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Obstacles and Opportunities Ensuring Health and Wellness for Lgbt Families

Obstacles and Opportunities Ensuring Health and Wellness for Lgbt Families

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Published by Ken Williams

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Published by: Ken Williams on Mar 26, 2012
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AuthorsIn Partnership With
March 2012
 This issue brief complements the full report,
 All Children Matter: How Legal and Social Inequalities Hurt LGBT Families
, available at
 The American public has a vested interest in ensuring thatall children have access to the basic resources they need tothrive, including quality health care and supportive health careproviders. Unortunately, inequitable laws and social stigma actagainst the health and well-being o the two million childrenbeing raised in lesbian, gay, bisexual, and transgender (LGBT)amilies, in our key areas:
Reduced access to health insurance.
Under ederallaw, most employers are not required to oer healthbenets to the same-sex partners o LGBT workers, nor thepartner’s children, even i the couple is legally married intheir state. When coverage is oered, LGBT amilies mustpay additional taxes. For transgender amily members,insurance plans may contain exclusions that createobstacles to coverage or even the most basic care.
Restrictions on caregiving and medical decision-making.
Under ederal and state laws, LGBT parents maybe denied leave to take care o one another. Additionally, inmost states, the non-biological parent is unable to establisha legal relationship to the child, meaning that parent maybe unable to make medical decisions or their children.
Unwelcoming healthcare environments.
Health careenvironments are oten inhospitable to LGBT amilies.Proessional caregivers, including physicians, counselors andsupport sta, may be uninormed, hostile, discriminatory, orreuse to treat LGBT people and their amilies.
Increased health disparities.
Key disparities betweenLGBT adults and the general population can be seen notonly in access to health insurance, but also in access tocare, the incidence o HIV/AIDS, and chronic physicalconditions such as diabetes, obesity and arthritis. LGBT amilies o color ace double jeopardy due to already-existing race-based disparities.
LGBT Families Are Less Likely to Have Health Insurance
 Research shows that LGBT adults are less likely to have healthinsurance than their heterosexual counterparts.
Approximately 82% o heterosexual adults have healthinsurance, compared to 77% o LGB adults and 57% o transgender adults.
 Even when a transgender amily member has health insurance,plan language may exclude coverage or both routine careand transition-related care.
  This reduced access is especially pronounced among LGBT people o color.
 Researchers believe that children raised by LGBT parents arealso less likely to have health insurance.
LGB Adults with Health Insurance by Race/Ethnicity
Source: Je Krehely, “How to Close the LGBT Health Disparities Gap,” Center or American Progress,December 2009.
Heterosexual AdultsLGB AdultsTransgender Adults
Percent o Adults with Health Insurance
Source: Je Krehely, “How to Close the LGBT Health Disparities Gap,” Center or American Progress,December 2009.2
In “All Children Matter: How Legal and Social InequalitiesHurt LGBT Families,” The Movement Advancement Project ( www.lgbtmap.org ), the Family Equality Council www.familyequality.org ), and the Center for American Progresswww.americanprogress.org ) co-authored one of the most comprehensive portraits to date of the wide range of obstaclesfacing LGBT families in America. In this companion issue brief, theco-authors have partnered with the National Coalition for LGBT Health ( www.lgbthealth.net  ) to highlight policy changes designed to improve the health, wellness, and lives of LGBT families.
 This issue brief complements the full report,
 All Children Matter: How Legal and Social Inequalities Hurt LGBT Families
, available at
Federal Law Restricts Access to Health Insurance or Same-Sex Partners and Spouses; State Laws Fail to Protect Their Children
 The Deense o Marriage Act (DOMA) prevents the ederalgovernment rom recognizing the marriages o same-sexcouples.
 Because most employee benets are regulated under theederal Employee Retirement Income Security Act (ERISA),which does not recognize same-sex couples because o DOMA,most employers are not mandated to extend health insurancebenets to the partners o LGBT employees, or to the children o these partners, i the employee does not have legal ties with thechildren.
 Because legal mechanisms to protect amilies like joint andsecond-parent adoption are not available in the majority o states, a lack o legal ties is common or LGBT amilies, whichurther decreases benet availability or children in LGBT amilies.
  The average LGBT amily could pay more than $3,100 extraper year because the parents cannot enroll their amily in anemployer-sponsored health care plan. Families who cannotaord the extra cost may be orced to go without coverage.
 Repeal DOMA. Then, legalize marriage or gay and lesbian couples to strengthen legal ties or the entire amily.
 Update ERISA to ensure that companies that elect to extend health benets to employees’ spouses and/or children are also requiredto extend benets to employees’ permanent partners and/or children or whom the employee acts as a parent/is a
de facto
parent.Likewise, require companies purchasing insurance through state exchanges to extend these domestic partner and amily benets i they extend benets to heterosexual employees’ spouses and children.
 Ensure that ederal and state-level enabling regulations and legal clarications or the Aordable Care Act dene “amily,“child,“spouse,and “parent” broadly to include LGBT amilies and
de facto
 Pass comprehensive parental recognition laws at the state level to ully protect children in LGBT amilies. Laws should allow joint andsecond-parent adoption, provide an automatic presumption o parentage or both mothers when lesbian couples having childrenthrough donor insemination, and provide legal recognition o 
de facto
Federal Tax Law Makes Health Insurance More Expensive When Employers Do Elect to Ofer These Benets
Even when employers choose to extend health insurance benets to domestic partners, non-ederally recognized spouses, and/ortheir children, LGBT amilies are taxed on the value o the benet while married heterosexual amilies are not.
 Taxation o health benets costs the average employee with domestic partner benets $1,069 more in taxes per year than a marriedheterosexual employee with the same coverage. In most states, amilies also have to pay state taxes on these benets.
Employers are also required to pay ederal taxes on the value o these benets, and in states without comprehensive relationshiprecognition, may also pay state taxes.
 Pass the Tax Equity or Domestic Partner and Health Plan Beneciaries Act/Tax Equity or Health Plan Beneciaries Act (DP Tax) or similarlegislation that provides or equal treatment related to the provision and taxation o health insurance benets.
 States that mimic ederal tax guidelines should eliminate their state’s portion o this tax.
Large Companies Ofering Health Insurance
Ofer Health Insurance
Ofer Domestic Partner Benets
Source: HRC, “Corporate Equality Index 2012.”
Availability o Domestic Partner Benets orSame-Sex Couples, 2011 National Compensation Survey
Private Sector Workers
State and Local Gov’t Workers
Source: Bureau o Labor Statistics, “Table 8. Health Care Benefts: Access or unmarried domesticpartners, National Compensation Survey, March 2011,” July 26, 2011.3

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