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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
ENSURING HEALTH ANDWELLNESS FOR LGBT FAMILIES
OBSTACLES AND OPPORTUNITIES:
March 2012
 
 This issue brief complements the full report,
 All Children Matter: How Legal and Social Inequalities Hurt LGBT Families
, available at
INTRODUCTION
 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.
REDUCED ACCESS TO HEALTH INSURANCE
LGBT Families Are Less Likely to Have Health Insurance
 
 Research shows that LGBT adults are less likely to have healthinsurance than their heterosexual counterparts.
1
 
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.
2
91%88%86%64%
Asian/PacicIslanderWhiteBlackLatino/a
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.
82%77%57%
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.
3
Opportunities
 
 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
parents.
 
 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
parents.
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.
4
 
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.
Opportunities
 
 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
89%
Ofer Domestic Partner Benets
64%
Source: HRC, “Corporate Equality Index 2012.”
Availability o Domestic Partner Benets orSame-Sex Couples, 2011 National Compensation Survey
Private Sector Workers
29%
State and Local Gov’t Workers
33%
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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