How the House and Senate Bills Affect LGBT Health

The Affordable Health Care for America Act could make the lives of gays and lesbians much healthier. Or not, depending on which language is used in the final bill.

While the health care bill passed in the House worked to significantly improve the lives of gays and lesbians with the creation of sweeping reforms, such as the elimination of preexisting condition exclusions that affect many Americans, the Senate bill removed all LGBT-specific language before reaching the chamber. Now reconciliation of the two bills could favor the Senate language, which would diminish the impact health care reform could have on gay people.

Allison Herwitt, legislative director for the Human Rights Campaign, said gay-specific language in the health care bill is vital to data inclusion for gays and lesbians fighting to save it. "It's better to have statutory language," she said. "We are going into conference to protect this language."

The HRC has worked closely with Wisconsin representative Tammy Baldwin, who is optimistic gay-specific language will make it into the final bill. Baldwin said while there's no expressed opposition by Democrats to the pro-gay provisions, there's a long road ahead before the matter is settled. "This is a huge priority for me, and I expect to keep it in the final [bill]," Baldwin told The Advocate.

Baldwin said the two bills are currently being merged in places the two houses generally agree upon in order to limit the amount of controversy early in the process. But she is gearing up for a war of words. "What we're doing right now is making the record of strong support for that language so that our leadership ... is in the best position possible to make the arguments to keep [the language] in," Baldwin said.

The final health care bill is expected to be on President Obama's desk before the State of the Union Speech in February.

Without the language, the secretary of Health and Human Services would have to mandate the gathering of the information.

The need for LGBT data inclusion in federal studies is apparent among health advocates. It's unclear whether gay men are at higher risk of heart disease than heterosexual men, or if lesbians are more susceptible to breast cancer. The information has never been compiled in federally funded research.

Moreover, the rate of uninsured gays and lesbians is unknown because health surveys don't currently ask LGBT-specific questions. Data inclusion, advocates say, would give doctors, insurance providers, and lawmakers the hard facts of gay health.

Rebecca Fox, director of the National Coalition for LGBT Health, said that the House bill has addressed many of her organization's long-term goals, including the dismantling of preexisting condition exclusions, but stresses the importance of LGBT data inclusion in reforms. "This is the first time that federal legislators have recognized the health disparities of our community," Fox said.

The Senate bill addresses health disparities and data collection in a way similar to the House bill, but without specific mention of race, gender, ethnicity, or sexual orientation.

Jason Schneider, immediate past president of the Gay and Lesbian Medical Association and a doctor at Grady Memorial Hospital in Atlanta, is confident that data inclusion in health surveys would provide valuable information on how to better diagnose and treat gays and lesbians. "We don't even know the extent of health disparities because those questions are not being asked," he said. "LGBT people are being left out of the equation."

Only limited data is available about gay health. Information on depression, HIV rates, and smoking are among the few known statistics. "There are disparities when it comes to prostate cancer among African-Americans," Schneider said. "We don't have those comparisons for LGBT individuals."

M.V. Lee Badgett, research director of the Williams Institute for Sexual Orientation Law and Public Policy at the University of California, Los Angeles, School of Law, believes LGBT data inclusion is not only essential for medical research but also makes for better public policy. Without data, it's impossible to detect disparities in care and, perhaps more important, in provider coverage.

"We can't know if there are problems [for gay people] accessing health care systems unless we have data to make those comparisons," Badgett said. "We would be able to see if there are differences. We need data to understand why those differences exist."

Badgett said research could commence with a simple question not included in federal health surveys: What is your sexual orientation?

Herwitt at the HRC believes that the recent death of Sen. Ted Kennedy had a significant impact on the language of the Senate bill. "I think [Kennedy] would have been a key position to help us get that language in the Senate bill," she said. "He was one of our strongest champions."