« June 2013 Issue

Advancing Health Equity for LGBT Americans through the Implementation of the Affordable Care Act

After years of small, incremental changes to our health system, the ambitions of the ACA are to fully transform how health care coverage in the U.S. is purchased, regulated and designed. In addition to this essential overarching goal -- the chance for millions of uninsured people to finally have quality, affordable health insurance -- there are hundreds of other equally important, population-specific opportunities within the law to change or align old systems with new realities. One of the most important areas for realignment lies with the Lesbian, Gay, Bisexual and Transgender (LGBT) community.

LGBT Americans, like many other marginalized communities, are affected by disparities that make it difficult to obtain quality, affordable health care coverage. Research shows that LGBT Americans are more likely to live in poverty in comparison to general population, putting them at a socioeconomic disadvantage. Coupled with discrimination on the part of insurance companies and employers, LGBT Americans have some unique barriers to accessible, affordable health care coverage. In addition to these systemic disadvantages that affect many LGBT individuals, there are financial burdens specific to same-sex couples and families. Federal laws, such as the Defense of Marriage Act (DOMA), meant that same-sex couples paid higher taxes than heterosexual couples, and many times employers will not offer health care coverage to a same-sex partner, when they will offer it to a heterosexual spouse. Finally, even when LGBT people have coverage, it can be a challenge to find providers who are without prejudice and understand how to deliver culturally competent care.

With these facts and realities in mind, it is particularly powerful that the ACA will make coverage more affordable for LGBT Americans and shape the system to be responsive to the specific needs of LGBT families and individuals. Yet while much the law goes a long way to improving the overall picture, there is still a need for advocacy to ensure implementation works for LGBT people. To contribute to this goal, Community Catalyst is partnering with a group of national organizations, including the Center for American Progress (CAP), the Trimpa Group, and Raising Women's Voices, to advocate for ACA implementation that serves the values and needs of LGBT individuals and families. This partnership has three top priorities: ensuring non-discrimination in state-based, partnership and federally-facilitated Marketplaces, shaping consumer assistance programs (such as Navigators) to be culturally competent, and influencing the design of the essential health benefits package so it works for the LGBT community.

According to Kellan Baker, Associate Director of the LGBT Research and Communications Project at CAP, the intersection of LGBT issues and health care was a natural fit for working together. "LGBT health is an LGBT equality issue, and it's also about health equity. The partnership between CAP's LGBT Progress team and Community Catalyst brings together LGBT and health advocates on both the state and national levels to fight for the health care that LGBT people and their families need."

Working together with our national partners, Community Catalyst is providing state health advocates with policy and advocacy expertise in a wide range of states, including Michigan, New Jersey, Georgia, Colorado, and New York. As a result of these partnerships, we are already seeing progress.

In Colorado, our partners at Colorado Consumer Health Initiative have been working closely with One Colorado, the statewide LGBT advocacy organization, to advance non-discrimination in health insurance. Together, the organizations have been advocating for the inclusion of coverage for transgender Coloradans in the state's Marketplace.

As Dede de Percin, the Executive Director of the Colorado Consumer Health Initiative says, "Everyone should be able to get the care they need, when they need it; access to coverage and care shouldn't be denied based on who you are. We are working with our state regulators and insurers to make this a reality for all, including transgender Coloradans."

Colorado is joined by several other states where Community Catalyst works - California, Oregon, Washington D.C., and Vermont - in pushing forward this sea change to ensure LGBT equity for all consumers.

In addition to progress in the states, the issue is gaining traction nationally. In March, Community Catalyst Deputy Director Susan Sherry participated in a panel at the Center for American Progress for LGBT Health Awareness Week, called "A New Era of Inclusion: How to Address LGBT and HIV/AIDS Issues in Health Reform Implementation." These developments make it clear that the timing is right for the ACA's LGBT equity policies to take hold.

Fortunately, there was a huge victory for the march toward equality this week as the U.S. Supreme Court declared the Defense of Marriage Act (DOMA) unconstitutional. While we are still sorting out what this means  for LGBT Americans in terms of health care and the ACA, our work with national and state partners will continue. We will be persistent in our aim to strengthen polices in the ACA so that LGBT individuals and their families may better access health insurance coverage and comprehensive health care.

O N   T H E   W I R E

Jessica Curtis, Hospital Accountability Project director, told the Associated Press that hospitals continue to use unfair billing and debt collection practices, despite Affordable Care Act Provisions.

Jacquie Anderson has been promoted to Chief Operating Officer. Jacquie previously served as Director of State Advocacy. She has been with Community Catalyst for more than 15 years and brings more than 20 years of experience working with community organizations.

Community Catalyst released a report assessing the economic viability of midlevel dental providers. Midlevel dental providers practicing in Alaska and Minnesota cost their employers less than 30 percent of the revenue they generate.

The Prescription Access Litigation Project led a successful campaign urging the Supreme Court and Congress to end to pay-for-delay deals between brand name and generic drug manufacturers that prevent consumers from getting timely access to affordable prescription drugs.

Christine Barber, senior policy analyst, explained in The New York Times that given the high number of people unaware of their new health care options, advocates, providers and other stakeholders must work together to make enrollment a success.

In April the Community Catalyst Board and members of the staff joined together to celebrate the contributions of outgoing Board member and longtime supporter, Stephen Rosenfeld. Steve has been and continues to be a leading and powerful advocate for consumers in the health care reform movement.

In May, current Board member Wendy Warring and her husband Troyen Brennan hosted a fundraiser in their home in support of Community Catalyst. The event was a tremendous success and we are grateful to Wendy and Troy for their care and generosity.

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