LGB Adults Are More Likely to Face Access and Affordability Barriers than Heterosexual Adults, Despite High Insurance Coverage and Strong Connections to the Health Care System
*Names in bold indicate Presenter
Methods: This study uses data from the Health Reform Monitoring Survey (HRMS), an internet-based survey of about 7,500 non-elderly adults each period, approximately 450 of whom self-identify as LGB. We examined coverage, access, and affordability for the LGB and heterosexual populations using data from the March and September 2016 surveys. Differences between the LGB and heterosexual populations were estimated unadjusted, adjusted for differences in health status, and adjusted for differences in health status, socioeconomic status, and urbanicity.
Results: In 2016, LGB adults and heterosexual adults were equally likely to have health insurance coverage at the time of the survey and to have had coverage for all of the past 12 months. LGB adults and heterosexual adults were also equally likely to have connection to the health care system, as measured by reporting a usual source of care (72.1 percent vs 72.6 percent).
LGB adults with full-year insurance coverage and a usual source of care were more likely than their heterosexual peers to report having had a problem accessing care (22.7 percent vs 16.7 percent). The 6.0 percentage point gap was reduced, but not eliminated, after adjusting for differences in health characteristics, socioeconomic status, and urban/rural status between the two groups. LGB adults were also more likely than heterosexual adults to report an unmet need for medical care due to cost (29.8 percent vs 20.0 percent), and this gap was also reduced, but not eliminated, after adjusting for differences in health characteristics, socioeconomic status, and urban/rural status.
Conclusion: While the ACA and marriage equality appear to have significantly improved health insurance coverage rates for LGB adults, gaps in access and affordability between LBG and heterosexual adults still persist. These gaps between LGB adults and heterosexual adults narrowed but remained after adjusting for differences in health characteristics, socioeconomic status, and urban/rural residence between LGB and heterosexual adults, suggesting that other factors created disproportionate access and affordability barriers for the LGB population. Prior research has demonstrated that LGB adults can face discrimination in the health care system that could present barriers to care, and some evidence indicates that those who feel they were treated unfairly or with disrespect by a provider or their staff frequently forgo care as a result. Further research is needed to disentangle the effects of differences between LGB and heterosexual adults in health insurance coverage type and quality, provider availability and behavior, geography, health care needs, and health seeking behavior on gaps in health care access and affordability. Further policy action may be necessary to protect LGB adults from discrimination in the health care delivery system, and to ensure adequate access to care for LGB adults with significant health care needs.