Although the Senate has delayed a vote on Trumpcare until after next week’s recess, GOP leaders are pledging to keep up the fight to pass their health care legislation. And the LGBTQ community has particular reason to be concerned about this ongoing effort.
Trumpcare would devastate access to health care among the vulnerable LGBTQ population. Because of discrimination in employment and education, queer people already face financial barriers that impact their access to health care — and that’s in addition to the discrimination they may already face when trying to receive that care.
Obamacare helped many LGBTQ people obtain insurance coverage for the first time. In 2013, before the Affordable Care Act came into effect, 34 percent of LGBTQ people making less than $45,000 per year were uninsured. By 2017, that number dropped by a third to 22 percent.
But Trumpcare would reverse that progress. There’s nothing in the legislation that actually helps improve the health of LGBTQ Americans — and with the Trump administration simultaneously rolling back data collection about LGBTQ health, there will be even less information available about what those needs are.
The Congressional Budget Office (CBO) estimated this week that the Senate version of Trumpcare would lead to 22 million fewer people having health insurance by the year 2026, having previously estimated that the House bill would have led to 23 million fewer. LGBTQ people would certainly be among those who would no longer have coverage, and could be even more dramatically impacted.
The Williams Institute calculated that, based on the House version of the bill, nearly one million LGBTQ adults would lose their health insurance by 2026. Half of them would lose their insurance by next year. The impact of the Senate bill would likely be similar, and would be felt most by those who are older (ages 50–64) and who have lower income. As a recent report from the Movement Advancement Project explained, LGBTQ older adults are more likely to struggle with economic security, social support systems, and competent, accessible health care.
The primary reason so many will lose insurance is because of Trumpcare’s cuts to Medicaid. The Senate Trumpcare bill would roll back Obamacare’s Medicaid expansions as part of its greater phaseout of the entire program.
According to forthcoming research from the Center for American Progress, about 5.6 percent of LGBTQ adults nationwide enrolled in Medicaid after being deemed eligible during the 2016–2017 enrollment period. (Disclosure: ThinkProgress is an editorially independent site housed at the Center for American Progress.) Assuming these individuals were newly eligible because of Obamacare’s Medicaid expansion, that amounts to 560,000 LGBTQ people who would lose coverage fairly quickly under Trumpcare. Those estimates similarly found that well over a million LGBTQ people dependent on Medicaid would lose their coverage by 2026.
Essential benefit coverage
Obamacare guaranteed that individual insurance plans were more comprehensive, covering “essential benefit” categories like ambulance services, prescription drugs, laboratory services, mental health services, and chronic disease management. Trumpcare would allow states to waive this requirement, opening the door to LGBTQ people having to pay more out-of-pocket for their basic health care needs.
This would particularly be true for anyone in the LGBTQ community that relies on prescription drugs to either treat their HIV, or in the case of PrEP, protect themselves from it. Transgender people who depend on the same coverage for their hormone replacement therapy might likewise be unable to continue the regiment they rely upon to manage their gender dysphoria.
Due to societal stigma and discrimination, LGBTQ people often face higher rates of depression and drug use, so a cut to these benefits would also make it harder — or impossible — for them to access the mental health care they need.
Both versions of Trumpcare have mechanisms that undermine Obamacare’s protections for people with pre-existing conditions. While the House bill aims to create high-risk pools, the Senate bill’s waivers for essential benefits will allow healthy people to take cheaper, less-comprehensive plans, driving up costs for those who require more coverage — a backdoor punishment for people with pre-existing conditions.
According to the Center for American Progress’ forthcoming research, some 65 percent of LGBTQ adults report having at least one pre-existing condition. This is about on par with the general population, but it’s unclear if the LGBTQ population is experiencing the same conditions in the same proportions — and whether that makes them more vulnerable to financial inequities as a result.
As an example, the rates of transmission suggest that it’s far more likely that LGBTQ people would report HIV as a pre-existing condition compared to the general population. If an insurance company is allowed to charge more for prescription drug coverage under the new regime, that would undoubtedly have a more disparate impact on the LGBTQ people, whereas those with pre-existing conditions like seasonal allergies or acid-reflux disease might be able to meet their needs without that additional, more-expensive coverage.
Access to care
Trumpcare would defund Planned Parenthood, which would severely limit the number of places LGBTQ feel safe to receive the affirming care they need. Planned Parenthood is one of the largest providers of health care for LGBTQ Americans nationwide — particularly for transgender people, who may be turned away or denied the services they need at other clinics. Lawmakers would be punishing Planned Parenthood for abortion services, but LGBTQ people would suffer even though that’s generally not the kind of care they are seeking at those clinics.