Coverage Rates Equalize For LGBT Community, But Disparities Remain

Coverage rates in the LGBT community have improved since the Affordable Care Act went into effect and the Supreme Court ruled on marriage equality, but access to care barriers remain, according to a study published in Health Affairs.

“We found that although insurance coverage increased for all groups during our  analysis period, the change was greatest for partnered LGBT people, and for this group, the gains were driven by an increase in private health insurance coverage. This suggests the importance of dependent coverage,” the researchers found.

“By the end of our study period there was no statistically significant difference in overall insurance coverage rates for LGBT and non-LGBT adults. In fact, after adjustment for demographic variables, coverage was slightly higher for the LGBT group.”

The researchers used Health Reform Monitoring Survey data from 2013 to 2019 to inform their analysis. The data covered almost 136,000 observations of adults between the ages of 18 and 64. Around 7 percent of participants identified as LGBT and this population tended to be younger, part of racial minorities, and in worse health conditions. They were also less likely to be US citizens and less likely to be employed.

Over the course of the study period, coverage rates increased for single and partnered LGBT individuals. In fact, around 2018 the coverage rate for partnered LGBT individuals exceeded coverage rates for both single and partnered non-LGBT individuals.

By the end of the study period, partnered LGBT and non-LGBT individuals both had coverage rates of 92 percent. In the three years from 2013 to 2016 alone, the disparity between partnered LGBT individuals and partnered non-LGBT people dropped 9 percentage points.

Partnered non-LGBT individuals were consistently about 5 percentage points more likely to have coverage than single non-LGBT individuals. Growth in coverage rates among partnered LGBT people outpaced growth among single LGBT individuals.

The coverage gains for partnered LGBT individuals were largely the result of increases in private payer coverage. In 2013, 52.2 percent of partnered LGBT individuals had private coverage. Between 2017-2019, that share increased to 68.0 percent. This growth far exceeded the growth that partnered non-LGBT individuals experienced during the same timeframe.

Access to care improved among all groups during the study time period.

“Over time, the percentage of adults with a usual source of care increased for all groups,” the researchers explained. “The change was significantly larger for LGBT adults than for non-LGBT adults. By 2017–19 there was no statistically significant difference in having a usual source of care.”

LGBT individuals had more trouble paying their bills than non-LGBT individuals and were more likely to skip medical care, prescription drugs, or mental healthcare even though LGBT community members are at high risk for mental health conditions. However, all of these improved between 2013 and the end of the study.

The researchers noted a couple of limitations to the study, namely that the survey format did not distinguish between subgroups of the LGBT community or different racial and ethnic identities, and all the results were self-reported.