Attacks on evidence-based medicine, such as restrictions on the provision of transgender medical care and reproductive care, proposed funding cuts to HIV prevention and treatment programs, and the reduction in capacity for programs that protect the health of disabled people magnify existing barriers LGBTQI+ communities face when trying to access appropriate health care.
To push back against these disparities, states and local governments must proactively foster equity in their health care systems. This article lays out the steps governing bodies can take to build the foundation for a health care system that truly works for everyone.
Supporting health coverage in LGBTQI+ communities
While overall rates of health insurance coverage for the community have risen over the past decade, LGBTQI+ people are less likely to be insured than their non-LGBTQI+ counterparts. Coverage rates particularly remain low for transgender people, adults with intersex traits, and LGBTQI+ people of color. Recent federal policy changes will further threaten access to health coverage. The One Big Beautiful Bill Act’s health care provisions, including new Medicaid work requirements, are expected to result in 10 million Americans losing coverage by 2034, with significant implications for low-income LGBTQI+ people.
Proactive campaigns created in partnership with local LGBTQI+ organizations can help people enroll in and maintain health coverage. These campaigns should provide education and enrollment assistance on the insurance options available to LGBTQI+ communities—especially for individuals who may not receive coverage through their employer and may have lower incomes than their non-LGBTQI+ peers.
LGBTQI+ cultural competency requirements in health care settings
In health care settings, discrimination may arise from a lack of training or educational resources for providers and medical students. To set providers up for success, policymakers can invest resources in robust cultural competency training. The Transgender Health Care Access Act (H.R. 2487) is an example of how this can be achieved at the federal level.
Cultural competency trainings are effective programs that ensure providers are equipped to work with LGBTQI+ patients. Trainings should be required for medical students and for medical providers who receive state funding for the provision of health care services. For medical providers not covered by those parameters, free course modules should be easily accessible. Health care insurers should also receive training on working with LGBTQI+ populations—especially staff who interface with patients and those responsible for coverage determinations.
Like all cultural competency courses, these trainings should be consistently updated in keeping with best practices as they evolve.
Comprehensive LGBTQI+ nondiscrimination protections
Discrimination and the fear of discrimination remain major deterrents for LGBTQI+ people who need health services. As many as 21 percent of LGBTQI+ adults in the country have delayed needed care due to the risk of discrimination. Section 1557, the major nondiscrimination protection in the Affordable Care Act, has already been weakened and remains under threat. The need to find a solution is urgent.
State policymakers must pass comprehensive nondiscrimination policies that provide LGBTQI+ people and their families with protections in housing, employment, and public spaces. These protections must include publicly funded services and health care settings.
Insurance nondiscrimination requirements vary by state, creating a confusing patchwork of protections. States and local governments can issue new guidance or improve existing laws to require health insurance providers in their state to provide equal treatment and coverage of needed care for LGBTQI+ people. Nondiscrimination protections must be supported by clear reporting and enforcement mechanisms.
State disability protections
Nearly half of all LGBTQI+ adults reported having a disability in 2024. Rates of disability are even higher for transgender adults, with 70 percent reporting a disability that year. Disabled LGBTQI+ people also face higher barriers to health care access: Increased experiences of discrimination and higher rates of cost barriers mean that disabled LGBTQI+ people are often going without health care that they need. States can implement new nondiscrimination protections and shore up agencies and departments that enforce laws protecting people with disabilities to ensure that everyone can participate in public life with equity and dignity.
In 2024, almost one-quarter of LGBTQI+ adults and nearly half of transgender adults reported a “mental health disability.” One type of mental health disability that affects transgender people uniquely is gender dysphoria—the medical diagnosis used to describe the distress caused by the incongruence a person feels between their sex assigned at birth and their gender identity.
At the federal level, cuts to programs, changes in Medicaid work requirements, and abandonment of long-standing civil rights law are putting disabled people at risk and leaving states without appropriate guidance and enforcement support. In light of additional federal actions against transgender health care and changes to nondiscrimination enforcement in the workplace, state and local governments should examine their laws protecting people with disabilities from discrimination and ensure gender dysphoria is appropriately included. These policies should include both individuals with documented disabilities and those perceived as having disabilities.
Conclusion
State governments have many tools at their disposal to ensure health care is provided equitably for all their constituents. States can improve health equity for LGBTQI+ people by focusing on policies that increase health care access and quality. Robust nondiscrimination protections are a necessary step to protect patients once they make it to the doctor’s office. Rather than viewing these as isolated policy changes, officials should take a whole-system view to ensure the health and well-being of LGBTQI+ people.