Two years ago President Barack Obama signed into law the Patient Protection and Affordable Care Act, the most significant reform of the U.S. health system since the creation of Medicare and Medicaid in the 1960s. Many of the law’s reforms are already making a difference in the lives of gay and transgender Americans, and many more benefits are still to come as key provisions of the law take effect in 2014.*
Take this quiz to learn more about how the health reform law benefits gay and transgender Americans.
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- Relative to the heterosexual population, how likely are gay adults to be uninsured?
- A) Twice as likely
Answer: A) Twice as likely
Due to discriminatory laws and unequal workplace policies, gay individuals are roughly twice as likely to be uninsured as their straight counterparts. As a result, they are more likely to delay or not seek medical care and more likely to have to rely on emergency rooms for health care services.
- B) Equally as likely
- C) Half as likely
- According to a recent survey, what percent of African American transgender individuals do not have health insurance coverage?
- A) 15 percent
- B) 19 percent
- C) 22 percent
- D) 31 percent
D) 31 percent
Transgender individuals, particularly transgender people of color, are especially likely to lack health insurance due in large part to the pervasive discrimination they experience in the job market as well as insurance policy exclusions that explicitly exclude care for transgender people. The majority of plans sold in the United States exclude coverage of any services for a transition-related medical purpose, even when the same or comparable services are routinely covered for other medical conditions.
- How will the Affordable Care Act help close the gap in health insurance coverage for gay and transgender Americans?
- A) By expanding Medicaid
- B) By expanding private insurance coverage
- C) Both
Answer: C) Both
Gay and transgender people are significantly less likely to have health insurance compared to their straight and nontransgender counterparts. Thanks to the health reform law, many gay and transgender Americans who have not been able to afford health insurance will be able to apply for Medicaid or purchase affordable private coverage through health insurance exchanges in every state starting in 2014.
- Under the Affordable Care Act each state must set up a health insurance exchange where customers can easily compare and enroll in different insurance plans. The law stipulates that the exchanges may not discriminate on the basis of which categories?
- A) Sexual orientation
- B) Gender identity
- C) Both
Answer: C) Both
Under the Affordable Care Act the exchanges may not discriminate on the basis of sexual orientation or gender identity in any of their activities. Each state is charged with enforcing these protections.
- D) Neither
- Eighty-three percent of heterosexual adults report having excellent or very good overall health. What percentage of gay adults report feeling similarly?
- A) 84 percent
- B) 80 percent
- C) 77 percent
Answer: C) 77 percent
Gay adults are significantly less likely to report having excellent or very good overall health than their heterosexual counterparts. Because gay people are more likely to be uninsured and to experience discriminatory treatment both inside and outside the doctor’s office, they experience a range of significant health disparities, including increased rates of cancer, substance use, and mental health concerns such as depression. Many of these disparities are even greater for bisexual people.
- D) 67 percent
- What percentage of transgender adults report having excellent or very good overall health?
- A) 84 percent
- B) 80 percent
- C) 77 percent
- D) 67 percent
Answer: D) 67 percent
Transgender individuals experience staggering health disparities as a result of discrimination in health care, insurance coverage, employment, and other areas of daily life. For example, 50 percent of transgender individuals report thoughts of suicide at some point in their lives, compared to just 2 percent of nontransgender individuals.
- Research shows that gay and transgender people of color face some of the greatest health and health care challenges in our country. Which of the following is NOT true concerning the health disparities facing gay and transgender people of color?
- A) Asian American gay adults are the gay minority group least likely to report experiencing psychological distress.
Correct Answer: A) Asian American gay adults are the gay minority group most likely to report experiencing psychological distress.
In fact, Asian American gay adults are the gay minority group most likely to report experiencing psychological distress. For individuals who belong to multiple populations that experience health disparities, these disparities do not simply add up: They multiply. For gay and transgender communities of color, a lack of affordable health care and insurance and culturally competent service providers—combined with persistent racism in society—are some of the largest causes of health disparities.
- B) Lesbian and bisexual African American women are least likely to have had a mammogram in the past two years.
- C) One out of every five gay African American adults has diabetes.
