On health care, White House and others reach out to LGBT Americans

December 16, 2013

As a critical deadline for signing up for insurance under President Obama’s health-care law approaches, the lesbian, gay, bisexual and transgender community has emerged as a major target for the White House and outside groups.

A disproportionate number of LGBT Americans are uninsured and qualify for federal premium subsidies to help buy coverage, and the administration is intensifying its efforts to get them enrolled before the end of the year. There are several reasons for this disparity, among them that same-sex partners often don’t qualify as family members for employer-based insurance plans and that individuals sometimes lose coverage when they are fired because of their sexual orientation or gender identity. The White House on Tuesday will release an infographic on the Affordable Care Act’s benefits for the LGBT community.

As the administration reaches out to encourage the LGBT community to buy health plans, federal officials are continuing to try to improve HealthCare.gov to make it easier for other uninsured Americans to get coverage. The federal insurance Web site was designed to tell people with low incomes whether they qualify for Medicaid and, if they do, to transfer their applications automatically to their state’s Medicaid program. But since the enrollment period began in October, that automatic transfer has not worked.

On Monday, federal health officials said they are beginning to try out the online transfers of Medicaid applications for people in 10 states whose computer systems are best equipped to handle them.

Meanwhile, several outside groups are pitching in for the LGBT outreach, including Out2Enroll, a collaboration among the Sellers Dorsey Foundation, the Center for American Progress (CAP) and the Federal Agencies Project. The group is working to educate men and women in major cities about their options for coverage and how to navigate the system. According to CAP, 900,000 members of the LGBT community could get some form of subsidized health care under the law.

The group has held workshops in major cities such as Houston, New York and Philadelphia. On Thursday, for example, White House public engagement adviser Gautam Raghavan joined Joanne Grossi, a regional director for the Department of Health and Human Services, for a training session with health-care “navigators” in Philadelphia, as well as a town hall event. Both focused on the LGBT community.

Some of the pitches are decidedly less conventional. Wednesday Night Tea, a drag show in Shreveport, La., has started promoting the health-care law as part of its act. And Out2Enroll is launching a social media campaign this week that will have “naughty” elements as well as holiday cheer, according to Kellan Baker, associate director of the LGBT Research and Communications Project at CAP.

The push is likely to resonate with many LGBT Americans, especially those not working in conventional jobs. Kenny Weinberg, 63, has struggled to get adequate insurance coverage for himself and his 60-year-old husband, Jeffrey, since he lost his job in the fashion industry in 2008.

The couple moved from New York to Philadelphia to cut costs, but that meant they were no longer eligible for the health plan they had because it applied only to New York residents. As retirees, they had trouble finding a reasonable private plan because of a preexisting condition of Jeffrey’s. In the past year, Weinberg said, “our out-of-pocket expenses have totaled close to $20,000.”

While Weinberg couldn’t initially access HealthCare.gov, he managed to sign up for an HMO plan this month.

“It will truly make a tangible difference in our lives,” said Weinberg, who attended the Out2Enroll community session in Philadelphia. “We started avoiding going to doctors. It’s an opportunity to get back into better health.”

Ezra, a 35-year-old fundraising consultant who asked to be referred to only by his first name, has been uninsured for three years. A self-described “white transmasculine gender queer,” he had been getting primary care and hormone therapy at Philadelphia’s Mazzoni Center.

After initial problems with HealthCare.gov — “It calculated my income at $96,000, and I was like, ‘I don’t think so,’ ” Ezra recalled — he found a health plan for $70 a month and dental insurance for $18 a month.

Ezra still faces some challenges: The Mazzoni Center is a Tier 3 provider under his new plan, meaning that his co-pays will double there compared with when he’s uninsured. So while he is now covered if he faces a catastrophe, his hormone therapy will be more costly. He said that while he first thought, “Oh, yay, it was so easy,” he then discovered, “Nope, it’s not.”

And he added that plenty of his friends — especially those who are undocumented immigrants and therefore ineligible under the law — are still uninsured.

“I’m glad this worked for me, but I think it’s far from meaning the system has worked out for queer/trans people,” he said.

Baker noted that many gays, lesbians and transgender Americans have had “pretty bad experiences with the health-care system,” and that some are unsure how they might qualify, given their same-sex relationships or transgender identities.

Out2Enroll is hoping to enroll 300,000 people under the law. Baker noted that since no one is formally tracking the sexual orientation or gender identity of those signing up for insurance, its success may be hard to assess.

“Who knows whether we’ll be able to get that close, or even whether we’ll be able to know if we’ve done that,” he said. “There are a lot of cases where we won’t know.”

Juliet Eilperin is a White House correspondent for The Washington Post, covering domestic and foreign policy as well as the culture of 1600 Pennsylvania Avenue. She is the author of two books—one on sharks, and another on Congress, not to be confused with each other—and has worked for the Post since 1998.
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