How Obamacare affects LGBT families

Obama on Same Sex Marriage

Say what you will about Obamacare, it makes me procrastinate. Sometimes for upwards of two months. It started on June 28, the day the US Supreme Court ruled that the Affordable Care Act was constitutional. That was the day I decided to write about how the massive law might affect LGBT people and their families and then commenced to panicking for two months. But here we are, eh?

The truth, friends, is it’s really not clear how the ACA will affect anyone once it’s up and running in 2014, partly because a lot of its effects will be indirect, and partly because how the law is implemented will make a big difference. For instance, the IRS definition of “affordable” is already making it likely that low- and middle-income families still won’t be able to buy health insurance. On the other hand, the Office of Personnel Management recently issued a proposed rule that would extend healthcare benefits to the children of federal employees’ domestic partners (but not the partners themselves, thanks to DOMA).

So with those caveats, here we go:

THE GOOD*  

*(Thanks to Gideon Alper, an attorney based in Orlando, for getting us started on this.)

Expanded coverage. LGBT people, particularly those who are poor and/or people of color, are more likely to have chronic stress-related illnesses, struggle with drug or alcohol abuse, experience discrimination in healthcare facilities, and report feeling unsafe seeking routine medical care. And gay and bisexual men have the highest rates of HIV/AIDS infection in the US, which means that, all other things being equal, LGBT people on the whole are more likely to be denied health insurance on the basis of a pre-existing condition. And as it turns out, fewer of us have health insurance under the present system than our straight counterparts. Under the ACA, more people will have coverage, even if they have pre-existing conditions. That can only be a good thing.

Free preventive services. All new insurance policies or plans have been required, since September 2010, to fully cover:

  1. Prenatal/preventive services including vaccinations, anemia screening, UTI screening, breastfeeding support and counseling (including breastfeeding equipment and lactation consulting), gestational diabetes screening, and ‘well-woman’ visits, which include pre-conception and prenatal care. They even cover folic acid supplements.
  2. Immunizations for kids from birth to age 18.
  3. HIV screening and counseling for adults and teenagers at ‘higher risk,’ depression and alcohol abuse screening, and support for smoking cessation are also covered. These aren’t family-specific problems, but they disproportionately affect LGBT people, among other groups. Making it easier for people to stay healthy will also make it easier for them to raise healthy families.

No coverage denials because of pre-existing conditions. Beginning in 2014, it will no longer be legal for insurance companies to deny coverage to people with pre-existing conditions, or to their children (unless the kids are older than 19). This is huge for people with HIV/AIDS or other chronic diseases, and it will also stop the practice of denying coverage for pregnant women or their partners. Until 2014, there’s the Pre-Existing Condition Insurance Plan (PCIP), which you can buy if you’ve gone uninsured for six months or more because of a pre-existing condition. Those six months will be a huge bummer, but it’s better than nothing.

No lifetime and annual dollar limits on ‘essential’ services. This is true for policyholders and dependents, meaning no loss of benefits due to huge medical bills if you or your child becomes seriously ill. Again, a huge benefit for people with HIV/AIDS or other chronic diseases.

Insurance companies can’t charge people more for being female, HIV-positive, or having a transgender medical history. It happens. Beginning in 2014, it won’t be legal.

A refundable tax credit for adoption costs. Adoption is expensive, y’all, and most same-sex couples have to go through it one way or another. Obamacare kept the adoption tax credit from expiring in 2010, and it has raised the max credit by nearly $1,000 since 2009 (it’s now $13,360).

THE LESS GOOD

DOMA is still out there. LGBT families still aren’t families in the eyes of the federal government. DOMA makes it legal for companies not to extend health coverage and/or COBRA benefits to employees’ same-sex partners. It also means that same-sex domestic partners or spouses who receive health insurance coverage through a partner’s employer still have to pay imputed-income tax on that insurance (you know, as punishment for not being federally recognized as having a ‘real’ lifelong partnership). The ACA doesn’t address these problems.

Expansion of Medicaid and the Children’s Health Insurance Program (CHIP) is optional by state (and DOMA is still out there). The expansion would raise the income threshold for Medicaid eligibility and extend CHIP to families that don’t qualify for Medicaid but can’t afford insurance. But states can opt out of the expansion. They’ll also set their own eligibility requirements for coverage, including what constitutes a “family” or “household,” so spousal benefits and those based on household size will vary depending on whether the state recognizes, and is willing to pay extra to cover, families led by same-sex couples.

The expansion would also make it possible for more low-income people with HIV/AIDS to get treatment, but again, states can opt out, and not all of them cover HIV before it has progressed to full-blown AIDS.

So yeah. Some good, some bad, some irrelevant unless DOMA is repealed. In the meantime, there’s a lot of politics and a lot of spin (seriously: check out the Department of Health and Social Services’ content-farmish fact sheet on ACA and the LGBT community here), and LGBT parents will still need to take every precaution they can to protect their families.

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