Payer Health Equity Elusive for LGBTQ+, But Improvements Are Ahead

Members of the LGBTQ+ community reported varying experiences of discrimination in the health insurance industry but indicated that payer health equity may be improving, according to a survey from Healthcare.com.

The 520 survey respondents identified as bisexual (40 percent), gay (30 percent), lesbian, (12 percent), queer (2 percent), pansexual (5 percent), asexual (4 percent), and unsure or questioning (2 percent) individuals, and other (4 percent). A little over one percent of the respondents (seven individuals) identified as transgender men and less than one percent identified as transgender women (four individuals).

The main results indicated by the survey stated that one in eight LGBTQ+ individuals reported facing discrimination.

One in three said that insurance coverage is improving for the LGBTQ+ community, but six in ten are not certain they will be able to receive gender-affirming medication. Additionally, three in ten are shouldering medical debts of more than $1,000.

In reviewing the results, researchers noticed that lesbian and gay individuals reported levels of discrimination of 8 percent and 4 percent, respectively, which is lower than the 12 percent of the entire population.

Although the survey results showed that a share of participants across every surveyed sexual orientation saw improvements in payer health equity, inequities still exist.

Age also played a significant role in levels of discrimination. Nearly a quarter of millennials (22 percent) reported facing discrimination, which was higher than the 20 percent of Gen Z, the 3 percent of Baby Boomers, and the 11 percent of Gen X.

Despite these negative results, the survey expressed a sense of encouragement regarding the portion of respondents that indicated payer health equity was improving for the LGBTQ+ population. Although many respondents (44 percent) were neutral, 32 percent indicated that they think improvements are occurring. Thirteen percent stated that payer health equity is worsening.

Researchers noticed that lesbian (33 percent), gay (39 percent), and bisexual (45 percent) people were more likely to indicate that coverage has been improving.

Researchers noticed that the most common type of coverage was Medicare, which covered 33 percent of survey participants.

Additionally, the results noted that 39 percent of survey participants were in medical debt.

Although the survey reported somewhat positive indications for the future, there were many negative aspects of healthcare delivered to the LGBTQ+ community. The researchers stated that these results could inform future policymaking and interventions to address the lack of payer health equity.

In the past, various projects sought to improve care access for the LGBTQ+ community while eliminating discrimination.

In October 2021, Colorado announced that it would add LGBTQ+ care as an Affordable Care Act marketplace essential health benefit. The statement shared that, beginning on January 1, 2023, small group health insurance markets would be required to cover care for LGBTQ+ people.

In January 2022, a report from the Association for Community Affiliated Plans indicated that Medicaid had plans to improve health equity for members of the LGBTQ+ community. Medicaid would cover gender-affirming services and targeted member services for the needs of the community and would promote partnerships between payers and providers who specialize in care for LGBTQ+ individuals.