Is Obamacare good for the LGBT community?

October 1, 2013
(James Buck / The Washington Post)
(James Buck / The Washington Post)

About a year ago, Selisse Berry, founder of the LGBT organization Out & Equal Workplace Advocates*, listened to a woman recount her journey to motherhood. Although the woman had a decent job at a global Fortune 500 company, she and her partner had taken out a personal loan to finance the birth and newborn care of the child they hoped to have.

The reason? Her partner was a woman, and her company did not offer domestic partner health benefits in the state they lived in, although it was mandated to offer it in some other states, such as California, where partner benefits are required by law.

Not so bad, you might say — we take out loans all the time. And it’s true: theoretically, for the price of a brand-new economy car you can take home a brand-new bundle of joy. According to the International Federation of Health Plans, vaginal delivery averaged $9,775 in the United States in 2012; a Caesarean section averaged $15,041.

But just as you can’t count on having average health for a lifetime, you can’t count on an “average” delivery. I learned that just last week, when the bill for the birth of my newborn baby girl arrived. The total was more than $87,000 for a Caesarean section, a blood transfusion for both birth mother and baby, four days in the neonatal intensive care unit, and one night on the pediatric floor. Add this amount to the $30,000 bill our insurance company received for a close call at eight months, the postnatal hospital procedure my partner required to remove placental tissue from her uterus (which we haven’t yet been billed for), and the thousands of dollars we shelled out (out-of-pocket) for insemination, and any loan we would have gotten would have been decimated, even before accounting for well-baby visits and other care.

Luckily everything turned out OK. And thank goodness we had insurance. I can only hope that the women who took out the baby loan had a pregnancy more free of complications than we did.

Most Americans receive their health insurance via their employers, and half of these workers choose to cover at least one family member on their plan. But this doesn’t hold so true for the LGBT population, according to “A Broken Bargain,” a recent study from the Movement Advancement Project, Center for American Progress and Human Rights Campaign.

More and more large companies, such as Wal-Mart earlier this month, are announcing that they’ll honor partners nationwide in their health insurance benefit programs. But some still do not, and midsize companies that operate in just one state or in a few states that don’t require domestic partner benefits have little incentive to cover LGBT partners. True, the repeal of DOMA by the Supreme Court mandates that marriages between LGBT people be treated like any other as far as federal benefits are concerned, which is also pushing companies to recognize same-sex marriage to avoid future legal pitfalls. But marriage between people of the same gender is only being performed in 13 states and the District of Columbia at the moment. (New Jersey is poised to join the ranks on Oct. 21.) Another seven states offer comprehensive domestic partnership or civil unions. If you don’t have the fortune to live in one of these places, you could very well be out of luck when it comes to making sure that your partner is covered by your health insurance.

“Over the years, I’ve met so many people who work for companies that don’t offer domestic partner benefits,” said Berry. “Where people just realized that they aren’t getting paid equal pay for equal work ” when benefit packages are taken into account.

Meanwhile, even if you travel to another state to get married or legally partnered, the unfortunate fact is that no comprehensive federal law exists to protect LGBT workers. In 29 states, anyone can be fired simply for being lesbian, gay or bisexual. In 34 states, it is legal to fire someone for being transgender. Thus, a company can offer partner benefits, but at the same time be legally entitled to fire you for being gay when you “come out” to request those benefits.

If you are HIV-positive or have full-blown AIDS, you’ll be hard-pressed to have insurance at all because of pre-existing condition clauses and lifetime caps on insurance benefits. As your condition progresses, you’ll be forced to rely on Medicaid and Medicare.

The net effect of all of this is that one out of every three LGBT adults nationally isn’t covered by a health plan, according to Secretary of Health and Human Services Kathleen Sebelius, speaking at a White House briefing on Obamacare and the LGBT community on Sept. 12. According to the Equality California Institute, an advocacy organization, LGBT people are twice as likely as the general population to be uninsured.

Obamacare, said Sebelius, will address all of these problems: no longer will your partner or employment status matter when acquiring group rates on insurance, pre-existing condition clauses won’t be allowed and lifetime caps will be illegal.

For all of these reasons, Obamacare is good for the LGBT community, whether like me, you currently enjoy employer-sponsored health care via a partner’s job, or whether like one in three of us, you currently don’t have health insurance at all. Our employment and relationship statuses, like our health, can change in the blink of an eye. We need to know that no matter where we work or what our partnership or health status is, we will be taken care of.

As Out & Equal’s Berry noted: “It evens the playing field on so many levels.”

Maria De La O is a journalist and documentary filmmaker in San Francisco. *De La O worked as a consultant doing PR on a book published by Out & Equal this summer.

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