Health care discrimination is not new, and the negative health impacts are well documented for some minority groups in the United States, especially Black, Indigenous and People of Color communities. While health care discrimination is also common against lesbian, gay, bisexual, transgender, queer/questioning, and other identified (LGBTQ+) individuals, the consequences are less clear.
Expectedly, there is significant evidence of health care discrimination against the LGBTQ+ community. A national study found that, in the past year, 47% of LGBTQ+ respondents were refused care from a provider and more than 20% were denied insurance coverage on gender-affirming care (e.g., hormone therapy, reconstructive surgeries).
What’s more, different states have different protections for LGBTQ+ individuals against health care discrimination. Given the diversity, I was curious to see if health outcomes also differed from state to state. Below is the research I found. Surprisingly, there isn’t much available.
Tennessee (TN): Minimal Protections
Laws
TN remains one of 27 states where there are no LGBTQ+ inclusive insurance protections. Additionally, state Medicaid policy and state employee benefits have explicitly excluded gender-affirming care and coverage since at least 2014. There also exists a recent for pre-pubescent minors, and State Senate and House leaders plan to expand it to include pubescent minors in their first bill of 2023.
Evidence of Health Outcomes
One study from 2021 found that LGBTQ+ Nashvillians were more likely to report unmet medical needs and repeated mental distress than their non-LGBTQ+ peers, due in large part to high prescription costs from being uninsured.
Nebraska (NE): Partial Protections
Laws
44% of Americans live in states without nondiscrimination protections and NE is one of them. While NE does not ban hormone treatment for minors, it has explicitly excluded it and gender-affirming surgery for state employees and those eligible for Medicaid since at least 2014.
Evidence of Health Outcomes
A 2016 study of over 400 Nebraskans found reduced rates of depression and suicide in transgender and gender non-conforming patients who had trans-inclusive health care providers. This mirrors national trends as well.
California (CA): Full Protections
Laws
Having the most legal protections, CA explicitly prohibits insurance discrimination, covers gender-affirming surgery and hormone therapy, and is the only sanctuary state for minors seeking gender-affirming medical care.
Evidence of Health Outcomes
This year, the UCLA Center for Health Policy Research found that although LGBTQ+ Californians are now insured as much as or more than their non-LGBTQ+ peers, there are still delays in accessing prescriptions and care.
Implications
Surprisingly, the data above is all I could find on health care discrimination and health outcomes for LGBTQ+ individuals. Given the significant research on barriers to health care and the resulting physical and mental health disparities among other minority groups (e.g., higher rates of illness and death across various conditions), I expected to find more.
Even more surprising, there were no studies to report on health outcomes in the most restrictive states (e.g. Arkansas, Arizona), nor in Alabama where gender-affirming medical care for minors is considered a felony crime.
Despite the minimal data available on impact, we do have enough evidence that health care discrimination exists within the LGBTQ+ community and that is enough to try to stop it.
At the federal level, the Department of Health and Human Services is currently trying to update the Affordable Care Act to include nondiscrimination protections for sexual orientation and gender identity. It’s not finalized yet though, as public comment in the upcoming months will determine whether this revision is adopted.
At the state level, the midterm elections will present another opportunity to address LGBTQ+ inclusive health care, as several candidates are running based on their opposition to it.
- In Florida, the Governor seeking reelection is currently working with the Florida Board of Medicine to ban puberty blockers, hormone therapy and gender-affirming surgery for minors.
- In Texas, the Governor seeking reelection has directed the state to conduct child-abuse investigations on parents providing gender-affirming care to their LGBTQ+ children.
- In Pennsylvania, some Governor and Senate candidates have platforms that incorporate openly supporting conversion therapy.
Plus, on the ballot in Nevada is a question asking voters whether or not their state should guarantee equal rights based on sexual orientation and gender .
While evidence is still thin on the health outcomes associated with health care discrimination against LGBTQ+ patients, there’s plenty to indicate that health care discrimination is happening. And plenty to vote on at the polls tomorrow.
