Association for Public Policy Analysis & Management

Most federal surveys do not collect information on sexual orientation, but there is significant policy interest in health insurance status and health care access in the lesbian, gay, and bisexual (LGB) community. Since 2013, several studies have shown large reductions in the uninsured rate for LGB adults. This study assesses whether this reduction in the uninsured rate has been accompanied by improvements in access and affordability, and assesses the extent of gaps between LGB and non-LGB adults.

Study Design

This study uses data from the Health Reform Monitoring Survey (HRMS), a quarterly, internet-based survey of about 7,500 adults each quarter, approximately 400 of whom self-identify as LGB. We examine changes in insurance coverage, health care access and use, and health care affordability for the LGB population using data from June/September 2013 (summer 2013) and December 2014/March 2015 (winter 2014/2015). Data from two quarters are combined to enhance sample size for the LGB population. We provide results for the LGB population as well as comparisons between the LGB and non-LGB population.

Principal Findings

The uninsured rate for LGB adults was cut nearly in half between summer 2013 and winter 2014/2015, and the share of LGB adults with a usual source of care increased from 67.2 percent to 78.1 percent during this period. However, LGB adults did not see statistically significant reductions in problems accessing care, unmet needs for care due to cost, or difficulty paying family medical bills, though, directionally, these barriers to care appear to have declined.

As of winter 2014/2015, the uninsured rate for LGB and non-LGB adults was not statistically different, and LGB adults were more likely than non-LGB adults to report a usual source of care. However, LGB adults continued to face more difficulty accessing and affording care than non-LGB adults, even after adjusting for differences in health care needs, socioeconomic status, and urbanicity. For example, nearly a quarter (24.4 percent) of LGB adults reported a problem accessing care over the past 12 months, compared to 16.1 percent of non-LGB adults (unadjusted).  

Conclusions

Prior to the ACA, several studies showed higher uninsurance and poorer access to care among the LGB population. While the uninsured rate for LGB adults has been cut nearly in half since June/September 2013 and the share of LGB adults reporting a usual source of care has improved, significant disparities in access and affordability by sexual orientation remain, even after adjusting for differences in health care needs, socioeconomic status, and urbanicity. Further research is needed to determine whether, over time, the ACA and expanded marriage equality help close the remaining gaps between LGB and non-LGB adults.