The road to healthcare access for LGBTQ individuals who test positive for HIV is often filled with obstacles. LGBTQ individuals with HIV have reported being denied necessary healthcare due to discrimination and have also faced providers that speak to them harshly, blame them for their HIV status, or refuse to touch them. These types of reports are especially prevalent among transgender patients, who also face particular discrimination challenges in employment and other contexts.
Traditionally, LGBTQ individuals have faced challenges obtaining insurance and have encountered discrimination in hospitals, clinics, and other healthcare settings. They may also face poor outcomes, particularly in emergency contexts, due to health care providers that refuse to provide the appropriate care due to religious or other personal beliefs. For example, one HIV-positive LGBTQ individual was scheduled to have spinal fusion surgery, but upon learning that the patient was HIV positive, the surgeon canceled the surgery and refused to perform it. One study determined that 1 out of 3 LGBTQ individuals with incomes below 400% of the federal poverty line were found to be uninsured.
The legalization of same-sex marriage and the anti-discrimination provisions of the Affordable Care Act (ACA) have led to greater healthcare access to HIV positive LGBTQ individuals. Same sex or transgender spouses that were previously unable to access insurance may now be able to access insurance through a spouse’s employer.
The ACA gives greater healthcare access to transgender individuals because it prohibits insurance companies from denying coverage to those with “pre-existing conditions.” Historically, many insurers have considered transgender identity a “pre-existing condition,” and refused to insure transgender individuals.
The ACA also includes anti-discrimination provisions related to sexual orientation, gender identity, and health status. No healthcare program or organization that receives funds or is administered by the federal government is permitted to discriminate on the basis of these categories. This means that federally funded or administered programs cannot discriminate on the basis of HIV status. A number of different entities receive federal funds, including doctor’s offices, drug rehabilitation centers, rape crisis centers, veteran’s health centers, hospitals, and community clinics.
In some states, the ACA also expanded Medicaid and created federally subsidized health insurance marketplaces. However, certain states have chosen not to expand. The ACA also faces an unclear future following recent political developments, although it remains valid at the time of this writing.
The Obergefell v. Hodges ruling that legalized same sex marriage and the ACA may reduce the rate of uninsured individuals in the LGBTQ community, and could also have a positive outcome on HIV positive LGBTQ patients. However, certain issues remain. One of the major issues is that state policies vary widely, especially with regard to Medicaid expansion. In states that have chosen not to expand Medicaid, many LGBTQ individuals are caught in a gap where they are not eligible for Medicaid, but are also too poor to qualify for subsidized coverage. Moreover, in many states employers can fire an employee for being LGBTQ, thereby ending the employee’s access to health coverage.
Since federal law doesn’t prohibit sexual orientation and gender identity discrimination outside of state marketplaces, discrimination can continue in certain spaces. Healthcare access for LGBTQ individuals with HIV is an area that may be affected in the future through impact litigation.