LGBT Healthcare In Post Affordable Health Care Act America

LGBT (lesbians/gays/bisexuals, transgenders) has faced a chronic health crisis. Since the 1980s, there has been a health epidemic that has afflicted the LGBT (lesbian, gay and bisexual, transgender, etc.) community. It was easier to understand the spread of HIV/AIDS and other health problems within the community during this era, when the fight for LGBT rights was still in its early stages. Before 1973, homosexuality was considered a mental disorder. Therefore, most literature and research focused on the “causes” rather than the health problems that affected the LGBT community (Boehmer 2002). While there was more research done in the 1990s regarding the LGBT community, they were not inclusive of all aspects. Therefore, when improvements in healthcare were made, many members of this community were not included. It has been nearly forty years since LGBT rights were first established. Despite significant advances in LGBT rights, including the passage of Affordable Care Act which covers LGBT-specific rights, poor health care remains a major problem. This research will identify and address the major causes of health disparities in the LGBT community. To adequately address the health care needs of the LGBT community, it is necessary to improve the inclusion in hospitals, to implement LGBT health needs into medical school curriculum, as well as to change the way policymakers make and enforce LGBT laws and policies.

Barack Obama signed in 2010 the Affordable Care Act. The Family Equality Council stated that the law prohibited discrimination based on gender (which includes sexual orientation or gender identity), and health status. It also prohibits discrimination against transgender people (“The AffordableCare …”2018”). The Affordable Care Act was introduced to make it easier for LGBT families to have health insurance. These families had a harder time getting insurance, as most employers didn’t offer coverage for the same-sex partner or children. Parents also had to purchase separate insurance plans to cover their family (“The Affordable care …” 2018″ Because of the law, LGBT parents and their children can now get health insurance at the equivalent rate to the general population. Transgender persons have access to more coverage. While the Affordable Health Care Act gave LGBT people more access to healthcare, it didn’t provide detailed guidance to hospitals or policymakers about how to best care for LGBT patients. Hospitals are free and able to make their own inclusive visions, often failing to follow the guidelines.

Although many hospitals and doctors’ offices display a poster or plaque stating their anti-discrimination policy, this is not the only evidence that they are welcoming to LGBT patients. People with LGBT issues are often not encouraged to post LGBT-related posters or handouts in public hospital. Public hospitals tend to display pamphlets and posters that are heterocentric. This means that most of them only have pamphlets and posters that focus on heterosexual lifestyles. LGBT people who seek medical care in public hospitals should have the same access to information as heterosexuals. LGBT patients will feel more comfortable knowing that their doctor is knowledgeable and caring about LGBT issues.

Together with handouts and posters, it is important to include LGBT-inclusive medical forms. People who are forced to complete medical forms that have only one binary gender or sexual orientation category are less likely to be able to identify with LGBT people (McWayne and co., 2010). Medical documents should be updated to reflect LGBT identities. They should not only consider them “other” but also include options to show their identity. It is stressful to be considered an “other” when you have to.
Inadequate forms can lead to LGBT people not seeking treatment or even meeting with their doctors. Accessible medical forms can help LGBT patients get better treatment. Health care providers will be better equipped to identify their needs and circumstances.

LGB and Transgender individuals, especially those in hospitals, need more bathrooms in their offices (Unger 2017,). Transgender people have been subject to a lot discussion over the years. Implementing family bathrooms will allow them to legally use public bathrooms within hospitals. Non-gender-conforming individuals will also find bathrooms beneficial. The stress of having to choose from two bathrooms can make it very difficult for them.

