Rates of Uninsured LGB Individuals Dropped Significantly Under ACA

While the Affordable Care Act (ACA) has allowed millions of Americans to gain access to health insurance coverage, limited data have been available thus far about how coverage changes have affected people who identify themselves as lesbian, gay, and bisexual (LGB), and who have historically faced substantial barriers in accessing healthcare.

LGB individuals are at heightened risk for a range of diseases; this population faces higher prevalence and earlier onset of diabetes, higher rates of asthma, and higher rates of osteoarthritis and chronic gastrointestinal diseases, among other health concerns. However, this population has long been blocked from receiving care for these and other conditions because of stigma, discrimination, workplace inequality, refusal of care, and denial of coverage related to sexual orientation or gender identity. Under the ACA, insurers could no longer discriminate on the basis of sexual orientation or gender identity in covering subject to Essential Health Benefits, or on the basis of sex (including gender identity) in any health program receiving federal funds. Furthermore, the ACA’s provision of the Medicaid expansion and the ability to purchase coverage through the insurance Marketplaces allowed new pathways to access coverage.

A new data note published by the Kaiser Family Foundation (KFF) provides new, nationally representative estimates of insurance coverage changes under the ACA for the approximately 3% of Americans who identify themselves as LGB. Comparing data for non-elderly adults from the CDC's National Health Interview Survey (NHIS) from 2013 (prior to ACA implementation) to 2016, KFF researchers found that rates of uninsurance declined significantly for this population after implementation of the ACA’s major coverage changes.

KFF found that the rate of uninsurance for LGB individuals fell from 19% in 2013 to 10% in 2016, representing approximately 369,000 fewer individuals without insurance in 2016 compared with 2013. Additionally, the rate of LGB individuals covered under Medicaid increased from 7% in 2013 to 15% in 2016, representing approximately 511,000 more individuals covered under the program. Both the drop in the uninsurance rate and the increase in Medicaid coverage for the LGB population were relatively similar to patterns observed in self-reported heterosexual individuals over the same period of time.

The researchers were unable to examine changes in private insurance coverage because of sample size limitations, but the report notes that it is likely that increases in private insurance rates may have contributed to the overall decline in the share of the uninsured LGB population. Separate research has demonstrated that access to employer-sponsored health coverage—which covered over half of the non-elderly population in the United States in 2015—for same-sex spouses has provided greater access to health insurance for LGB individuals; in 2017, among employees who worked at businesses that offered opposite-sex spousal health benefits, 84% also had access to same-sex spousal coverage (9% did not have access to this benefit, and 7% worked at companies that reported that they had not yet had requests for this benefit).

The KFF researchers highlight the fact that, as the current administration, Congress, and the states continue to make changes to the healthcare landscape, it will be important to monitor how these trends affect coverage trends for LGB individuals.