Denial of Healthcare Policy for the Lesbian, Gay, Bisexual, and Transgender
Lesbian, gay, bisexual, and transgender (LGBQT) people across the world have faced numerous challenges over the years. From the denial of their rights to assemble associate with others and even to marry, the LGBQT have faced significant challenges over the years, and have been actively involved in activism to be allowed to enjoy certain rights. In the activism towards their rights, this particular group has faced resistance from governments, individual activists, and even certain homophobic factions. Through the inclusion of human rights organizations in their fight for equal rights as other members of the public, the LGBQT have realized some of their goals such as the freedom to be legally married. However, there are still challenges in various aspects of access to social resources, the key of which is healthcare service. There have been challenges in LGBQT access to healthcare on account of discrimination as many healthcare practitioners and facilities across the United States and the world in general, deny people access to health because of their sexual orientations.
The battle for equal rights should be pursued to ensure that the right to equal access to healthcare services is enjoyed by all members of society. According to Albuquerque et al. (2016), the concerns of the LGBQT community around access to healthcare are centered on fears of not getting healthcare providers who are knowledgeable about their needs. Additionally, most healthcare providers and insurers discriminate against the LGBQT. Because of these two reasons, it has been difficult for people in this group to access care as they also fear negative treatment hence they either postpone or forego visits to healthcare facilities. In more recent times, various state legislations have been coming up to prohibit discrimination against the LGBQT on account of their sexual orientation. Previously, the absence of such legislation placed the LGBQT at risk of being discriminated against and receiving poor healthcare services.
LGBT History and Challenges
Recent data shows that the LGBT community comprises nearly 2.8% of the population in America, comprising of more than 5.5 million adults aged above 18 years (Albuquerque et al., 2016). This population includes only the self-declared members of the community; it is estimated that the population of LGBT may actually be as high as 10 million people in the U.S alone. Most of the self-declared members are from minority groups. The population varies from state to state, with the highest prevalence being in the District of Columbia to the lowest prevalence in South Dakota (Lim et al., 2013). This difference is however attributed to differences in the state regulations pertaining to the equality of the LGBT with other members of the society. In spite of this high population, the LGBT are still considered a minority in the national population and are in some instances, treated as such.
The consideration of LGBQT people as outliers in society has been the cause of many forms of discrimination, including the consideration of homosexuality as a disease in earlier days. However, there has been progressing over several years, with the fight for one right after another. The right to equality has in many instances excluded the LGBQT, resulting in separate civil battles on the way forward to according to members of this population rights that are similar to those of other members of the society (Chance, 2013). The right to marry was only recently allowed legally in some states, with ongoing discussions around the same in other states. Previously, there was no legislation in any state that stipulated that the LGBQT community should also be given the same rights to healthcare policy as other populations, a status that has resulted in significant discrimination of the population not only by healthcare practitioners but also by healthcare insurance service providers (Buffie, 2011). The fear of discrimination and the blatant refusal of service by the healthcare providers, along with limited access to healthcare insurance policies have constrained the LGBQT’s access to healthcare services and vulnerability to various health issues.
Further discussions have been ongoing around the healthcare policy available for the LGBQT. Even after the federal acceptance that both Medicare and Medicaid should be accessible to LGBQT individuals, various forms of discrimination still exist such as in the visitation rights enjoyed by this population relative to those enjoyed by others in the community. In spite of the LGBQT registering and making individual payments for healthcare policy, they have not been allowed, for instance, to enjoy open visitor designations as others. Their designation of hospital visitors is required to be more restrictive According to a study by Steele et al. (2017), the forms of discrimination have been ongoing even after the confirmation of the rights to healthcare access. To some extent, this discrimination could be hypothetical, attributed to the perception of discrimination by the LGBQT members who may feel generally excluded from society. To help address this feeling of exclusion, the government has in various states promoted the development of regulations that facilitate inclusivity in access to healthcare, by not allocating specific healthcare facilities and units for use by the LGBTQ. This requirement is founded on the fact that the LGBT community faces the same healthcare challenges that other members of the population face.
Health Issues among the LGBT
While most of the healthcare challenges faced by the LGBT are similar to those in the general society, the LGBT community is more vulnerable to some conditions than other people. They are also more likely to face certain conditions in greater severity than others. Such health conditions include HIV/AIDS, sexual and physical abuse, mental disorders, and substance use and abuse disorders. These conditions set them apart from others in healthcare access, and are also the cause of concern to organizations offering healthcare insurance policies. There are certain barriers to accessing care in various environments, and these barriers include poor treatment by healthcare providers, limited access to healthcare services due to financial constraints, poor healthcare insurance coverage of certain healthcare conditions to which they are vulnerable, and cost-related hurdles because of lack of health insurance cover.
