The National Coalition for LGBT Health

"Of all the forms of inequality, injustice in health care is the most shocking and inhumane."

- Martin Luther King, Jr., 1966

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A System in Crisis

The U.S. health system has long been in crisis. The U.S. is the world’s richest country, and we spend 16 percent of our massive gross domestic product (GDP) on health care – far more than any other industrialized democracy. Yet at the beginning of the 21^st century, after decades of innovation that made America’s medical expertise the envy of the world, our healthcare system has been failing millions of people in America itself. By almost any measure, including efficiency, equity of access and outcome, and effectiveness, the U.S. health system has consistently ranked well below its developed-nation peers. In its landmark 2000 study of the healthcare systems in 191 countries, the World Health Organization awarded the U.S. system 37^th place for overall performance, just ahead of Slovenia and Cuba, and 54^th place for fairness.[1]

Healthcare costs have been outpacing the growth of America’s GDP since 1970, increasingly restricting access to vital healthcare services to those who can secure adequate insurance coverage or who can afford to pay for expensive treatments out of pocket. In 2007, 50 percent of healthcare spending in the U.S. was used to treat just five percent of the population.[2] Insurance is also becoming harder to obtain: the shortcomings of America's for-profit insurance industry include practices such as denying coverage to people with pre-existing conditions like hypertension or previous cancer diagnosis (“cherry picking”) and searching for excuses to cancel a sick person’s coverage rather than pay for their treatment (“lemon dropping”). Such practices have left an estimated 46 million Americans without insurance, in addition to an unknown number of people without citizenship documents, and almost 45,000 people die in America every year because they lack insurance coverage.[3]

Even those who have insurance have enjoyed no guarantees. Aside from the threat of losing coverage as a result of job loss, divorce, or insurance company discrimination, an increasing number of people in America are underinsured, meaning that their health insurance does not adequately protect them from high medical expenses.[4] Every year, medical bills bankrupt 700,000 Americans, accounting for over 60 percent of bankruptcies in the U.S. Of these people, 75 percent were insured at the time they became ill.[5]

Healthcare Reform: The Patient Protection and Affordable Care Act of 2010

To begin to remedy this situation, both chambers of Congress began work on a comprehensive overhaul of America's healthcare system in 2009. The House of Representatives approved the Affordable Health Care for America Act (H.R. 3962) on November 7, 2009 in a close vote of 220-215, with one Republican voting in favor. The Senate approved the Patient Protection and Affordable Care Act (H.R. 3590) by a party-line vote of 60-39 on December 24, 2009. The two bills were eventually combined with a proposal from the President to form the final law, and President Obama signed the landmark Patient Protection and Affordable Care Act (the "Affordable Care Act," H.R. 3590) on March 23, 2010. The bill was slightly amended by the subsequent Health Care and Education Reconciliation Act (H.R. 4872), signed by the President on March 30, 2010.

The Coalition worked extensively with allied organizations and with reformers and health advocates in both the House and the Senate to ensure that the Affordable Care Act would be as inclusive as possible of LGBT health concerns. To guide our work, we developed a set of Guiding Principles for LGBT Inclusion in Health Care Reform, which were sent to Congress and the Obama Administration. The Guiding Principles have also been condensed into a shortened LGBT Health Manifesto.

While the final law does not address all of the concerns of the LGBT community, it does lay out numerous important provisions that are key to improving the health and well-being of everyone in America, including LGBT people.

The Affordable Care Act has been endorsed by numerous advocacy and professional organizations such as the American Association of Retired People (AARP) and the American Medical Association (AMA) for the benefits it offers to healthcare consumers, including:

• expansion of eligibility for Medicaid
• requiring most employers to offer insurance benefits
• insurance market reforms, including the creation of state-based Health Insurance Exchanges in 2014
• regulations on setting and raising insurance premiums
• prohibition of insurance industry practices that limit access to coverage for those who need it most
• creation of temporary Pre-existing Condition Plans in each state to provide coverage for people who have been denied coverage due to a prior illness or medical condition
• identifying and addressing health disparities through data collection, funding, and targeted programming
• increasing funding for prevention and wellness programs
• reining in healthcare costs by streamlining administration, improving efficiency, and eliminating fraud

For detailed information on several of these provisions and background on areas of priority concern in LGBT health under the Affordable Care Act, please click here.