Lesbian, gay, bisexual, and transgender (LGBT) individuals often face challenges and barriers to accessing needed health services and, as a result, can experience worse health outcomes. These challenges can include stigma, discrimination, violence, and rejection by families and communities, as well as other barriers, such as inequality in the workplace and health insurance sectors, the provision of substandard care, and outright denial of care because of an individual's sexual orientation or gender identity. While LGBT individuals have many of the same health concerns as the general population, they experience certain health challenges at higher rates, and also face several unique health challenges. In particular, research suggests that some subgroups of the LGBT community are more likely to suffer from certain chronic conditions and face higher prevalence and earlier onset of disabilities compared to heterosexuals. Other major health concerns include HIV/AIDS, mental illness, substance use, and sexual and physical violence. In addition to the higher rates of illness and health challenges, some LGBT individuals are more likely to experience challenges obtaining care. Barriers include gaps in coverage for certain groups, cost-related hurdles, and stigma, including poor treatment from health care providers. Several recent changes within the legal and policy landscape have served to increase access to care and insurance for LGBT individuals and their families. Most notably these include the passage of the Affordable Care Act (ACA) and the Supreme Court's overturning of a major portion of the Defense of Marriage Act (DOMA) in United States v. Windsor and subsequent ruling in Obergefell v. Hodges legalizing same-sex marriage nationwide. The ACA expands access to health insurance coverage for millions, including LGBT individuals, and contains specific protections related to sexual orientation and gender identity, although recent actions taken by the Trump Administration have sought to scale back some of these gains. The Supreme Court's 2013 ruling on DOMA resulted in federal recognition of same-sex marriages for the first time and paved the way for recognition in many more states and its 2015 decision in Obergefell ruled that the Fourteenth Amendment requires a state to license same-sex marriages and to recognize such marriages performed out-of-state, thereby further expanding access and coverage across the country. This issue brief provides an overview of what is known about LGBT health status, coverage, and access in the United States, and reviews the implications of the ACA, the Supreme Court rulings on marriage equality, and other recent policy developments for LGBT individuals and their families going forward.
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