The hospital should not only make bathrooms and forms more inclusive but also provide training for staff on how to communicate with LGBT patients (Unger 2017). It will be easier for LGBT individuals to access the medical care they need. Current and future doctors should receive training in LGBT health. LGBT people are more likely not to have to reveal their sexual orientation or gender identity in order to receive care at offices. If LGBT patients feel that their rights have been protected, they will continue to seek care. Obama, the former president, issued a memorandum to hospital administrators in 2010. This directive instructed staff to devise a protocol to prevent discrimination based on gender identity or sexual orientation in medical settings (McWayne and al. (2010)). Janice Langbehn & Lisa Pond were the central characters of the story that led Obama to issue this memorandum. Janice and Lisa were vacationing when Lisa collapsed. Janice had to be taken to hospital. Janice was prevented from entering Lisa’s room. She was also not permitted to see Lisa’s condition. Janice claimed that Janice was told by the nurse that Janice was not allowed into Lisa’s room because she was from an “anti-gay state and city”. Janice was also instructed by the nurse to have Janice have health care proxies. This allows Janice to access Lisa’s medical information, and Janice can make any medical decisions for Lisa. Janice received the health care proxy forms faxed to her hospital. Janice was only allowed to see any information when Lisa’s sister arrived at her hospital. Janice did not witness Lisa’s passing and Obama ordered the memorandum. This memorandum was hugely beneficial for LGBT medical rights.

While it’s helpful for current doctors to be trained in diversity, it’s also important to develop a curriculum that is more inclusive for potential medical professionals about LGBT sexual orientations and gender identities. Cecile Unger, in her “Care Of The Transgender Patient” survey, states that less than a third of respondents were comfortable caring and informed about transgender patients. Only one-third were knowledgeable about transition steps and half knew how to recommend routine health screenings. Only 141 of the 352 providers who received the survey responded. Unger’s survey shows two things. 2) Healthcare providers are not willing to share their knowledge and views on LGBT care.
As I had stated in my introduction that homosexuality was a psychological disorder until 1973. Therefore, it is not surprising that medical students around 1973 and those who followed that time would still be convinced that LGBT health-related matters were a manifestation of a mentally disorder. The sudden removal of any reference to homosexuality by medical professionals or institutes was a shock. Since the classification changes, 45 years have passed and no change has been made to ensure LGBT health providers are adequately educated. Unger’s survey revealed that transgender patient who had to explain their transgenderism to their physicians were four times more likely than patients who didn’t need to seek treatment because of discrimination. A curriculum that covers LGBT health issues will foster a closer relationship between the clinicians and their patients (McWayne, 2010). This can also encourage LGBT individuals and families to seek care more frequently.

Unger’s other finding is that the majority (or even most) of providers didn’t answer the survey. It shows that many providers don’t want to talk about their involvement in LGBT discrimination. It’s not surprising that many health care professionals are uncomfortable with caring for Trans and LGB patients. In the last two decades, there have been tensions between health care workers’ moral/religious rights as well as women’s/LGBT healthcare needs. George W. Bush was the first to implement policies to safeguard religious liberty of healthcare workers (Shugerman 2018,). The American Medical Association resisted these policies as they were too broad. They allowed workers to refuse treatment such as blood transfusions and birth control. These policies were deemed discriminatory in health care systems towards LGBT patients, and they were terminated. Trump is currently trying to reinstate these policies in January 2018. This would be an omission for LGBT rights or a step backwards. It will also further divide LGBT patients from their health care providers. These policies and the inability of healthcare professionals to build a relationship with LGBT patients show that they don’t want to be responsible for their care. These professionals need to understand that they are being discriminatory and unethical in refusing care for patients with HIV/AIDS, as well as for those who have been affected by it, and this is dangerous for them and the society.

It is also harmful to society to deny gay people the right to donate plasma and blood. People in need of blood donation should have the chance to be helped by eligible donors when disasters strike, whether they are man-made or natural. Medical centers across the country are forbidden from allowing gay men to donate blood. The American Red Cross website states that the FDA only recently changed their regulations on gay men donating blood, changing it from a lifetime deferral to one year from the time they had their last sexual encounter. This decision has a problem because the American Red Cross says that there is not enough scientific data to decide whether donation eligibility can be determined solely on individual behavior risk factors. (American Red Cross 2018, 2018). According to the ARC’s statement, there is no evidence that gay men can be deferred from donating by the FDA. This is also supported by the question potential transgender donors may ask: “I am transgender and I am eligible to donate because my assigned sexual partner at birth was a female.” But, I have had sex in the past with another man. Can I donate?” According to the American Red Cross (2018), _______________. The ARC has answered this question with the following: Transgender males can’t donate until they have sex within 12 months. These rules are discriminatory because they do not have sufficient research.
Plasma and blood donation centers perform screening tests for infectious diseases prior to sending off donors’ plasma and blood. This means that pre-screening questions relating to sexual orientation will not be asked and are not helpful in determining donor eligibility. While the change from lifetime to twelve months to defer the donation is progressive, it still has the same biases that were present in the original decision barring gay men from donating. FDA policy makers must create anti-discrimination policies, laws, and guidelines that are more specific and based on sufficient research. This will improve the quality and effectiveness of laws and policies that are meant to benefit LGBT people and society in general.

