LGBTQ+ adults have closed health insurance gap, but access to care still lags
Before the federal policy changes, LGBTQ+ adults were less likely than others to have a usual source of care and were more likely to report they went without care for financial reasons.
LGBTQ+ adults remain significantly more likely than others to report going without health care because of the cost, despite closing gaps in the coverage itself.
Although the health insurance landscape has changed dramatically, the drivers of that change also should have reduced barriers for LGBTQ+ people, according to a study from the University of Michigan, Harvard University and the Massachusetts Institute of Technology.
“It is very impressive that in such a short period of time, the disparity in health insurance coverage between non-LGBTQ+ and LGBTQ+ adults has completely disappeared,” said Thomas Buchmueller, a health economist at University of Michigan’s Ross School of Business and the study’s corresponding author. “Although things have improved a lot, a sizable number of people still find it difficult to afford health care. So we still need to focus on how to improve the quality of insurance coverage and bend the health care cost curve.”
Those disparities in access to care have persisted despite the potential for improvements envisioned by Affordable Care Act insurance coverage expansions and the 2015 Supreme Court ruling on marriage equality.
The study notes a crucial feature of the survey typically missing from previous surveys. It includes three questions on sexual orientation and either one or two gender identification questions, depending on the survey year. It compared outcomes for LGBTQ+ and non-LGBTQ+ adults in three distinct periods — before the start of the ACA coverage expansions, the early post-ACA period and the late post-ACA period.
Before the federal policy changes, LGBTQ+ adults were less likely than others to have a usual source of care and were more likely to report they went without care for financial reasons. By the end of the study period, researchers found no statistically significant difference in overall insurance coverage rates for LGBTQ+ and non-LGBTQ+ adults, although persistent gaps in health care access remained.
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Researchers offer several possible reasons for the access gap. LGBTQ+ adults could have enrolled in less-generous plans with higher cost-sharing, and they face greater challenges related to bias, discrimination and stigma, barriers not addressed solely by improving insurance coverage.