Ending Exclusions Under Obamacare

Andrew Shaughnessy, Manager of Public Policy for PROMO

By: Andrew Shaughnessy
@andrewshag

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.

End

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.

Benson & Hedges Targets LGBTT Communities in Puerto Rico

Juan Carlos Photo

 

Juan Carlos Vega, MLS

Blogging for the Citizens’ Alliance Pro LGBTTA Health of Puerto Rico, National Latino Alliance Pro Health Equity and the Network for LGBT Health Equity

 

 

This is bad! As health professionals, community prevention programs, and the Puerto Rico Department of Health strive to reduce tobacco use prevalence among island inhabitants, we have busted Benson & Hedges, twice, targeting lesbian, gay, bisexual, transgender, and transexual (LGBTT) communities in San Juan area’s LGBTT clubs. Cute girls, in tight outfits, look to scan your driver’s license in order to continue to help folks initiate or facilitate access to low price cigarettes. If you fill out the survey that they present at these bars and allow them to scan your id, you can purchase a pack of Benson & Hedges from the bar at a huge discount. No wonder LGBTT smoking prevalence is two to three times higher than that of the general population.

Health Authorities Warn: Smoking Kills

Health Authorities Warn: Smoking Kills

Twice, I have been with gay guys who are trying to quit smoking for health and financial reasons and they have been accosted by such tobacco industry tactics. One time, we bought the cigarettes, the second time we resisted. Yes, I was included. After nine years of being smoke free, I have become an occasional social smoker for the past 3-4 years. It is so nasty, the smoke inhalation, the after taste, yet, after a few drinks, I see myself taking a “hit” or two from my friends’ cigarettes. I don’t blame the industry for my personal unhealthy choices, but they sure don’t help us quit for good!  Access to cheap smokes at bars should not be allowed! 

Last weekend, was the second consecutive month, we have seen this predatory practice in our local LGBTT bars. It was contrasting to see as we were distributing promotional flyers for the  3rd LGBTT Health Summit of Puerto Rico, April 4th and 5th at the School of Nursing of the Medical Science Campus of the University of Puerto Rico, free of cost for the general public and $45.00 fee for Continuing Education for Physicians and Nurses. Against the luring of the tobacco industry to get us to smoke again, the Citizens’ Alliance Pro LGBTT Healthefforts continue to fight the dangers of tobacco use with the support ofLegacy Foundation, the Network for LGBT Health Equity, theComprehensive Cancer Center at the University of Puerto Rico, and the local tobacco free coalition. For more information, on how tobacco affects the health of LGBTT communities, come to the 3rd LGBTT Health Summit of Puerto Rico: Tendencies Towards Health EquityApril 4th and 5th in San Juan. Come by, our Summit is cheaper than the pack of cigarettes sold those nights and you will get great information, make new friends and learn how to take better care of yourselves!

spanish tobacco

Juan Carlos Vega shows a tobacco cessation material in Spanish “Tobacco is a murderer that does not discriminate”

Press Release: LGBT Cancer Survivors’ Voices Spotlight CRACKS in Health CarE SYSTEM

liz-image1

 

by Liz Margolies, LCSW 

Director, National LGBT Cancer Network

 

 

FOR IMMEDIATE RELEASE

JUNE 11, 2013

CONTACT: Cathy Renna, 917-757-6123, cathy@rennacommunications.com

 

LGBT Cancer Survivors’ Voices Spotlight

CRACKS in Health CarE SYSTEM

 

MAKES PRACTICAL, LIFE-SAVING RECOMMENDATIONS FOR PROVIDERS

New York, NY….June 11, 2013….The National LGBT Cancer Network released a new report today that uses the direct experiences of cancer survivors to paint a stark picture of the effect of discrimination on LGBT health. The free, downloadable booklet, “LGBT Patient Centered Outcomes,” uses the findings to suggest practical recommendations for improving health care for LGBT people.

“When we asked cancer survivors to tell us what they wanted health care providers to know, we were saddened, angered and moved by many of their stories; cancer is enough of a burden, no one should have to endure the discrimination, alienation, and, in some cases, less than adequate care because of who they are,” said Liz Margolies, Executive Director of the National LGBT Cancer Network. “For many of  the survey respondents, cancer treatment is both the same, and scarier.”

4482499Quotes from study participants highlight her point:

“I was never out during the whole process to anyone. I had no one in the hospital or doctor visit me for fear of my gayness being discovered and then the doctors ‘accidentally’ not removing all the cancer lesions.”

“… It is important to know where it is safe to bring a partner, because my family hates me and even my mother told me right before the surgery that she hoped I would die in surgery and that she wished I had never been born.”

