Yesterday was a busy day for Health and Human Services Secretary Kathleen Sebelius. In the morning she spoke at Howard University Hospital for the release of the Human Rights Campaign’s 2012 Healthcare Equality Index, before joining a call at noon to highlight a report outlining her department’s LGBT health objectives for this year.
Numerous themes from the HHS list of LGBT health objectives for 2011 made a repeat showing on this year’s list, including LGBT cultural competency training for health care providers, equal treatment of LGBT youth and families, and funding opportunities that explicitly include LGBT communities. Happily, this year’s objectives are more specific and concrete than last year’s, demonstrating the department’s intention to make measurable progress on all of its commitments.
Still, significant progress remains to be made in several areas that were for the most part not explicitly addressed in the report:
- Removing transgender exclusions from health insurance plans
- Advancing gender identity data collection
- Including LGBT communities in cultural competency standards
- Formally designating the LGBT population as a health disparity population
Trans Health Exclusions
One of the most blatant examples of discrimination against members of LGBT communities is the persistence nationwide of health insurance policy exclusions targeting transgender individuals. These exclusions, found in many private plans and in the government-financed Medicare and Medicaid programs, deny transgender people coverage for health care services that are routinely covered for nontransgender individuals, including pelvic exams, mammograms, and mental health services.
HHS recently released regulations governing the health insurance exchanges, which are marketplaces that will sell affordable, comprehensive coverage in every state starting in 2014. These regulations prohibit insurers participating in the exchanges from discriminating on the basis of gender identity or sexual orientation. However, forthcoming regulations regarding the benefits exchange plans must offer need to clarify that transgender exclusions violate these nondiscrimination protections and will unfairly restrict access for transgender people to the same standard of essential coverage other consumers will enjoy.
Gender Identity Data
Though the report recommits the department to its 2011 objective of increasing the number of federally supported health and demographic surveys that collect and report data on sexual orientation and gender identity, another area of concern is a lack of progress on the development of a gender identity question. Initially promising signs such as two roundtables of HHS officials and transgender health and research experts in 2011 and early 2012 have lapsed into silence, and it remains unclear whether HHS will achieve its self-stated goal of increasing the number of federally funded surveys that collect the data on gender identity needed to better understand the health disparities facing the transgender population.
Cultural Competency Standards
The department maintains a set of standards, the Culturally and Linguistically Appropriate Services (CLAS) Standards, that guide health care organizations and providers in serving diverse communities. Some of the standards are mandatory for recipients of federal funds, while others are recommended for adoption as mandates by federal and other accrediting agencies. While the CLAS Standards describe general principles of respect for diversity in health care, they do not yet follow the example of national standard-setting bodies such as the Joint Commission in explicitly defining patient diversity to include LGBT communities. The updating of the CLAS Standards to define communities at particular risk of discrimination in health care settings would reinforce the report’s goal of promoting LGBT-inclusive cultural competency tools to make sure all patients are treated with the respect and care they deserve.
Health Disparity Designation
Finally, the report made no mention of LGBT inclusion in the health disparity population designation overseen by the National Institute for Minority Health and Health Disparities. Despite evidence of LGBT health and healthcare disparities from nationally recognized sources such as the Institute of Medicine, Healthy People 2020, the Office of Minority Health, and the Agency for Healthcare Research and Quality, the institute has not formally designated the LGBT population as a health disparity population.
Until sexual orientation and gender identity are formally recognized as factors associated with health disparities, researchers, service providers, and others working to address LGBT health disparities will continue to have severe difficulty building a robust research agenda and attracting the resources necessary to support their efforts. Designating the LGBT population as a health disparity population is an important part of promoting a comprehensive understanding of health equity for diverse disadvantaged communities and focusing attention on the additional investments needed in efforts to eliminate health disparities not just for LGBT communities but across the board.
2012 has been an exciting year for LGBT health so far. In their efforts to blaze new paths to health, well-being, and equality for LGBT people and their families, Secretary Sebelius and her team at HHS have much to be proud of. Continued leadership and progress on these objectives is something LGBT communities can look forward to.