The healthcare environment is shaped by various factors including the economic, political, social, and cultural environment. For the LGBT, the healthcare system is shaped by additional factors such as ostracism, discrimination, and stigma. These factors mostly affect health outcomes, the interaction of the members with the healthcare systems, and general access to care (Redman, 2010). This implies that for those health issues that are unique to the LGBT and those to which they are more vulnerable, accessing quality healthcare can be a challenge especially if the healthcare systems are not structured to serve this population. One of the most prevalent healthcare issues associated with the LGBT is the prevalence of chronic conditions such as arthritis, and gastrointestinal problems. Compared to heterosexual individuals, the LGBT are more vulnerable to chronic conditions and also experience earlier onset of disability (Ponce et al., 2010). Lesbian and bisexual individuals are also more prone to diseases such as urinary tract infections, hepatitis B and C, and asthma compared to heterosexual women. It is also reported that lesbian and bisexual women are more likely to be obese compared to heterosexual women even if they have the same level of physical activity. Gay men, on the other hand, have a lower probability of obesity compared to their heterosexual counterparts. According to a study by Chance (2013), these differences cannot be attributed to any other factors, as they can be observed even where all social, economic, and political factors are uniform. This observation explains the need to have easily accessible healthcare resources and services for the LGBT as there are for the general population.
Besides the chronic conditions, the LGBT are also vulnerable to HIV/AIDS and sexually transmitted infections. The LGBT constituted the highest percentage of the population with HIV/AIDS and STIs. The vulnerability to these conditions is also varied across people of different ethnicities even among the LGBT. Gay and bisexual men are the most affected by both HIV/AIDS and STIs, and access to good healthcare services is a prerequisite for effective health management among this population (Baker, 2016). Furthermore, they are mostly affected by Human Papillomavirus (HPV), which is a precursor for other health conditions such as cervical cancer, mouth and anal cancers (Ponce et al., 2010). All these conditions are sexually transmitted and the risky sexual behaviors of the LGBT are considered the cause of the health disparity between the LGBT and the general population.
Another healthcare concern commonly associated with mental and behavioral health issues. According to Baker (2016), the societal perception of the LGBT contributes to the prevalence of depression, anxiety, and substance use issues among this population. The LGBT population is approximately 2.5% more likely to experience mental and behavioral health issues compared to the heterosexual population due to their exposure to various forms of discrimination and ostracism. Additionally, men having sex with men are more likely to abuse other forms of substances besides conventional alcohol abuse. For instance, amphetamines are the other most commonly abused substance by bisexual and gay men; they are approximately 12 times more likely to use amphetamine than heterosexual men and also 10 times more likely to be using heroin (Lim et al., 2013). State-level data can be used to further clarify substance use and abuse trends among the LGBT populations and the general population.
Other health issues that commonly affect the LGBT include sexual and physical abuse, which is mostly a result of rejection by friends and family; and lack of support during adolescence and early adulthood (Lim et al., 2013). Understanding this range of health issues should be essential towards developing policies and plans towards better healthcare service delivery for the LGBT.
Access to Care and Insurance Coverage
Because of the prevalence of various health issues among the LGBT and the lack of clear structures to address those issues, the need for a proper healthcare policy is evident. Ramchand and Fox (2008) posit that the LGBT need different health policy coverage patterns compared to their heterosexual counterparts, and there are already efforts to cover the gap that exists between conventional health policies and the needs of the LGBT. The need for more diverse coverage could be the cause of concern about the unawareness of the health needs of the LGBT population, which prevents them from accessing healthcare services in a timely manner. Additionally, there are other issues surrounding access to health insurance and policy, and these issues may at times be difficult to identify or address immediately.
Studies have shown that there are higher levels of unmet medical needs among LGB individuals than those among heterosexual individuals. The LGB always find it costlier to access healthcare services, probably because they postpone treatment and may be subject to wider arrays of physical illness by the time they pursue treatment. Ramchand and Fox (2008) further suggest that the cost of medical care hampers access to timely healthcare by bisexual and lesbian women. The high costs of medical care among the LGBT are due to the limited health insurance coverage available to this population. Particularly, while many employers offer medical coverage for the spouses of their employees, there are some employers who choose not to offer coverage to spouses of employees in same-sex marriages. Moreover, insurance policy providers may also at times limit the access of LGBT individuals to healthcare services by reducing the scope of cover to general medical care only while the general populations access general and specialty care covers. Because of these discrepancies in the healthcare policies that can be accessed by LGBT populations, gay and bisexual men are three times likely to report delays in obtaining prescription medicines especially for specialty issues compared to heterosexual men (Steele et al., 2017). Such concerns continue to characterize the healthcare environment for the LGBT.
