The Senate Health Care Bill Would Be Devastating for LGBTQ People

This column contains a correction.

The idea behind the Senate GOP’s health care bill—the Better Care Reconciliation Act (BCRA)—is simple: Americans will pay more money for worse coverage. The BCRA will lead to 22 million people losing their health insurance and higher costs for millions more.

• The average person buying insurance through the health insurance marketplaces will see total costs, including premiums plus cost-sharing, rise by an estimated $2,294 in 2026.
• Health economists estimate the Senate bill could lead to 208,500 additional deaths by 2026.
• LGBTQ people cannot afford to lose the progress made under the Affordable Care Act (ACA): Under the health reform law, uninsurance among low- and middle-income LGBTQ adults dropped by 35 percent between 2013 and 2017.
• The ACA is still needed: 15 percent of LGBTQ adults still need health insurance compared to 7 percent of non-LGBTQ adults.

The BCRA slashes Medicaid by $772 billion over 10 years and would end Medicaid expansion over time:

• Medicaid covers at least 1.8 million LGBTQ adults,** including 31 percent of LGBTQ adults living with a disability and 40 percent of LGBTQ adults with incomes under 250 percent of the federal poverty level.
• An estimated 560,000 LGBTQ adults will lose coverage if Medicaid expansion is ended.*
• The BCRA prohibits federal Medicaid reimbursements for Planned Parenthood for one year; Planned Parenthood is one of the country’s largest providers of transgender-inclusive health care.

The BCRA eviscerates standards meant to ensure the quality and adequacy of insurance coverage.

The BCRA allows states to waive the essential health benefit (EHB) standard, which requires most plans in the individual and group markets to cover vital medical services such as mental health care; treatment for conditions such as cancer; and maternity care. These EHB waivers would also weaken protections and raise costs for people with pre-existing conditions.

Fifty-one percent of the U.S. population—and an estimated 65 percent of LGBTQ adults—have pre-existing conditions such as diabetes, asthma, heart disease, or HIV.* An estimated 5.3 million enrollees with pre-existing conditions will face significant out-of-pocket cost increases or other barriers to care for key health services because they live in states that would likely waive the EHB requirements:

• More than one-third of LGBTQ adults have had a child. By 2026, a year of coverage under a separate rider for maternity care would cost parents an additional $17,320.
• Lesbian, gay, and bisexual adults, who are twice as likely as heterosexual adults to have substance use disorders, would pay $20,450 more for substance use treatment coverage.
• Lesbian, gay, and bisexual adults are significantly more likely to have major depression than heterosexual adults. Coverage for depression would cost them an extra $8,490 per year.
• In one study, 16 percent of transgender college students—a rate four times higher than among cisgender students—were diagnosed with an eating disorder in the year prior to the study. These patients would pay $14,470 annually more for coverage for anorexia/bulimia nervosa.

Here’s the bottom line: LGBTQ adults are more than twice as likely to be uninsured as non-LGBTQ people. The ACA was a massive step towards narrowing the coverage gap, but the Senate health care bill could roll back that progress—all while costing millions of people their health insurance and forcing many others to pay more for worse coverage. LGBTQ communities can’t afford to go back.

Kellan E. Baker is a senior fellow with the LGBT Research and Communications Project at the Center for American Progress. Sejal Singh is the campaigns and communications manager for the LGBT Research and Communications Project at the Center. Shabab Ahmed Mirza is a research assistant for the LGBT Research and Communications Project at the Center. Laura E. Durso is the vice president of the LGBT Research and Communications Project at the Center.

*Authors’ note: Findings from a nationally representative survey commissioned and designed by CAP and fielded by Knowledge Networks, which surveyed 1,864 individuals about their experiences with health insurance and health care. The survey was fielded online in English in January 2017. Survey on file with the authors.

** Correction, July 6, 2017: A misprint in this column has been corrected; the column now includes the accurate number of LGBTQ adults covered by Medicaid.