LGBTQ+ individuals may no longer have a health insurance gap, but still get less medical care

June 19, 2023

Source: Bolibol et al Health Affairs, June, 2023 LINK

Researchers from the Urban Institute report that the disparity in health insurance coverage between adults who self-identified as LGBT was largely erased by 2019. The authors cite two changes that led to this improvement in insurance rates

●      Expansion of coverage through the ACA both through exchange plans and Medicaid, which began in 2014.

●      Marriage equality, based on the Supreme Court’s Obergefell decision (2015) which made it possible for partner coverage for those in marriages that are not between a man and a woman.

The Affordable Care Act (ACA) requirement that those under 26 be covered on their parents’ plan also likely increased the insurance rate in the LGBTQ population, since the rate of self-identification as LGBTQ is higher among young adults. This was implemented in 2011, so any positive impact predated the survey period.

While insurance rates were much improved, LGBT people continued to report less access to care.  For instance, LGBT people reported lower rates of having a usual source of care (64% vs. 70%), and more frequently going without care (21% vs. 14%) and going without prescription drugs (24% vs. 16%) compared to those who did not self-identify as LGBT.

Implications for employers:

-       Access to care (and use of medical care) remains lower among those who self-identify as LGBT.

-       Employers can continue to provide equitable benefit designs, and seek networks that include providers who are sensitive to the needs of various diverse communities.

Tomorrow: Value based payment works best when it’s “high intensity”