on sexual orientation and gender identity.
Momentum began building for private companies to be more proactive about anti-discrimination healthcare policies in 2002 after the Human Rights Campaign Foundation launched its Corporate Equality Index (CEI)—a national survey that measures policies and benefits for the LGBTQ+ community.
In 2008, a number of health associations began issuing strongly-worded anti-discrimination statements, calling for more inclusive insurance policies. As a result, many insurance carriers and companies have started to make changes that protect the healthcare coverage rights of the LGBTQ+ community.
Today, 71% of Fortune 500 companies and more than 91% of those rated by the Corporate Equality Index offer transgender-inclusive health coverage, compared with 0 in 2002.
A 2013 survey of LGBT people living below the poverty level found one in three were uninsured and four in 10 carried medical debt. Fast forward to today: Expansion of the Affordable Care Act and federal marriage equality legislation have both played significant roles in helping secure healthcare insurance coverage for all members of the LGBTQ+ community.
When the Affordable Care Act was first passed in 2010, it included a provision that prohibited healthcare discrimination on the basis of race, color, age, disability or sex. In 2016, the U.S. Department of Health and Human Services took it one step further and incorporated language that expanded the definition of sex to include gender identity and further prohibited blanket prohibition of coverage for gender transition healthcare services.
Despite the Trump administration's efforts to roll back some regulations (specifically related to nondiscrimination), the LGBTQ+ community remains protected from healthcare discrimination after the U.S. Department of Health and Human Services finalized its rules in June 2020 that expanded the definition of what was protected under the nondiscrimination clause of the Affordable Care Act.
Looking Ahead: The Equality Act
And that’s where the Equality Act comes into play. This sweeping legislation would ban discrimination against someone based on their sexual orientation or gender identity across a number of areas, including education, housing, and healthcare.
The bill has passed the House of Representatives and is now in the Senate’s hands. The Equality Act stems from a 2020 ruling (6-3) by the U.S. Supreme Court that stated that firing someone for being gay or transgender was a violation of Title VII of the Civil Rights Act of 1964.
The proposed legislation has widespread support across the nation, with 76% of Americans saying they support laws that would protect the LGBTQ+ community from widespread discrimination. This would include healthcare, which would make a huge difference in insurance issues for LGBTQ+ people.