“As an alone, aging senior, I am also dealing with fear of rejection by being “out” even though I was very “out” when younger and in a partnership.”

lgbt1

“Although my doctor knew all about me, each encounter with new people—with blood draws, ultrasound, breast x-ray, etc.—had the basic anxiety of the procedure and layered on to that, the possibility of homophobia and having to watch out for myself.

“Being a Lesbian facing having your breasts cut off, it would be good if they did not assume you were concerned about how “men” would see you in the future!”

“I believe my perceived orientation allowed my caregivers to give superficial care, and my own latent shame allowed me to accept a quick and incorrect diagnosis of health.”

Dr. Scout, a co-author and the Director of the Network for LGBT Health Equity at The Fenway Institute noted the direct relevance to the new patient centered care movement. “Data continue to show satisfied patients, that is patients who feel safe and understood during health care, stay healthier. This is why patient-centered care is best. But for LGBT patients, their care often falls short of being patient-centered and sometimes it’s blatantly patient-intolerant,” continued Scout.

“This new report is not about theories, it is based on the lived experiences of people who can teach us about how to make things right for LGBT patients. These stories show us exactly what is needed to improve the climate for LGBT people in all areas of health care, not just cancer care,” said Margolies. The report highlights recommended suggestions for each section, including some that are newer to the field. “We clearly saw the need to actively monitor LGBT patient satisfaction. This is a new idea, and we’ll be including suggestions on how to do this in all of our cultural competency trainings now,” said Margolies. The report also highlights innovative recommendations about family support and the need to nurture LGBT employees. The biggest recommendations are the pillars of most current LGBT cultural competency trainings: to actively convey welcoming through outreach, policies, environment, and provider trainings. An estimated 50% of the hospitals in the country have now passed LGBT inclusive nondiscrimination, often quietly and without fanfare. “Passing a policy without promoting it doesn’t create change,” said Dr. Scout. “And LGBT people need change in health systems now.”

lgbt-patient-centered-outcomes-banner

“These people spoke up about sometimes heart wrenching experiences because they wanted healthcare workers to know how to make care better for others.  I hope everyone in healthcare will listen,” concluded Margolies.

The National LGBT Cancer Network works to improve the lives of LGBT cancer survivors and those at risk by: educating the LGBT community about our increased cancer risks and the importance of screening and early detection; training health care providers to offer more culturally-competent, safe and welcoming care; and advocating for LGBT survivors in mainstream cancer organizations, the media and research. For more information, visit http://www.cancer-network.org.

The Network for LGBT Health Equity is a community-driven network of advocates and professionals looking to enhance LGBT health by eliminating tobacco use and other health disparities by linking people and information. The Network is a project of The Fenway Institute in Boston. The Fenway Institute at Fenway Health is an interdisciplinary center for research, training, education and policy development focusing on national and international health issues. For more information visit https://lgbthealthlink.wordpress.com/ and fenwayhealth.org.

Download the full report HERE

Check out the National LGBT Cancer Network website

Deconstructing a Disparity: Association of Violence and Discrimination with Smoking Among Sexual Minority Youth Adults

This afternoon, I attended some intriguing presentations from the Population Center’s Summer Institute graduates. Among them, John Blosnich, PhD candidate of Public Health Sciences at West Virginia University stuck out as a researcher looking into violence and discrimination within the context of LGB youth smoking rates. In his presentation, titled:  “Deconstructing a Disparity: Association of Violence and Discrimination with Smoking Among Sexual Minority Youth Adults,” John discusses the hypothesis that minority stress (including homophobia, alcohol abuse, depression, disclosure and bullying) may impact smoking rates among LGB youth–specifically, with regarding minority stress, how sexual minorities use tobacco as a strategy to deal with stress.

Using the National College Health Assessment Survey Fall 2008/Spring 2009 data, John identified the variables victimization, discrimination and tobacco use in comparing gay, lesbians and bisexuals with heterosexuals. As expected, GLB youth experienced not only higher rates of smoking but also higher rates of sexual assault, discrimination, physical assault and threats. However, despite higher rates of all of these factors, higher rates of discrimination and assault did not translate into higher smoking rates. In other words, discrimination and other minority related negative experiences did not affect smoking rates in this sample.

As a result of these findings, John plans to look at resiliency as a factor in why LGBT people who experience discrimination don’t smoke. In addition, he plans to look more closely at gender and race within this context. We are very excited to follow the progress of John’s research project to see what his research yields. Stay tuned for some information, and for more information or to discuss the project, please email him.

by Emilia Dunham

Program Associate with the Network for LGBT Tobacco Control

 

Bookmark and Share