The Health Care Ruling and Its Possible Impact on LGBT Alaskans

The Supreme Court is expected to decision this week on the 26-state lawsuit against the Affordable Care Act passed by Congress and signed into law by President Obama. In 2010, Governor Parnell added Alaska to the list of states in the lawsuit challenging the constitutionality of the law.

According to the Center for American Progress the following are key provisions in the Affordable Care Act that benefit the members of the LGBT community and could be impacted by the impending Supreme Court ruling.

Data collection to better understand gay and transgender health disparities

According to the law, the secretary of Health and Human Services may collect any demographic data he or she believes to be important for understanding and addressing health disparities. In June 2011 Secretary Sebelius announced a plan for including sexual orientation and gender identity in national data collection efforts starting in 2013, in addition to the law’s required categories of race, ethnicity, primary language, sex, and disability status. The state-based health insurance exchanges, which will sell affordable private health insurance coverage starting in 2014, also offer an opportunity to gather data on the insurance needs and experiences of gay and transgender enrollees.

Patient’s Bill of Rights to end health insurance industry abuses

The new Patient’s Bill of Rights outlaws many of the insurance industry’s worst abuses. It ended lifetime limits on coverage in 2010 and will phase out annual limits on coverage by 2014, both of which are particularly important for people with high medical bills from conditions such as HIV or cancer. As of 2014 it also prohibits insurance carriers from denying coverage on the basis of a pre-existing condition such as HIV or a transgender medical history and from arbitrarily canceling a sick person’s coverage.

Expansion of public insurance coverage through Medicaid

The law sets a new national threshold for Medicaid eligibility. Starting in 2014 adults under age 65 who make less than $15,000 per year will be eligible for Medicaid coverage in every state. These 16 million newly eligible Medicaid beneficiaries will include many gay and transgender Americans and their families, since widespread discrimination in the workplace and in relationship recognition means gay and transgender people are disproportionately likely to have lower incomes and to be uninsured.

In particular, the expansion will benefit those living in the 10 states with the most restrictive current Medicaid eligibility standards, including Texas, Alabama, Arkansas, Virginia, and Louisiana. These 10 states are home to an estimated 1.5 million gay and transgender Americans, many of whom are lower-income African American and Latina lesbian couples raising children.

Expansion of private insurance coverage through the exchanges

The law also requires every state to operate a health insurance exchange starting in 2014. The exchanges will offer subsidies that allow small employers and individuals who make between $15,000 and $43,000 per year to purchase affordable private coverage. Exchanges may not discriminate on the basis of sexual orientation or gender identity in any of their activities, and all exchange plans must offer comprehensive benefits across 10 essential health benefit categories, including prescription drugs, hospital stays, and mental and behavioral health services.

Coverage of preventive care

Under the Affordable Care Act, all Medicare beneficiaries receive free annual checkups, and insurance companies may not charge co-pays or other fees for preventive services that are recommended by the U.S. Preventive Services Task Force. These services include HIV and other sexually transmitted infection testing, depression screening, vaccinations, tobacco-use screening, cholesterol and high-blood-pressure screening, and other services of particular importance for gay and transgender people. The Women’s Health Amendment also requires insurers to cover comprehensive preventive services for women, including contraception, intimate-partner violence screening, and annual well-woman visits.

Easy-to-find information about health reform for consumers

The website—one of the consumer-friendly reforms the law requires—is the one-stop shop the Department of Health and Human Services maintains for all things related to health reform. The site offers a wide range of information about the law, including a Health Plan Finder tool that allows consumers shopping for coverage to compare plan details such as cost-sharing and benefit design in order to choose the option that best meets their needs.

Same-sex couples, many of whom do not have access to health insurance through their own or their partner’s employer, can use a built-in filter to find plans offering coverage for domestic partners. The exchanges may also offer relevant information to gay and transgender consumers through outreach and enrollment mechanisms such as websites, phone services, and navigator programs.

A diverse and culturally competent health care workforce

The law prioritizes building a culturally competent and diverse health care workforce, with a particular focus on primary care providers. The law triples the size of the National Health Service Corps, which places newly trained health care providers in underserved areas around the country, and the corps is offering gay and transgender cultural competence training to its members.

In addition, an $11 billion fund supports new community health centers and expansion of existing centers, and several centers that historically focus on serving the gay and transgender population have already received grants. The law also requires the exchanges to ensure access to community health centers and essential community providers, including Ryan White Providers for HIV/AIDS care.

Services for people living with HIV or AIDS

A major aspect of health reform is making prescription drugs more affordable, which will help seniors and people living with HIV or AIDS afford the medications they need. The law phases out the Medicare Part D “donut hole” (the gap in insurance coverage for prescription drugs) by 2020, and requires pharmaceutical companies to provide a 50 percent discount on brand-name drugs in the donut hole. To connect people living with HIV to health coverage and services, the law:

  • Prohibits insurers from using pre-existing condition exclusions and charging higher premiums based on health status starting in 2014
  • Removes the requirement that people with HIV have an AIDS diagnosis before they can qualify for Medicaid coverage
  • Promotes patient-centered medical homes in which providers work together to coordinate high-quality and timely care for people with chronic conditions

Nondiscrimination protections

The Affordable Care Act extends federal nondiscrimination protections under the Americans with Disabilities Act and the Rehabilitation Act, which protect individuals living with HIV or AIDS, and Title IX of the Education Amendments of 1972, which offer protections on the basis of sex. A national trend in case law interprets Title IX to include gender identity and sex stereotyping, though not sexual orientation. The Equal Employment Opportunity Commission also recently ruled under Title VII of the Civil Rights Act that discrimination on the basis of gender identity constitutes sex discrimination.

Community-based prevention programs

According to the National Prevention Strategy, “all Americans should have the opportunity to live long, healthy, independent, and productive lives, regardless of their … sexual orientation or gender identity.” To support this goal the law created a $15 billion Prevention and Public Health Fund to fund new public health initiatives such as the Community Transformation Grants program at the Centers for Disease Control and Prevention. In 2011, 61 communities and states received $103 million to fight leading causes of illness and death for 120 million people, and several of these grantees included the gay and transgender population as a priority. Another round of Community Transformation Grants will be awarded this fall.

Now that you know a little more about the potential impact of the Supreme Court ruling coming down soon, we ask you to share this with your friends on Facebook, email and other social media so they also can learn about this groundbreaking legislation.

For more information about Center for American Progress, please visit their website.

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