In recent times, there have been changes in healthcare policies occasioned by various federal rulings, particularly for married members of the LGBT population. Those in same-sex marriages, particularly the state and federal employees are now able to be covered by their employers’ policies as spouses and not domestic partners as was done before. The Windsor ruling created precedence for the recognition of same-sex marriage spouses even in healthcare policy, and the provision of benefits similar to those given to individuals in heterosexual marriages (Jennings et al., 2019). The trend has thus been changing with more organizations choosing to cover spouses of same-sex employees. However, some challenges are still faced by employees of discriminative employers, particularly since there is no clear federal regulation that obliges employers to cover all the spouses of their employees.
Changes in healthcare insurance policies over the past decade or so have been instrumental in promoting better access to health policy coverage among LGBT individuals. A study by Whitehead et al. (2016), confirmed that the affordable care act has played a critical role in the increase of health insurance coverage among the LGBT. The study reported that state policies on insurance, compensation, benefits, and LGBT marriages have significantly impacted access to healthcare through healthcare policies for the LGBT. First, the ACA has expanded access to healthcare among the LGBT, through reforms in the insurance markets (Baker, 2016). Secondly, the enforcement of non-discrimination protections for the LGBT has reduced the prevalence of discrimination against the community, either from health insurance companies or from employers and healthcare providers (Baker, 2016). Additionally, the ACA has expanded the requirements for data collection and research in changing regulations pertaining to health insurance policy pursuit. Each of these outcomes has resulted in changes in healthcare coverage and service delivery for millions of people, particularly the LGBT.
The effects of the ACA have increased with time. Since January 2014, it has been impossible for private health insurance companies to deny individuals with preexisting conditions such as the transgender and the HIV positive cover on account of those conditions (Jennings et al., 2019). These are the same conditions that are prevalent among individuals who are LGBT, and which have previously been the rationale for denying them access to insurance cover. Additionally, individuals are required to be offered preventive services when joining any private health insurance policy. Accordingly, the LGBT access better services, through preventive counseling for sexually transmitted infections, HIV/AIDS, and even various chronic conditions (Jennings et al., 2019). These services are offered without additional cost-sharing with the health insurance organizations and may include specific services such as screening for various forms of health issues, counseling for depression, anxiety, and substance use, screening for STIs, and other mental health issues. LGBT individuals who access health insurance through Medicaid additionally receive services such as mental health services and prescription drugs.
The other aspect of the ACA that has facilitated access to health policy by the LGBT is the inclusion of non-discrimination protections. Prior to the ACA, there were various clauses that promoted discrimination in healthcare insurance in addition to provider-level discrepancies. For instance, clauses that prohibited the provision of insurance policy to cover individuals with preexisting conditions such as HIV, mental illness, and those who had undergone a transgender transformation. Lim et al. (2013) report that some healthcare insurance providers used the regulations on the control of insurance for gender transitions to deny transgender individuals access to coverage for services that are unrelated to gender transition. From the ACA, there have been other federal regulations on the implementation of the ACA that have come up to prohibit discrimination in many other areas of healthcare.
One of the areas addressed is the denial of health insurance providers on account of gender identity or the sexual orientation of receivers. According to Baker (2016), the law now includes sexual identities and stereotypes as specific discriminations to avoid in the provision of health insurance coverage. Any health program that receives funds from the federal government is prohibited from denying members of the public insurance cover on account of their sexual orientations. They are also prohibited from engaging in health insurance marketing practices that implicitly discriminate against various populations, particularly the LGBT. Given that most of the hospitals in the country are involved in grandfathered insurance plans, the requirement to avoid marketing discriminately can be considered an extension of LGBT protection.
LGBT populations across the world have faced numerous challenges in gaining recognition and support for various services. Through the years, there have been efforts to push for equality and to promote equal access to resources among the LGBT. The most recent challenge has been in healthcare service access and constraints on health insurance policies. The challenges in access to healthcare services are based on the argument that the LGBT population is vulnerable to a wider scope of healthcare issues, including mental health challenges and HIV. To curb these challenges, the ACA has provided distinct regulations on the protection of the LGBT by expanding the scope of care services for which they can be insured and by protecting them from discrimination by the insurance service provider
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