On August 1, provisions in the Affordable Care Act went into effect, which mandates that insurers provide a number of preventive health services for women, free of charge. In Massachusetts, the federal law expands their existing state-funded coverage, adding well woman visits, breast feeding support, gestational diabetes screening, and interpersonal violence screening to the list of “mandatory” women’s health services. This mandate is especially important for lesbian, bisexual and transgender women, who have much lower rates of accessing health care than their straight counterparts.
"These services represent a paradigm shift from a health care system built on diagnostic treatment of disease toward a foundation of disease prevention and wellness promotion," said Dr. Paula Johnson, a member of the Institute of Medicine Committee on Women’s Health Prevention Services and chief of the Division of Women’s Health at Brigham and Women’s Hospital.
The eight free services under this provision of the Affordable Care Act (also known as Obamacare) include well-woman visits; screening for gestational diabetes; Human papillomavirus (HPV) testing; screening and counseling for HIV and sexually transmitted infections; screening and counseling for interpersonal and domestic violence; breast feeding support, supplies and counseling; and contraceptive methods and counseling for all women with reproductive capacity.
Johnson noted that an estimated $466 billion is spent annually on treating the ever-growing number of cases of chronic illness among women, many of which are preventable. She asserted that this new mandate would in fact save money in the long run. In addition to keeping the female population healthy, forcing insurers to pay for these preventive services has the potential to save billions of dollars in health care costs. This news is particularly important for lesbian, bisexual and trans women.
"We are a population that has been underserved and has historically had more health disparities," said AIDS Action Committee of Massachusetts President and CEO Rebecca Haag.
Health insurance is expensive. Most people obtain it through their employer, or for low-income individuals who qualify, through a government-subsidized program like Medicaid. Only 16 states, including Massachusetts, have statutes that protect against both sexual orientation and gender identity discrimination in public and private sector jobs. Because of this lack of protection and a lack of understanding, lesbian, gay, bisexual and especially transgender people are statistically more likely to lose their jobs, not be hired in the first place, and work low-wage jobs without benefits.
In addition, because of Congress’ continuous refusal to pass the Employment Nondiscrimination Act, many states offer little to no protection against discrimination based on sexual orientation. And even fewer have nondiscrimination statutes for gender identity. Even those who have full-time employment with benefits may discover that when it comes to their same-sex partner, relationship recognition is a problem.
Under the Defense Of Marriage Act (DOMA), states can opt not to recognize same-sex marriage as legitimate, which enables employers to deny access of health insurance and other benefits to their employees’ same-sex spouses or domestic partners. And on the federal level, government benefits are not awarded to same-sex couples or domestic partners.
Consequently, LGBT people find themselves at a severe disadvantage when it comes to obtaining health insurance. Which is why removing the cost barrier for essential elements of preventive health care is so important.
In addition, lesbian, bisexual and transgender women may need some of these free services even more than heterosexual women. For example, gay youth, who comprise 20 percent of all homeless youth, are more likely than their heterosexual peers to face abuse by a family member.
Providing free interpersonal violence (IPV) screening and counseling for young LBT women is one step toward improving the health and lives of those who would otherwise have no means of accessing help.
It is estimated that HIV/AIDS prevalence among transgender women exceeds 25 percent. Expanding access to free HIV counseling and testing under this ACA provision is an unarguably positive measure to help fight the epidemic that has permeated the LGBT community for so long.
"Whatever we can do to expand services to include women who are lesbian, bisexual, and transgender is a sending the right message. We’ll see many more LGBT women taking advantage of the health care system and feeling that they, too, are entitled," said Haag.
The Outlook is Bright for Massachusetts Women
While the announcement of these no-cost services seems like a reason to rejoice, the unfortunate reality is that not all women will be able to secure the benefits laid out in the ACA. In June, the Supreme Court ruled that states may choose not to expand Medicaid, an act that keeps many of America’s poorest women from receiving care, including the preventative services outlined above.
In order for a woman to qualify for the unexpanded Medicaid, she must be pregnant, disabled, a mother with a dependent child, or a senior citizen. She must also fall into a specific low-income category. This leaves a huge, uncovered gap in the female population, and also prevents many LBT women from accessing free health care.
State leaders who reject this expansion risk the health of millions of women. Luckily, for Massachusetts women, the outlook is much brighter. The ACA draws on many provisions that have already been in effect in the Bay State since the Health Care Reform Law was passed in 2006. This means the changes will be less drastic than in other states, but they will still have a positive impact.
Commonwealth Care, the state-funded MA health care provider for low-income individuals and families, has offered no-cost contraception and Pap smears, along with other mandatory women’s services, to its insurance-holders since 2011. Now, under the ACA, private and employer-sponsored insurance companies will have to comply as well.
The federal law expands Massachusetts women’s coverage, adding these additional preventative services and screenings to the list of “mandatory” women’s health services. With the benefits of lower cost and increased services, it is a good time for Massachusetts lesbian, bisexual and transgender women to shop for health care.
(Antoinette Weil, EDGE Boston)