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


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:


LGBT Policy · Resources · social media · Uncategorized

Out2Enroll: Getting LGBT communities connected to care!

Network for LGBT Health Equity
Out2Enroll LGBT Communities 

The Network for LGBT Health Equity, along with CenterLink: The Community of LGBT Centers would like to announce the roll-out of our #GetCovered ad campaign, highlighting the experiences of uninsured and underinsured LGBT folks and the barriers they faced accessing healthcare prior to the Affordable Care Act. We hope that it both educates and motivates people to visit Out2Enroll to sign up before the open enrollment window closes on March 31st, 2014!

Out2Enroll is a collaboration by the Sellers Dorsey Foundation, the Center for American Progress, and the Federal Agencies Project to educate LGBTQI communities about their options under the Affordable Care Act (aka “Obamacare”).

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

Want more information? Check out this report or head right to Out2Enroll.org!

*And remember! In order to get health insurance coverage by January 1st 2014, you must enroll by December 15th 2013!

Check out the powerful images below, and feel free to download and share (Click to enlarge). This campaign will have a series of phases, with more photographs being posted to our blog and social media channels- so stay tuned!




















We want to send out a huge thank you to the folks who shared their stories with us! Also a big thanks to the organizations that we have co-branded with- Center for Black Equity, Trevor Project, and GetEqual.

Would your organization like to co-brand with us on any of the above ads? Send us an email at lgbthealthequity@gmail.com!