How Medicaid Expansion Affects Gay and Transgender Communities

Our guest bloggers are Andrew Cray, health policy consultant for LGBT Progress, and Kellan Baker, health care analyst for LGBT Progress.

The Supreme Court’s decision on health reform concludes a tense chapter in the life of the Affordable Care Act. The lawsuit decided today challenged the constitutionality of several important provisions of the law, including the expansion of the Medicaid program to cover lower-income people without insurance.

On the issue of Medicaid, the court’s decision was mixed. Overall the court held that while states can receive federal funds to expand Medicaid coverage to all Americans under the age of 65 who make less than $15,000 per year, they cannot lose all Medicaid funding as a penalty for refusing to do so. States that expand eligibility will receive increased federal funding to cover the vast majority of the costs of covering new beneficiaries — a 2010 report projected that the expansion of Medicaid in all fifty states would cost the states $21 billion between 2014 and 2019, while the federal government would spend $443 billion. States that don’t expand eligibility will forfeit this funding and could potentially leave millions of people still without coverage.

By upholding the Medicaid expansion as constitutional, the Court’s decision leaves the door open for states to extend lifesaving access to care for an additional 16 million currently uninsured people, including many gay and transgender people and their families. Despite common stereotypes, poverty and unemployment are higher among LGBT communities, particularly LGBT communities of color, than for the general U.S. population. For example, lesbians and bisexual women are 20 percent more likely to be poor than straight women, and a recent survey indicates that transgender people are twice as likely as the general population to make less than $10,000 a year.


Additionally, without the Affordable Care Act, people living with HIV must have had a disabling AIDS diagnosis before they could qualify for Medicaid coverage. The law eliminates this requirement for states that accept new federal funds to expand their Medicaid programs.

Many experts anticipate that most states will opt to expand their Medicaid programs with the new federal funds available under the Affordable Care Act. Sara Rosenbaum, a health policy professor at George Washington University, expects “the overwhelming number of states” to adopt the Medicaid expansion. “The pressure to participate will be enormous from health care providers and communities,” she says, and “the majority of states will not want to have [their] poorest residents without coverage.”

A recent study estimated that 26,000 people die every year because they do not have health insurance coverage. While today’s decision is a major victory for gay and transgender people, there is still work to be done to make sure our communities fully benefit from the Medicaid expansion. Advocates across the country will need to work hard to make sure that their state governments do not turn their backs on those who are literally dying for coverage.