Ending Exclusions Under Obamacare

Andrew Shaughnessy, Manager of Public Policy for PROMO

By: Andrew Shaughnessy

For the LGBT community health is a complicated matter. It is further complicated when health insurance companies deny or exclude certain forms of coverage that for some are basic health needs. For LGBT folks seeking gender-affirming health care coverage barriers exist at every turn — until the Affordable Care Act. Or so we thought…

Section 1557 of the Affordable Care Act prohibits discrimination on the ground of race, color, national origin, sex, age, or disability under “any health program or activity, any part of which is receiving Federal financial assistance … or under any program or activity that is administered by an Executive agency or any entity established under [Title I of ACA]….” To ensure equal access to health care, Section 1557 also applies civil rights protections to the newly created Health Insurance Marketplaces established under the Affordable Care Act.


Upon researching a complaint raised to us by a Missourian, who qualified and enrolled in a federal marketplace plan, we concluded that exclusions still exist under ACA plans that inhibit transgender patients from getting the basic care they need. Under certain Federal marketplace health insurance plans exclusions have been put in place that state “sex change services and supplies for a sex change and/or reversal of a sex change.”

A real life example of how this affects transgender patients was raised to me, “I had a large cyst on my ovary that had to be removed a several years ago. I hadn’t started transitioning, so my insurance company didn’t blink when I claimed the surgery to remove it. Fast forward to now. If I had the same problem and walked into the doctor’s office with a beard and “male” on my documents, the insurance company can (and would absolutely) deny my claim.”

The State of Missouri’s, along with several states’ ACA exchange, is administered by the federal government and is governed by this rule, however this exclusion is a clear violation of Section 1557. Transgender patients who rely on marketplace coverage for health insurance are forced to censor their own health management for fear that marketplace plans will deem any healthcare on a transgender body excluded from the plan.

I along with the support of hundreds of Missourians requested that the Department of Health and Human Services investigate these claims and make efforts to remedy any claims of sex discrimination in health insurance plans under the Affordable Care Act.

If you are or know someone who is affected, please consider making a request to the Department of Health and Human Services to investigate these claims.


Taking a Breath: First Night at the Conference on LGBTI Health Research

Dr Herukhuti-Lambda 2014

Herukhuti, Ph.D., M.Ed.

Professor, Goddard College

Founder and CEO, Center for Culture, Sexuality and Spirituality

I awoke this morning feeling a familiar restriction in my chest. Asthma held at bay a part of the air I depend upon to breathe. My rescue inhaler, acquired from someone else, read fourteen more puffs of relief medicine. I haven’t had health insurance in nearly ten years.

Prior to Obamacare, also known as the Affordable Care Act (ACA), I received health care on a sliding scale at the municipal hospital–a place where waiting for service takes up the vast majority of the appointment. Since November, I have been on a long, arduous journey to obtain the promised affordable care of the ACA through my state’s health exchange. I live in a blue state so our exchange is fully realizing the vision of Obamacare.

But it’s a vision obscured by bureaucracy and tattered with holes that I struggle to not slip through in the process. Early in my attempts on the state exchange website, the system did not recognize me. Being Black, bisexual and male, I found the experience of being unrecognizable quite familiar. But I persisted. A couple of call center conversations led me to create several accounts–each an attempt to try a different suggested strategy. Finally, a call center operator told me I needed a state ID number through our Department of Motor Vehicles.

I don’t have a drivers’ license nor non-drivers’ ID but I used to have a learners’ permit. DMV told me the ID number attached to the permit was still associated with me but in order to obtain it I would have to file a form and pay a fee. At that moment, the no-fee sign-up promise of ACA disintegrated for me. I began a hunt for the old, expired permit among my papers. I didn’t find it but I did find the one and only receipt of my failed drivers’ test with my state ID number on it.

A final account registration with my no-cost, retrieved ID number granted me recognition and access to complete an application. I hurriedly did so, eventually finding out that the exchange determined me ineligible to obtain ACA-supported health insurance until they conducted an income verification. As a member of the contingent faculty class, my income does not fit into the neat little box of standardized, continuous employment.