Also, policymakers should be more open to the LGBT community’s voices and advocates. There are many factors that can impact laws and policies. The impact of political and social factors on LGBT anti-discrimination legislations is varied. It all depends on the political and social composition of the state, whether they are liberal or conservative. The ever-changing political climate in the United States has led to a disparity in anti-discrimination laws within and between states. Taylor’s (et.al., 2012), investigation of what influences the creation anti-discrimination law and policies for LGBT communities found that liberal states with Democratic legislatures are more inclined to adopt policies and laws than states and legislatures that are more conservative.

A bill to protect LGBT rights in Indiana, 2015 and 2016, was considered by the Republicans …” 2015. The bill generated heated debate about whether the rights for LGBT persons should be protected the same as those of other races and religions. The bill was proposed after a poll conducted by Angie’s List Inc. CEO and LGBT-rights advocate, Bill Oesterle, found that most Indiana voters support adding sexual orientation and gender identity to Indiana’s civil rights law (“Republicans…”2015). This important research is significant considering that the Pew Research Center reports that 42% (or 37%) of Indiana’s registered voters support adding gender identity and sexual orientation to Indiana’s civil rights law. Due to Indiana’s red status (majority of conservative voters), it is unlikely LGBT protection laws will be created or passed. The Republican Senators decided not only not to debate the bill but also not to approve it. Although a majority of Indiana voters agree that LGBT people should be protected by civil rights laws, the majority party still has an impact on whether or not legislation or policies are passed. It is difficult to make progress on LGBT rights in Indiana when there aren’t voices for LGBT people. This is evident in Indiana’s legislature. The bill was not even discussed in a formal way, so there weren’t any advocates or LGBT people present to push for its passage.

In order to ensure that LGBT anti-discrimination policies and laws are taken seriously in areas where people have a tendency not to support them, there needs to be more LGBT voices in medical boards and legislatures. In order to reduce loopholes and discrimination laws and policies, it is important that LGBT advocates and individuals be included in the discussions. Davis and Berlinger present the negative consequences of the Affordable Medical Care Act on the transgender group in Davis and Berlinger’s article, “Moral Progress in the Public Safety Net. Their article reveals that Transgender people are more likely to be discriminated against when they seek care. Furthermore, the Affordable Health Care Act does not address their specific health needs.

Policymakers must also consider how anti-discrimination and healthcare policies impact hospitals that adopt them. They should also look for ways to financially support hospitals in order to uphold these policies and laws. Davis and Berlinger also discuss the negative effects of the Affordable Care Act on public hospitals.
They discuss how Medicare, Medicaid and other policies have reduced the number who can stay longer than two night in public hospitals. This is especially true for transgender individuals. Some transgender patients require more time in hospitals than they can afford due to complications. Failure to comply with Medicare audits will result in hospitals losing more funding and being audited. Public hospitals are also suffering due to the reduction of payments they receive if they are considered a “disproportionate-share hospital”, the fear of losing even more funding is making it harder for medical professionals to help low income or “difficult” (transgender) patients when they already do not have the funds to support them. Policies must be updated to account for the financial needs of LGBT patients who are being cared for in public hospitals.

It is clear that LGBT people can feel overwhelmed by the issues. It would be much easier to stop seeking out care if they were to face them head-on. Living in a first country should not discourage anyone from seeking healthcare, regardless of their status as a member or non-LGBT community. It is up to policymakers, doctors, and general populations to collaborate to improve the quality of LGBT health care. It’s possible by reflecting LGBT ideals and issues in hospital environments and properly educating future and existing medical professionals on LGBT medical needs.