STUDY: Obamacare Improves LGB Access to Health Insurance

The Affordable Care Act has greatly reduced the number of uninsured lesbian, gay, and bisexual adults in the U.S., although disparities in access to health care remain, according to a new study.

Nearly nine in 10 LGB adults -- 88.9 percent -- have health insurance, according to data gathered in winter 2014-2015, after the ACA's coverage provisions went into effect, reports the Urban Institute study, funded by the Robert Wood Johnson Foundation and published in the October issue of Health Affairs. That's up from 78.2 percent reported in summer 2013. The data came from the online Health Reform Monitoring Survey.

The key coverage provisions of the ACA, also known as Obamacare, are the expansion of Medicaid in 31 states and the creation of health insurance marketplaces, a source of insurance for those who had difficulty obtaining it elsewhere. These provisions went into effect at the beginning of 2014 and have helped many non-LGB adults gain coverage as well. The spread of marriage equality also improved LGB coverage rates, the study's authors note, as people in same-sex marriages have gained access to spousal benefits, although the data came in before this summer's Supreme Court decision struck down all remaining marriage bans.

Since the ACA's implementation, the percentage of LGB people reporting that they have a usual source of health care has increased, to where it's actually slightly higher than the percentage of non-LGB adults (78.4 percent versus 73.2 percent). But LGB Americans report more difficulties with access to and affordability of care, even though their access to insurance has improved. A quarter reported problems with accessing care, compared to 16.1 percent of non-LGB adults, and 42.6 percent of LGB adults reported an unmet need for care because of cost, compared to 32.4 percent of non-LGB people.

Also, gender disparities continue to exist. "Although sample sizes were small and our estimates were imprecise, lesbian or bisexual women were more likely than gay or bisexual men to report difficulty accessing and affording care in winter 2014-15, despite similar rates of having insurance and having a usual source of care," note study authors Laura Skopec and Sharon K. Long.

The marriage equality decision, Obergefell v. Hodges, could further improve access to and affordability of care, the authors report. So could another high court ruling from this year, King v. Burwell, which upheld subsidies for insurance purchased through the marketplaces.

"In addition, a growing body of research suggests that marriage equality may result in improved physical and mental health for LGB adults," the study relates. "National marriage equality may also reduce social stigma against LGB adults, which could reduce actual and perceived discrimination by providers."

"Aided by the recent Supreme Court decisions, the Affordable Care Act dramatically increased access to health insurance for lesbian, gay, and bisexual Americans," concluded Kathy Hempstead, who directs coverage issues for the Robert Wood Johnson Foundation, in a press release announcing the study. "For this and other populations the question now turns to whether affordable health insurance and easy access to care providers can be sustained."

The full study is available only to magazine subscribers, but an abstract is available here.