Nearly 20 million American adults are members of the LGBTQ community and many face health disparities as a result of social stigma and discrimination.
A 2018 study of 10,000 participants found that nearly 40 percent of LGBTQ individuals lacked basic healthcare access. It also found that LGBTQ individuals were twice as likely as heterosexual and cisgender peers to be unemployed and uninsured.
Fortunately, legislation is in the works to change this and countless healthcare organizations, human rights activists, and community leaders are paving the way to better, more inclusive access to health care. As a result, we're seeing policy changes that can help close equity gaps. But is that enough?
Identifying prevalent social determinants of health in the LGBTQ+ community
LGBTQ+ individuals face many health-related challenges, including barriers to employment, greater risk of homelessness, lack of social programs, and shortage of healthcare providers who are knowledgeable and culturally competent in LGBTQ+ health.
In order to take action to support LGBTQ+ individuals, we must understand the common social determinants that are impacted:
- Housing: Research shows that LGBTQ youth are 120 percent more likely to experience homelessness than their straight peers. Discrimination, family conflict, social rejection, and lack of support programs contribute to this staggering number. Transgender individuals are especially vulnerable to housing insecurity, with nearly 30 percent of the transgender population experiencing homelessness at some point in their lifetime.
- Mental health: Research shows that 48 percent of LGBTQ youth between the ages of 13 and 24 reported wanting mental health counseling in 2020 but were unable to receive it. Forty-two percent of LGBTQ youth also seriously considered attempting suicide and 70 percent reported their mental health as "poor" most of the time or all of the time.
- Employment: Household income is a prevalent concern in the LGBTQ+ community, with so many facing discrimination and harassment in the workplace.
- Food Insecurity: Due to the pandemic, millions of children are facing food insecurity in unprecedented numbers, many of whom are members of the LGBTQ+ community. A recent survey found that 30 percent of LGBTQ youth experience food insecurity and 27 percent have concerns that food at home will run out before their household can buy more.
- Isolation: Older gender minority individuals in the LGBTQ+ community face additional barriers to health care because of isolation, fewer family support, and a lack of social and support services, says the National LGBT Health Education Center.
The LGBTQ+ community is diverse, comprised of individuals of all races and ethnicities, age groups, socioeconomic statuses, and other intersectional identities. This puts many at risk of experiencing more health-related problems.
When we look at the intersection of sexual orientation and gender identity along with another identity, such as race, it's important to see that a unique, distinct experience is at the intersection. Rather than compartmentalizing each identity into its own separate "box," we should look at how these identities intersect and compound.
A study in the American Journal of Preventative Medicine shows that gender minority Black individuals were more likely to report longer periods of being physically or mentally unwell than cisgender Black individuals.
Intersectionality can impact many areas of life. Black LGBTQ youth, for example, face an 83 percent higher risk of experiencing homelessness than LGBTQ youth of other races. In order to provide better care to members of the LGBTQ+ community, we must acknowledge intersectional factors and take individual experiences into account.
The good and bad of federal initiatives and policy changes
The Social Security Act ensures that hormone therapy is now covered by Medicare and Medicaid. Gender-affirming surgeries may also be covered when deemed medically necessary, which is decided on a case-by-case basis. For Medicare to pay for surgery, however, a doctor must make a diagnosis of gender dysphoria or gender identity disorder. Each state has a different set of guidelines that must be followed, too. This can make it challenging, and expensive, for transgender individuals to access care.
While federal policy changes obstructed LGBTQ+ rights during the Trump administration, the Department of Health and Human Services announced in 2021 that prohibitions on discrimination in Section 1557 of the Affordable Care Act would now include the prevention of discrimination on the basis of sexual orientation and gender identity. This is critical to protecting the basic human rights of LGBTQ+ members, but it’s still not enough.
The Equality Act is currently in movement, which would help in many ways to protect LGBTQ+ members. It has passed through the House of Representatives and if it passes through the Senate, then discrimination of sex and gender identity would be prohibited in all major areas of life, including employment, housing, credit, education, public spaces and services, federally funded programs, and jury service.
Progress in anti-discrimination laws for the LGBTQ+ community is being made, but still more work needs to be done. Just this year alone, 250 anti-LGBTQ bills have been introduced in state legislatures, the majority of which would have a tremendous impact on LGBTQ+ youth.
The health of the LGBTQ+ community is at risk and it’s up to government entities, healthcare organizations, businesses, and community organizations to come together to recognize imminent needs.
How to support the health of LGBTQ+ members
Even though health plans now have a lawful duty to offer services without discrimination to LGBTQ+ members, many challenges are still faced. To support LGBTQ+ members and ensure quality care is made available, health plans can implement the following initiatives:
- Make online resources available for LGBTQ+ members.
- Offer guidance on how to find LGBTQ-friendly providers within the network.
- Broaden offerings to support transgender healthcare, which could include transgender-friendly fertility and birthing services.
- Update your online messaging, from your website to your social media, to make sure it’s inclusive of LGBTQ+ members.
- Build partnerships with community-based organizations (CBOs) who offer LGBTQ-friendly social services.
Many health insurance forms also require members to identify themselves as male or female. Instead of offering binary options, health plans should broaden self-identification options to better represent members of the LGBTQ+ community—whether they are transgender, gender-fluid, non-binary, or otherwise. Not only does this express support by understanding how members self-identify, but it will provide health plans more insight into what types of services their members need.
When all members of the healthcare ecosystem work together, real change can be made. Contact us to learn more about Healthify's mission and join us in supporting better health outcomes for all Americans—including those in the LGBTQ+ community.