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Healthcare Reform's Unintended Queer Upside | The Nation

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Healthcare Reform's Unintended Queer Upside

Here's a talking point Democrats probably won't be using to defend healthcare reform this week: it's a game-changer for the LGBT community.

In part this is because healthcare reform extends health insurance to 32 million mostly low-income people, thereby covering thousands of the LGBT poor. True, we don't know precisely how many LGBT people have been affected by the law, because we don't know how many of us there are in this country, period. As you may recall from this past summer's brush with the census folks, there's no nationwide standard for data collection on sexual orientation or gender identity. But we do know from the Williams Institute's study and others that lesbians and gay men are twice as likely as heterosexuals to be uninsured (rates for bisexual and transgender people are likely as bad or worse). 

Homophobia and transphobia have their costs—literally. There's the difficulty of finding and keeping employment that includes health insurance, especially in a country where anti-LGBT discrimination, including policies around hiring and firing, is still legal in over half the states. Then there's our exclusion from marriage and its benefits. And it's no coincidence, given our higher incidence of being alienated from our biological families, that over 40 percent of homeless youth are LGBT.

Healthcare reform addresses a surprising number of these inequities. By redefining poverty, and by creating alternatives for those who fall outside of that new definition, it has extended insurance coverage to 32 million low-income people, including LGBT people. Of those, some 16 million are now eligible for federal public health programs like Medicaid and Medicare. That's because a new single national standard says that an individual or family can earn up to 133 percent of the Federal Poverty Level (FPL) and still qualify for those programs. Previously, states determined eligibility, which was all over the map and frequently draconian. Texas, for example, tossed a single parent raising two kids off of Medicaid if s/he made more than $396 per month. By 2014 Texas will need to conform to the new national standard of $2,029 per month, minimum—still not great for a family of three, but literally five times better than before.

Still another 16 million more citizens can now buy private coverage, sold through state-operated healthcare exchanges that provide sliding-scale premium subsidies based on income. Finally, and perhaps most helpfully for many lower-income LGBT adults, healthcare reform requires that all states allow childless adults with incomes up to 133 percent of FPL ($14,403 a year) to apply for Medicaid coverage. Previously, only seven states allowed this; others forbade it, no matter how low the individual's income.

While this is all great news, it's just a happy accident of unhappy circumstance: LGBT people inadvertently benefit because we're a subset of a larger group of low-income, uninsured people. The greater challenge, which I'll address in tomorrow's post, concerns the current struggle by advocacy groups, coordinated in large part by the National Coalition for LGBT Health, to argue that LGBT people are specifically protected or included under certain provisions of the act that address discrimination, data collection, disparity and the definition of family itself.

 
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