In the last five years, the federal government has taken significant steps toward recognizing and addressing health disparities that affect LGBT people. These include increasing data collection about sexual orientation and gender identity, establishing new nondiscrimination provisions that cover these characteristics, and increasing research and prevention services targeting LGBT health.
But there are two more things that the U.S. Department of Health and Human Services can do that will make an even bigger impact on closing the gap in health care disparities between LGBT people and the general population: designate LGBT people as a medically underserved population (MUP) and as a health professional shortage area population (HPSA).
If HHS makes these designations, community health centers and other safety net providers will get access to desperately needed federal funding to reach out to LGBT people and provide them with culturally competent and affirming preventive care.
Currently, the LGBT population experiences health disparities that are significant both from a clinical and a public health perspective. Lesbians are more likely than heterosexual and bisexual women to be overweight and obese, which increases their risk for cardiovascular disease, lipid abnormalities, glucose intolerance, and morbidity related to inactivity. While lesbians and bisexual women experience cervical cancer at the same rate as heterosexual women, they are much less likely to get routine Pap tests to screen for cervical cancer. As a group, LGBT people are 1.5 to 2.5 times more likely than other Americans to smoke. Gay and bisexual men and transgender women experience high rates of HIV and sexually transmitted infections, as well as high rates of violence victimization, minority stress, and mental health burden.
LGBT people experience barriers to accessing primary care inclduing a lack of providers trained to address the specific needs of LGBT people, low rates of insurance coverage for same-sex couples and LGBT individuals (especially black transgender people), and a lack of access to culturally appropriate health care, including preventive services such as mammography and other cancer screenings. Most importantly, LGBT people report widespread discrimination in health care. A recent national survey by Lambda Legal found that more than half of LGB respondents and 70 percent of transgender respondents report experiencing discrimination. A survey of 452 Massachusetts transgender residents that the Fenway Institute and the Massachusetts Transgender Political Coalition published this summer found that one in four transgender people did not seek routine health care, and one in five did not seek emergency care, due to prior experiences of discrimination in a health care setting.
All of this should qualify the LGBT population as both medically underserved and one for which there is a shortage of providers. Indeed, the Negotiated Rule Making Committee ― which was convened under the Affordable Care Act in order to update methodologies to make MUP and HPSA designations — recommended overwhelmingly in October 2011 that the secretary of Health and Human Services designate LGBT people as an MUP and HPSA population group.
This fall, HHS secretary Sylvia Matthews Burwell is considering making additional MUP and HPSA designations. A policy brief published last month by the Fenway Institute, the Center for American Progress, the Human Rights Campaign, and GLMA: Health Professionals Advancing LGBT Equality urged HHS to make these designations. Implementation of the recommendations made in 2011 by the Negotiated Rule Making Committee will dramatically increase access to culturally and clinically competent health care for LGBT people, and could play a critical role in addressing persistent disparities in health care access and outcomes.
SEAN CAHILL, Ph.D., is director of health policy research at the Fenway Institute and adjunct assistant professor of public administration at New York University’s Wagner School of Public Service.