I submitted the required documentation. A form letter response arrived requesting the exact same information. I resubmitted the required documentation. Another form letter arrived requesting the exact same information. I had my employer send a version of the documentation with the requested information. I waited for a response. Waited more for a decision on my appeal. Continued to wait. Without health insurance and with a depleting supply of asthma medication. I didn’t believe I could return to the hospital to receive a prescription on the same pre-ACA sliding scale.

On another call to the exchange call center to inquire about the status of the review, I asked if I would benefit from having a navigator assist me. The call center operator responded in the affirmative. Because I have worked with online systems and websites successfully for decades, I originally thought I didn’t need the help of a navigator. But my challenges weren’t located in the functionality of the website, they emanated from the system of policies, practices and procedures of the exchange.

I located a navigator–the only one to answer the phone when I called–who happened to work at our local LGBTQI health center. She immediately appeared competent, knowledgeable and experienced in navigating the system.

Now, I have someone who can work on the bureaucracy of obtaining my access to affordable health care while I attend events like the Conference on Current Issues in Lesbian, Gay, Bisexual, Transgender, and Intersex (LGBTI) Health Research hosted by Baldwin Wallace University (Berea, OH) with fourteen more puffs of relief medicine. I am here on special assignment for the Network for LGBT Health Equity writing about the conference.

The work of the ACA navigator on my behalf allowed me to sit a little more comfortably at Thursday evening’s reception hosted at the Rammelkamp Atrium of the MetroHealth Center here in Cleveland, OH. After opening remarks from conference co-organizer, Dr. Emilia Lombardi, assistant professor of public health at Baldwin Wallace University, Dr. Akram Boutros, CEO of MetroHealth, welcomed everyone and spoke about the progress MetroHealth has been making in becoming a workplace that is welcoming of sexual and gender diversity and a health care organization that effectively serves people of all sexualities and gender expressions with cultural competence. conference article1

Afterwards, I spoke with Dr. Henry Ng, who leads MetroHealth’s Pride Clinic serving LGBTQI people in the local community. He shared with me a significant challenge to the work of the clinic; there is no industry standard for creating space for people to self-identify as LGBTI on medical forms. In addition to the ways this present absence hinders efficient data collection on who clinics serve–data collection that can lead to tailoring and improvement of services–but it has a direct impact upon clinical service providing in that gender designations on third-party billing forms can limit the kind of care provided to someone. For example, a transgender man who has a cervix will require care regimes that not permitted by the billing procedures unless a doctor designates him as female or some other cumbersome workaround the service provider creates. Dr. Ng expressed significant interest in ongoing efforts to address, what I consider to be, the embedded and manifest heterosexism and cisgenderism within health policy and systems that make it possible for people to remain unrecognized and unrecognizable within the bureaucracy.

Friday’s schedule includes discussions about translating research into policy and health interventions; LGBTI health and population-level and clinical data; histories of LGBTI health research; and LGBTI health research education at the college/university level. Twelve puffs remain.

Dr. Herukhuti is founder and Chief Erotics Officer (CEO) of the Center for Culture, Sexuality and Spirituality and editor-in-chief of sacredsexualities.org. He is also a member of the faculty at Goddard College. Follow him on Twitter and Tumblr and like his Facebook Fan page

White House

Vice President shout-out to LGBT community for ACA enrollment awesomeness

HealthEquity Logo

The Network for LGBT Health Equity
Keepin’ you in the loop! 
Passing on the good news! 




With the end of open enrollment only a few days away, Vice President Joe Biden and Secretary of Health Kathleen Sebelius hosted a call yesterday thanking LGBT community centers, health centers, and organizations for their work in getting LGBT communities enrolled in the health insurance marketplace. Both spoke about the parallels between equal rights for LGBT people and equal access to healthcare, and about the significance and importance of the Affordable Care Act.


