Alex Blaze

LGBT health care provisions hanging even more tenuously now

Filed By Alex Blaze | February 24, 2010 3:00 PM | comments

Filed in: Politics
Tags: Barack Obama, bisexual, health care reform, lesbian, LGBT, transgender

With all the hub-bub in the straight media this week over Obama's health care proposal cutting the public option (I guess the White House isn't even going to pretend to support a popular cost-cutting measure anymore if it displeases the health care industry), community media points out that most of the LGBT provisions got cut:

Most LGBT and HIV activists had supported the House bill because it included key LGBT specific provisions, including provisions. In addition to the data collection, it prohibited discrimination based on sexual orientation and gender identity in the provision of health care; enabled people with HIV and low incomes to obtain Medicare coverage earlier in the course of their illness; and eliminated the tax that gay employees must pay if their same-sex partners or spouses receive health coverage from their employers' plan. Straight employees don't pay that tax but, for gay couples, the coverage is characterized by the federal government as additional income for the gay employee.

This stuff isn't that controversial. Starting Medicare coverage earlier for people with HIV seems to be something that would help everyone. Banning discrimination in health care is probably something most straight people think has already happened. And the last item is an obscure tax provision that wouldn't cost too much money but is a completely fair change to the system.

The only people who'd care about any of these would be the FOTF and AFA sorts, which are too busy whining that not even the far right pays attention to them anymore as the Tea Baggers are just wingnuts who put down their crosses and picked up Confederate flags. If anything, now's the time for these proposals.

Discrimination against LGBT people in health care is still rampant:

The survey included questions about the following types of discrimination in care: being refused needed care; health care professionals refusing to touch patients or using excessive precautions; health care professionals using harsh or abusive language; being blamed for one's health status; or health care professionals being physically rough or abusive. According to the results, almost 56 percent of lesbian, gay or bisexual (LGB) respondents had at least one of these experiences; 70 percent of transgender and gender-nonconforming respondents had one or more of these experiences; and nearly 63 percent of respondents living with HIV experienced one or more of these types of discrimination in health care. We found that not only did sexual orientation or serostatus affect the respondents' access to quality health care, but transgender or gender-nonconforming respondents faced discrimination two to three times more frequently than lesbian, gay, or bisexual respondents. In nearly every category, a higher proportion of respondents who are people of color and/or low-income reported experiencing discriminatory and substandard care. Close to 33 percent of low-income transgender and gender-nonconforming respondents reported being refused care because of their gender identity and almost a quarter of low-income respondents living with HIV reported being denied care.

In addition to instances of discrimination, respondents also reported a high degree of anticipation and belief that they would face discriminatory care. Overall, 9 percent of LGB respondents are concerned about being refused medical services when they need them and 20 percent of respondents living with HIV and over half of transgender and gender-nonconforming respondents share this same concern. Nearly half of LGB respondents and respondents living with HIV and almost 90 percent of transgender respondents believe there are not enough medical personnel who are properly trained to care for them. These barriers to care may result in poorer health outcomes because of delays in diagnosis, treatment or preventive measures.

Sounds like a problem that could use solving to me. Over half of LGBT people have experienced discrimination in health care (I'd be in the out-group, but that's because I don't have coverage when I'm in the US and I don't present in a way that most people read as gay, especially in France where the average straight man... well), and I doubt there's a large group of people out there who'd be supportive of health care reform generally but just wouldn't be able to get past that anti-discrimination provision.

Tammy Baldwin is quoted in the article saying that this "is not the final word." She's right, although it'll probably be taken as the left-most word, and now it'll have to be compromised with the Republicans so that the Democrats will fall in line to get enough votes to pass it, even through reconciliation.

The idea that Congress will add back in these proposals, with the Senate bill already rejecting them and the White House now effectively saying they're off the table, seems unlikely to me. It's too bad, since it's not like the LGBT community's going to want to agitate for this legislation later.

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"it prohibited discrimination based on sexual orientation and gender identity in the provision of health care"

This is incorrect - there is no provision in the bill that requires nondiscrimination on the basis of sexual orientation or gender identity.

The House version of the Health Care Reform Act includes a nondiscrimination clause that some believe will afford lgbt people protection from discrimination without explicitly stating our inclusion. It is a novel, and to my mind, possibly uncertain approach given the provision operates more like an executive order at the discretion of an apponttee than explicit inclusion in the legislation. The bill requires that health services be provided without regard to extraneous personal characteristics and tasks the Secretary of Health and Human Services with promulgating regulations that delineate these characteristics and develop an enforcement structure to ensure compliance.


(a) In General- Except as otherwise explicitly permitted by this Act and by subsequent regulations consistent with this Act, all health care and related services (including insurance coverage and public health activities) covered by this Act shall be provided without regard to personal characteristics extraneous to the provision of high quality health care or related services.

(b) Implementation- To implement the requirement set forth in subsection (a), the Secretary of Health and Human Services shall, not later than 18 months after the date of the enactment of this Act, promulgate such regulations as are necessary or appropriate to insure that all health care and related services (including insurance coverage and public health activities) covered by this Act are provided (whether directly or through contractual, licensing, or other arrangements) without regard to personal characteristics extraneous to the provision of high quality health care or related services."

Although there have been assurances sexual orientation and gender identity will be among the characteristics the Secretary names in the regulations; there is nothing in the legislation that requires inclusion of gender identity or sexual orientation. Nor is there any language that would prevent future political appointees from reversing previous decisions to include any characteristic. Our history tells us that when administrations change, there is a high degree of risk this will occur. As many may remember from Scott Bloch’s attempts to ignore the existing executive order covering sexual orientation and his success in removing those protections from union contracts while he served as in the Bush years.

Skeptical Cicada | February 24, 2010 3:33 PM

Oh, it's just another knife in the back from our "fierce" advocate.

The GLBT related reforms Alex mentioned are real enough but extremely minor. So are all the 'reforms' in the Obama-Democrat bill.

You don't have to go too far to figure out why. Just today AmericaBlog repeated what the National Nurses Organizing Committee, AFL-CIO and Physicians for a National Heath Program have been saying for months. THE FIX IS ON. The White House and Congress were long ago bought by insurance giants, HMOs and Big Pharma.

Congressional 'leaders' from both parties gorged at the trough, taking in $28 million in 'contributions'. Obama got an additional $18.6 million.

"An honest politician is one who, when he is bought, will stay bought." Mark Hanna, Republican National Committee Chairman (1896) In that contest, and only in that context, can Obama and the Congressional leadership be described as honest.

I don't imagine the insurance companies, HMOs or Big Pharma will have any problems with their lapdogs in the White House and Congress.

Obama is the Lap Dog in Chief. According to the Huffington Post Obama "has hosted at least 27 meetings with some of the most influential private health-industry executives ..." and tried to keep them a secret until exposed by the LA TIMES.

His 'reform' is anything but. It'll require people to pay exorbitant prices for private insurance and then they'll get to meet someone like Linda Pino, CMO at Humana.

Socialized medicine is the only viable answer.