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The Big Picture on Healthcare Reform for LGBT People | The Nation

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The Big Picture on Healthcare Reform for LGBT People

Yes, I’m yet another citizen unhappy with the downscaling of healthcare reform. Sure, it stinks that the public option died, and that the drug industry escaped having to negotiate cheaper prices, in the final legislation. But I’ve been surprised to learn of its unintended queer upside through my talks with advocates and activists this past week.

Even in downscaled form, the Affordable Care Act (ACA) may transform the Big Picture for LGBT people more radically than any other federal legislation in this last decade. I say this with no disrespect to the marriage equality movement and the repeal of "don’t ask, don’t tell." But not all LGBT people are ready, willing or able to enlist in marriage or the military, whereas everyone needs medical care.

The ACA’s queer potential isn’t obvious at first glance. As Kellan Baker of the National Coalition for LGBT Health puts it, “The ACA is just the CliffsNotes of healthcare reform.” The regulations written to provide the actual underpinnings of the new healthcare policy are being hammered out right now by a roundtable of agencies, under the watchful eye of various advocacy groups.

And that’s where the door could open for us. Because large swaths of the ACA’s rhetoric and funding are devoted to addressing how discrimination, ignorance and underreporting of distinct groups impede delivery of healthcare—and to turning things around. Yes, the federal government is about to spend big bucks on data collection that will help it understand which groups have, for example, higher rates of strokes or obesity, or a greater incidence of HIV or addiction, and why. Ditto for improving providers’ “cultural competency”—their ability to interact effectively with the many soon-to-be-insured patients who don’t fit the white/straight/middle-class norm.

If the healthcare needs of LGBT people are to be known and addressed, questions about sexual orientation and gender identity and expression need to be included whenever "counting" happens—the census, epidemiological studies, needs assessment for cultural competency training, etc.—alongside the already recognized categories of race, ethnicity, and primary language. That’s what will open the door to our being researched in terms of those health issues that appear to affect us disparately, and included in widespread cultural competency initiatives. Both of which will give us a better shot at having our needs addressed—respectfully, well and across the board. And that’s the argument that queer health advocates seated at that regulations roundtable are making.

It’s vital that LGBT people be counted and treated: info gathered from a patchwork of available data from smaller studies suggests that health disparities in our communities are real, and deadly. We smoke at rates up to 200 percent of the general population. Gay and bisexual men comprise more than half of new HIV infections in the United States each year, with HIV prevalence among transgender women exceeding 25 percent nationwide. Black and Latina lesbian and bisexual women are much more likely to be overweight than their heterosexual peers. Thirty percent of LGBT youth report having been physically abused by family members because of their sexual orientation or gender identity or expression.

You’re disappointed by healthcare reform? Aren’t we all. Take a number. Want to push the federal government to enact it in the most radical way possible? Take a stand.

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