Sebelius started off the call by reviewing the health disparities in LGBT Communities, including the higher rates of cancer and tobacco use. Biden described the initial website issues as a “tough start”, but went on to credit Sebelius with the fact that “things are now moving!” He gave a few shout-outs to Out2Enroll and the Lesbian Health Initiative, among others, and emphasized two really important points: 1. Legally married same-sex couples can now get healthcare coverage, even if same-sex marriage is not recognized in their home state. 2. NOTHING about enrolling can affect immigration status AT ALL.

Biden described access to health insurance as being about responsibility, peace of mind and security, and choice, opportunity and freedom- Taking responsibility for yourself and your health, having peace of mind (and he said that for the young folks who aren’t worried about their health, do it for peace of mind of your mothers and fathers!), and the choice, opportunity and freedom to not be stuck in dead-end jobs because of insurance, and to not have to worry that if you move to another state you will lose your insurance.

Biden closed the call by saying that the ACA is one of the “seminal changes in American policy” and encouraging a huge push of the last few days of open enrollment- either online, over the phone or in-person!

– enroll on-line at healthcare.gov

-enroll over the phone at 1-800-318-2596 (open 24 hours!)

– enroll in person by going to local help.healthcare.gov and finding a navigator at your local community center, health center or library!


“Healthcare is a RIGHT. The debate is over.” – Joe Biden

* * *

“Thanks to the Affordable Care Act, it really is a new day”. – Kathleen Sebelius

Huffington Post LGBT Wellness

Honestly, Signing up for Obamacare Was Hard but Worth It


 It’s a bit embarrassing to admit how difficult it was to sign up for health insurance on the new exchanges. As a public health professional who’s trying hard to spread the word that people need to #GetCovered, I was trying to studiously ignore how every time I called there was some problem in signing up. Ultimately, it seemed to be related to my name change. Maybe it was more complicated because I only have a single name? I just hope every trans person doesn’t have to go through some of the hoops I did in proving they are U.S. citizens, because I know it delayed my enrollment by months.

One of the myths about these health insurance exchanges is they are only for the uninsured among us, or only for low-income folk. Actually the exchanges offer a chance of better health insurance for many of us. For example, I was already enrolled in health insurance, but to my dismay it didn’t cover any testosterone, which left me skipping some months then finally shelling out $400/month through clenched teeth. Plus, my health insurance didn’t include dental coverage, so I carefully unclenched those teeth again.

To be honest, I had to call the Rhode Island health insurance exchange probably eight times. First there was the complication of not living in the same state as my partner. While some private insurance plans would cover us both, the exchanges wouldn’t. Then they asked me to send in my drivers license and social security card to prove I was a citizen. So I scanned and uploaded them to the site then I waited for some notice it was ok to proceed… and crickets. It’s easy to put off enrolling like it’s easy to put off writing a will. Nothing bad is going on now, right? With three teenagers and a busy job, I had lots of other things competing for my attention. But once a month, as I shelled out that $400 for hormones, I kept remembering that maybe that insurance exchange could do this better?

So I called back and filled out more of the application with the friendly person on the line. But now they needed to know how much my kids’ health insurance premiums were. Really? I am not the parent who pays them, so why did it matter? It stopped me again, until that $400 payment came again and I was motivated to track down the info and called back. This time, they needed even more information about my name change. I was definitely trying hard not to curse the insurance exchanges at this point. Remember, the party line is #GetCovered. Repeat until you believe it. Or better yet, go back and watch the hilarious SNL skit on the early website problems. I’ve watched it so many times now I can do a fair impersonation of their Sebelius impersonator.

Ultimately, it was the coming deadline which moved me off my duff again. If people don’t get enrolled by March 31st, it’s see ya later until next year’s open enrollment period. So, I found my birth certificate, my legal name change document and uploaded them to the site. And voila — they finally admitted I was a U.S. citizen. I could choose a plan!

But wait, the runaround stop didn’t stop there. I wasn’t going to sign up for another plan that didn’t include hormones. Plus, I needed to make sure my trans-friendly doc was in their plan. That took four more confusing calls, this time to Blue Cross. But everything was included. And I was going to get sweet dental coverage for the whole family too, including 50 percent of my kids’ braces costs. I signed up like lightning.

