What the Affordable Care Act Means for LGBT People

What the Affordable Care Act Means for LGBT People

Harvey J Makadon MD and Sean Cahill PhD The Fenway Institute Boston, MA

Learning Objectives

By the end of this session, learners will be able to:

1. Describe the impact of stigma on the health of LGBT people

2. Describe terminology used to identify LGBT people

3. Identify key issues in the Affordable Care Act (ACA) whose implementation will particularly affect LGBT communities

4. Describe how the ACA has influenced access to health coverage and care for LGBT people, particularly transgender people and same-sex couples

5. Describe linkages between the ACA and other critical health coverage and care issues for LGBT people

Why Programs for LGBT People

Stigma, Discrimination and Health

Interpersonal

Stigma

Structural

Intrapersonal Stigma

Stress/Anxiety/Depression

Health Disparities/Inequities

Hatzenbuehler, ML, Link, BG. Introduction to the special issue on structural stigma and health. Soc Sci Med 2014 Feb;103:1-6. doi: 10.1016

Effects of Stigma on Health

LGB people who experienced a prejudice-related stressful life event (e.g., assault, being fired from a job) were three times more likely than those who did not to suffer a serious physical health problem over a one-year period (Frost, Lehavot, & Meyer, 2011)

Internalized homophobia, experiencing discrimination, and expectations of rejection, were associated with HIV risk behavior (Hatzenbuehler, Nolen-Hoeksema, & Erickson, 2008)

Enacted and anticipated stigma resulted in approximately a 40% increase in delaying needed urgent and preventive care in a sample of 2,578 FTM trans masculine people. (Reisner et. al. 2015)

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