gay and lesbian health

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More Health Coverage, And Perhaps More Health, For Same-Sex Couples

A crowd waves rainbow flags during the Heritage Pride March in New York on Sunday, June 28. (AP)

A crowd waves rainbow flags during the Heritage Pride March in New York on Sunday, June 28. (AP)

You know how it goes: You have the great joy of the wedding — or of the gay pride celebrations that followed the Supreme Court’s marriage decision — and then the honeymoon’s over and it’s time to talk about the mundanities of stuff like (sigh) health insurance.

But still, it can be at least quietly pleasing to contemplate the many a newlywed who’ll now qualify for insurance offered by their new spouse’s employer. (And that on top of the several million people whose health insurance subsidies were just saved by the previous Supreme Court decision, on Obamacare.)

Not to rain on the weddings, but it’s also likely that many employers’ “domestic partner” benefits will go away. The picture is complex, but a study just out in JAMA finds that legalizing gay marriage does indeed increase employer-based health insurance coverage for same-sex partners. It looked at New York after gay marriage was legalized there in 2011, and more than 12,000 same-sex couples wed. From the press release:

Compared with men in opposite-sex relationships, same-sex marriage was associated with a 6.3 percentage point increase in ESI [employer-sponsored health insurance] and a 2.2 percentage point reduction in Medicaid coverage for men in same-sex relationships. Same-sex marriage was also associated with an 8.9 percentage point increase in ESI and a 3.9 percentage point reduction in Medicaid coverage for women in same-sex relationships vs women in opposite-sex relationships.

I asked the study’s author, Gilbert Gonzales of the University of Minnesota, whether anyone had done a similar study in Massachusetts after our own pioneering legalization of gay marriage more than a decade ago. He replied by email:

The only Massachusetts study I’m familiar with is an American Journal of Public Health study that found potential improvements in gay and bisexual men’s health after MA enacted same-sex marriage in 2003. There were significant reductions in mental health care visits and expenditures in the year after MA enacted same-sex marriage, which suggests broad public health benefits for LGBT people when states recognize same-sex marriage.

Another related study on health insurance coverage looked at the 2005 domestic partnership law in California, and found the law increased health insurance coverage among lesbian women relative to heterosexual women. There was no similar finding for gay men. The JAMA study suggests that legal same-sex marriage–rather than domestic partnerships–may improve coverage options for both men and women in same-sex relationships.

How many people in all may gain employer health insurance thanks to the Supreme Court ruling? Continue reading

Further Reading:

How Best To Care For LGBT Patients? New Medical Guide Reflects Change

(Courtesy of Marilyn Humphries)

(Courtesy of Marilyn Humphries)

By Dr. Harvey Makadon
Guest Contributor

In 2007, only one state — Massachusetts — recognized the marriages of same-sex couples. Today, 37 do, and based on the outcome of a pending U.S. Supreme Court case, marriage equality may be extend to all 50 states by June.

A similar sea change has taken place in the area of health care for LGBT people and those living with HIV — at least in terms of awareness of the problems that LGBT people face in accessing health care.

In 2007, when the first edition of the “Fenway Guide To Lesbian, Gay, Bisexual, and Transgender Health” was published, the critical need for culturally competent health care for LGBT people was being discussed among a relatively small group of LGBT people and allies.

Dr. Harvey Makadon (Courtesy)

Dr. Harvey Makadon (Courtesy)

But in 2011, the Institute of Medicine’s report, “The Health of Lesbian, Gay, Bisexual and Transgender People,” firmly established the existence of broad health disparities affecting LGBT communities, and laid out an ambitious agenda for addressing them.

The second edition of the “Fenway Guide To Lesbian, Gay, Bisexual, and Transgender Health,” which has just been published, is a natural outgrowth of this new information. About 80 percent of the text is brand new, and all of it is built on a strong new foundation of understanding the impact that actions — and inactions — by health professionals have had on LGBT people.

Today, we know that, in comparison with the general population,

• LGBT youth are more likely to attempt suicide and be homeless.

• LGBT populations have higher rates of tobacco, alcohol and other drug use.

• LGBT populations have a higher prevalence of certain mental health issues. Continue reading