I can’t lie; it was a total hassle for me to sign up and it could be for you too, but trust me it’s worth the hassle. I was cursing the insurance exchanges before but now I say bring on the new coverage as fast as it can come. Remember, we’ve only got until March 31st to sign up so spread the word. Visit Out2Enroll for more information and find more social media friendly images on the CenterLink Network for LGBT Health Equity blog here.


Dr. Scout, Director

The Network for LGBT Health Equity

As published on Huffington Post’s new LGBT Wellness blog, see original at: http://www.huffingtonpost.com/scout-phd/obamacare-enroll-health-insurance-exchange_b_4961096.html?utm_hp_ref=lgbt-wellness

Follow Scout, Ph.D. on Twitter: www.twitter.com/scoutout

It’s Not Too Late To Get Covered!

BioPic b&w

Felecia King
Project Specialist
The Network for LGBT Health Equity

LGBT people make up for 3.5 percent of all Americans, bringing us to about nine million people. And, one in every three LGBT people don’t have health insurance (which is more than two times higher than the national average). The many health disparities that LGBT people face, such as societal stigma, discrimination, and denial of civil/human rights, are some of the reasons that many of us lack health coverage. For example, 82 percent of uninsured LGBT people reported discrimination in the process of getting on the same plan as their partner. But, times are changing: “Have No Fear! ObamaCare is here”!

ObamaCare, technically called the “Affordable Care Act”, or the ACA, is a (QUITE controversial) law, which ensures that all Americans have access to health insurance that is, just like its title says, affordable. the ACA was signed by President Obama in March of 2010, and went into effect Jan. 1, 2014. It makes affordable care possible by offering the consumers discounts or tax credits on government-sponsored health insurance plans, and expanding the Medicaid assistance program to include more people who don’t have it in their budgets to pay for health care.

Oct. 1, 2013 marked the official launch of open enrollment of the ACA. In February alone, some 700,000 people have enrolled and since the official launch over four million people have signed up for the ACA. With the deadline around the corner it’s not too late to get enrolled. If you haven’t signed yourself up for health insurance, you still have until March 31, 2014.

It is possible to buy insurance outside of the open enrollment period (ending March 31st, 2014) if you qualify for a special extended enrollment period due to a qualifying life event (such as marriage, divorce, birth or adoption of a child, or loss of a job). People who opt out of all health coverage options will have to pay an “individual responsibility payment” (either 1% of your annual income or approx. $100/year), and will also have to pay the entire cost of all their medical care (with no government subsidies). For more information on opting out, click HERE.

The Affordable Care Act is not going to solve all the problems afflicting the health care system, and establishing care for so many previously uninsured people is bound to be complicated (and at times awkward). However, the ACA represents “one giant step for mankind”, toward addressing injustices in the health care realm, and connecting millions of Americans, including LGBT Americans, to the health care that they and their families need to live happier and healthier lives.

A study by the Center for American Progress discovered that a whopping 71% of uninsured LGBT people don’t know their options under the new healthcare act. LGBTQ people are less likely to be insured, and less likely to seek or be able to access preventative care. While the Affordable Care Act is in the beginning stages, this is the perfect opportunity to spread the word in our communities about the significantly expanded options available now, including:

  •  LGBT people and their families have equal access to coverage through the new Health Insurance Marketplaces in every state.
  •  Plans will cover a range of essential benefits such as doctor visits, hospitalizations, reproductive health, emergency-room care, and prescriptions.
  •  No one can be denied coverage based on pre-existing conditions.
  •  Financial help is available to pay for a health insurance plan, based on household size and income.
  •  There is family coverage that is inclusive of same-sex partners

Check out these powerful images below, and feel free to download and  share!

get covered 2

get covered 3

get covered 4

get covered

part three

Health Care



Need help getting enrolled? Check out Out2Enroll.com

Need additional assistance? Many LGBT Centers around the country have received funding to train and provide “certified educators” to help community members

navigate ACA enrollment…call your local LGBT Center and make an appointment with an expert!

