There isn’t a lot of talk about Medicaid in gay and transgender politics. Most are familiar with LGBT issues that have gotten enough attention to make the Democratic platform and the reactionary hit list: marriage equality, employment nondiscrimination, anti-bullying policies, immigration rights for bi-national couples, and an end to HIV and AIDS. But when it comes to Medicaid, the LGBT movement is too often at a loss for words about a program that provides lifesaving health care to more than 50 million of the poorest Americans — including gay and transgender people.
Despite common stereotypes, unemployment and poverty are higher among gay and transgender communities, particularly communities of color, than for the general U.S. population. Lesbian and bisexual women are more likely than straight women to experience poverty, transgender individuals make $10,000 a year or less at twice the national average, and gay men earn on average between 10 and 32 percent less than straight men.
The consequences of employment discrimination against gay and transgender people don’t stop with lower wages. The United States health insurance system is based on the presumption that most people can get insurance coverage through their employers or their spouse’s employer. But unemployment, lower-wage jobs that don’t come with benefits, and laws denying legal recognition to same-sex couples all mean that traditional routes to health insurance coverage are closed to many gay and transgender people.
This is why Medicaid matters for gay and transgender communities.
Medicaid was created more than 40 years ago when our nation decided that it is immoral to abandon people who cannot get private health insurance to a high-stakes struggle to get the health care they need. Medicaid now covers more than 50 million people, and more than half of Americans have a personal connection to the program either because they have received benefits themselves or because they know someone who has. Medicaid coverage is low-cost and high-quality, and it makes a huge difference in people’s lives.
The health reform law opens the possibility of Medicaid coverage for an additional 16 million people with annual incomes below $15,000. As a result, many gay and transgender adults will become eligible for the program, and people with HIV will no longer have to wait for a disabling AIDS diagnosis before they can qualify for coverage.
But while the importance of Medicaid doesn’t get much airtime in discussions of gay and transgender priorities — or in the national news — behind closed doors, conservatives are sharpening their knives for the program. The Romney/Ryan campaign wants to slash federal funding for Medicaid and convert these funds to block grants too small to support existing state Medicaid programs. As funding gets squeezed, states will increasingly look for ways to kick current beneficiaries off the Medicaid rolls, and the eligibility expansion under health reform will wither before it even has a chance to get off the ground.
It’s not too late to save Medicaid. To ensure LGBT people do not lose this essential protection, everybody must understand why Medicaid matters to all communities across the country.