- D) One in four Latino transgender people has been refused medical care due to bias.
- Secretary of Health and Human Services Kathleen Sebelius announced a plan in June 2011 for including sexual orientation and gender identity questions in national data collection efforts. When will the Department of Health and Human Services begin collecting sexual orientation and gender identity data?
- A) 2013
Answer: A) 2013
According to Section 4302 of the Affordable Care Act, the secretary may collect any demographic data that she believes to be important for understanding and addressing health disparities. Secretary Sebelius has announced that these data collection efforts will include sexual orientation and gender identity. These efforts will begin in 2013 and will help policymakers, researchers, and health advocates better understand the health disparities experienced by gay and transgender Americans.
- B) 2014
- C) 2020
- D) The department already routinely collects national data on both sexual orientation and gender identity.
- Many provisions of the Affordable Care Act are important to gay and transgender Americans, but work still remains to make sure the U.S. health system is equipped to serve gay and transgender people and their families. Which of the following provisions was NOT included in the final health reform law?
- A) Funding and support for community-based prevention programs
- B) Equal health insurance benefits for same-sex partners of federal employees
Answer: B) Equal health insurance benefits for same-sex partners of federal employees
Federal employees with same-sex partners cannot access the same health care benefits currently afforded to straight employees and their partners or spouses. Unfortunately a provision that would end discrimination in benefits for the families of gay federal employees was not included in the final health reform law.
- C) Promotion of cultural competency and workforce diversity
- D) Funding and support for community health centers
- How does the Affordable Care Act benefit those living with HIV or AIDS?
- A) It makes prescription drugs more affordable.
- B) Starting in 2014, it prohibits insurers from using exclusions for pre-existing conditions, including HIV/AIDS, as a reason to deny insurance coverage.
- C) It eliminates the requirement that people with HIV must have a disabling AIDS diagnosis to qualify for Medicaid coverage.
- D) All of the above.
Answer: D) All of the above
The Affordable Care Act offers many benefits for those living with HIV or AIDS. It phases out the Medicare Part D “donut hole” for prescription drugs by 2020, provides individuals living with HIV or AIDS greater access to health coverage through the expansion of state Medicaid programs, and will prohibit insurance carriers from dropping or refusing to accept applicants based on their HIV status.
- Who said, “The Affordable Care Act may represent the strongest foundation we have ever created to begin closing LGBT health disparities”?
- A) President Barack Obama
- B) Surgeon General Regina Benjamin
- C) Secretary of Health and Human Services Kathleen Sebelius
Answer: C) Secretary of Health and Human Services Kathleen Sebelius, in a speech in fall 2011
In a recent speech at the first-ever White House LGBT Health Conference, Secretary Sebelius also noted, “When this Administration took office, the health care system wasn’t working for a lot of Americans. But it was especially broken for LGBT Americans. …that wasn’t right. All Americans, regardless of where they live or their age, sex, race, sexual orientation, or gender identity, have a basic right to get the care they need.”
- D) White House Press Secretary Jay Carney
- What provision is NOT currently included in the Affordable Care Act’s new Patient’s Bill of Rights?
- A) Prohibits insurers from denying coverage to adults with pre-existing conditions starting in 2010
Answer: A) The Patient’s Bill of Rights prohibits insurers from denying coverage to children under age 19 with pre-existing conditions as of 2010
This requirement will extend to adults in 2014. The Patient’s Bill of Rights can be found on HealthCare.gov, the health reform website maintained by the Department of Health and Human Services. The site also includes a Health Plan Finder tool that allows same-sex couples to search for plans offering coverage for domestic partners.
- B) Provides coverage for people with pre-existing conditions through Pre-Existing Condition Insurance Plans
- C) Prohibits lifetime limits on insurance coverage
- D) Requires insurance companies to spend at least 80 percent of each premium dollar on health care services rather than administrative costs
Kellan Baker is a Health Policy Analyst and Crosby Burns is a Research Associate at the Center for American Progress.
* In this quiz, “gay” is used as an umbrella term to describe individuals that are gay, lesbian, or bisexual.