In 2024, state legislatures introduced an all-time record of 533 bills targeting LGBTQ+ populations. These policies create a patchwork of legal landscapes that vary widely between and within states, affecting aspects of everyday life ranging from how kids learn and play to where adults live and work.
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All of these policies have implications for the health of not only LGBTQ+ people but also the general public.
I am a health policy researcher who studies how state and federal legislation affect public health. Research has shown that the social determinants of health – the opportunities and resources that affect how people live, learn, play, work and age – play a significant role in LGBTQ+ well-being. Newly published work from my colleagues and I show how anti-LGBTQ+ public policies can have lasting effects on everyone’s health.
Existing policies and LGBTQ+ health
Same-sex marriage provides a clear example of the direct and indirect ways public policies affect LGBTQ+ health.
Most people in the U.S. have health insurance through their employer, which usually offers coverage for employees and their family, including a spouse and children. A landmark 2015 study found that health coverage significantly increased for adults in same-sex marriages after its legalization in New York state. After same-sex marriage was legalized nationwide, a follow-up study also showed an increase in health insurance coverage among gay and lesbian couples.
Even among single LGBTQ+ people who did not get married, same-sex marriage may have also improved their health by improving social attitudes toward LGBTQ+ people overall. Researchers found that gay and bisexual men, regardless of whether they were single or married, spent less on medical visits, mental health visits and overall health care spending after Massachusetts legalized same-sex marriage in 2004.
Access to gender-affirming care provides another example of how public policies affect the health of LGBTQ+ people.
A 2020 national study of nearly 30,000 transgender and nonbinary people found that suicide attempts and mental health hospitalizations declined in states that passed policies requiring private insurers to equally cover services they already provide for cisgender people for transgender people. No other studies directly analyze how policies regulating access to care affect the health of trans and nonbinary people.
However, a large body of clinical research supports the health benefits of gender-affirming care. A randomized clinical trial and prospective study found that starting gender-affirming hormone therapy reduced depression and suicidality in transgender and nonbinary people. Several recent systematic reviews analyzing 124 peer-reviewed studies conducted over the past 50 years also found that gender-affirming surgery and hormone therapy improved quality of life and mental health.
Policies outside health affect LGBTQ+ well-being
Policies outside of health care – such as nondiscrimination, education and workplace protections – also affect LGBTQ+ well-being.
For example, transgender and nonbinary people living in states with policies that specifically include gender identity in hate crime and discrimination protections reported better mental health than those in states without protections. Similarly, LGBTQ+ students in schools with designated safe spaces reported lower rates of suicidal thoughts.
However, the surge in anti-LGBTQ+ policies in the U.S., initially focusing on youth, has significantly increased polarization between and within states. For example, while 17 states have implemented guidances to make schools safer and more inclusive for transgender youth, 25 states have banned transgender youth from using bathrooms and playing on sports teams that align with their gender. Meanwhile, South Dakota and Missouri have enacted laws to preempt progressive schools and districts from adding LGBTQ+ student protections and supportive resources.
The Trump administration is also actively targeting resources that support LGBTQ+ students by reducing funding to schools that offer these programs.
In 2020, the Supreme Court ruled 6-3 in Bostock v. Clayton County that federal sex-based nondiscrimination protections in the workplace included discrimination based on gender identity and sexual orientation. Researchers found that LGBTQ+ older adults with co-workers supportive of their gender and sexuality experienced less workplace conflict and cognitive health problems compared with those who did not.