Also Check out our previous blog post about the ACA:



Eldin the Cabbie: Wellness Policy Savant

by Scout

Stay tuned, Institute over but more posts to come

It’s been a busy week with posting to the blog, but stay tuned, it’s not done. We still have a few more posts to finalize about lessons from the Tobacco & Diabetes Training Institute 2010, and today our team splits forces to head into 2 more meetings, I’ll be up in DC meeting with Secretary Sebelius and members of the new HHS Task Force on LGBT Health, while Gustavo and Emilia stay in Atlanta to attend the all-day tobacco disparity network planning day. So stay tuned for blogs on all.

Eldin the amazing

How did it start? I jumped into the cab to race to the airport and I think my cabbie warned me about his New York style driving but next thing you know he’s launching on a world class high volume rant about how we’re messing up health in this country. Crazy part was, he’s like a policy savant, nailing every single problem us fancy wellness folk are trying to prioritize.

Eldin on city planning for health

“Now New York has it right, in NY you can walk everywhere. Now look at Atlanta downtown, go down after dark, do you see anything? No! And it’s dangerous. They need to build more stores in those big buildings, so people can have something to walk to at night.” Right on Eldin. “And look at it here.” We’re zipping through Atlanta sprawl-lands. “Those people can’t go anywhere without their car. They can’t even walk anywhere at all. Now in New York, you can walk for hours. And do you wanna know how many different juristictions we just went through? Four. All of those places have to agree to do anything new.”

Eldin on exercise

“And what about bicycles? We’re driving through a park right now, you see any people biking or even walking? You used to use your bicycle to go places, but now you have to put it in your car before you can get anywhere safe to bike, and then we don’t, we just don’t even use our parks. Now think if you were in New York City now, how many joggers would you see in Central Park?” I admit, plenty. “Yah, we don’t even use our parks here, it’s such a shame.”

Eldin on diet

“And look around you, have we passed any grocery stores at all?” No sir. “You see, where are you supposed to even get vegetables. Yet you wanna know what’s one block that way? Lines of fast food restaurants all the way into Atlanta. What is that stuff? It’s all fried. There’s no vegetables in it. People don’t even know to eat them any more. That’s why we’re all fat. Now back in Haiti when I was a boy, whenever my mama was pregnant, my grandma would be cooking spinach and greens for months because that made your blood strong. But here, where do you even find them?”

Eldin on tobacco

I tell Eldin one of the tidbits I learned at the training, that part of the aid we sent to Haita after the quake included cigarettes.  He’s incensed, “Like they can eat that? I mean people are going to do what they’re going to do, but we’re growing enough tobacco there already. We used to grow lots of our own food, now other countries keep teaching us how to get rid of our farms and buy things from companies instead. But none of it is healthier!”

“This country is messed up!”

“And it’s going to take a long time to fix!” Eldin finishes with a flourish. He’s gotten all worked up and I sigh thinking, yup, it’s going to take a lot of time to make it simpler for people stuck in the car wilds of Atlanta sprawl to have easy access to routine exercise. Back in my doctoral program I remember wondering why the World Health Organization had Transportation as one of their top 10 social determinants of health, now that link is becoming crystal clear. (I’m not even counting how naïve me thought their listing of Food as another major determinant of health was mostly about famine, not feasting. Ha!)

New health care reform prevention council

But change is afoot from top to bottom here. The passing of health care reform, also known as ACA or Affordable Care Act is setting some big pieces in motion to focus on wellness and prevention nationally. A large step is the creation of a new Prevention Council filled with cabinet members from all over government. And no, it’s not just filled with people from Health and Human Services, but with the head of the EPA, Dept of Transportation, Dept of Agriculture, etc. Folk realize we need changes at all these levels to clear the path to make it easy to be healthy in our country. Nicely, in the first report of this council, they are also naming sexual orientation (crossing fingers for gender identity soon) as a disparity population! So, I’m looking forward to this new top level coordination to change systems and the from-the-getgo inclusion of LGBTs. I know they’re putting together an attached community advisory council, I sure hope we have LGBT health experts on it. And I think we should have Eldin too!