By LESLIE CALMAN & SUZANNE SCHLATTMAN
Two recent developments provide the opportunity for LGBT Marylanders to achieve equality.
The first is obvious: After a hard-fought battle and with the help of innumerable straight allies, marriage equality is now law of the land in Maryland. Although the federal Defense of Marriage Act continues to bar a number of benefits to married LGBT people, state-level benefits are now fully available.
This means that many more Marylanders will be able to qualify for health insurance coverage. What’s the connection? Many more people will be able to access health insurance through their spouses. And Maryland is ahead of the curve on implementing President Obama’s Affordable Care Act. The new insurance exchanges and reduced rates the ACA mandates are sure to expand coverage to more than 300,000 previously uninsured state residents — including many lesbian, gay, bisexual and transgender Marylanders.
To maximize the benefit of both of these major policy changes, it’s important for LGBT Marylanders to get informed and get engaged.
LGBT Marylanders are more likely than heterosexual people to be uninsured. LGBT people are more likely to be self-employed, to earn less or to work for employers who don’t offer health insurance. For an American woman, the best predictor of whether she has health insurance is if she is married — a status previously denied to LGBT women.
Marriage equality and the Affordable Care Act confront these inequities in many tangible ways that increase coverage, improve quality and help build a better system to ensure that all Marylanders can get the healthcare they need free from unnecessary administrative burden or prejudicial judgment.
First, for people with low incomes, the ACA makes health insurance available for free or at reduced rates. Individuals earning up to about $15,000 per year will be able to get free coverage through the expanded Medicaid program starting Jan. 1, 2014.
Other single Marylanders earning up to $44,680 can get tax credits to subsidize their coverage through our new Maryland Health Connection. Plans sold in the Connection will provide robust benefits at affordable rates by encouraging competition and making it easier for consumers to compare and shop for insurance.
Qualifying small businesses can also get tax credits of up to 35 percent of the business’ health care costs if they provide health insurance for their employees.
There are many other provisions in the law that can make it an even greater win for LGBT Marylanders. For example, the state will set a benchmark, or minimum standards of medical treatments to be guaranteed in the Maryland Health Connection. This is an opportunity to eliminate arbitrary exclusions based on sexual orientation and gender identity that currently create significant barriers to care, particularly for transgender people. There are a number of insurance plans that deny coverage for any services or medications related to sex transformation — and that can apply to denial of vital screenings, like mammograms or pap tests, for a person born female but has since become a transgender man.
The ACA also creates a unique opportunity to learn more about the different experiences of LGBT Marylanders in our healthcare system: how does the experience of being stigmatized affect health and access to health care? Are LGBT people less likely to get recommended cancer screenings? More likely to suffer stress? More likely to smoke? Collecting data on sexual orientation and gender identity can be a way to better understand and address inequities and injustice in health and in our health care system that disproportionately affects LGBT patients.
Finally, the ACA also creates a Navigator program that can empower trusted service providers in the LGBT community to conduct education and enrollment work and ensure that state marketing efforts cater to LGBT people and direct them to brokers or community-based organizations that understand unique health care considerations in the community and help them find coverage that best suits their needs.
It is important for those advocates who were engaged in the successful campaign for marriage equality to now turn their attention and efforts to make sure that Maryland’s implementation of the Affordable Care Act goes as far as it possibly can to guarantee meaningful access to quality, affordable health care for LGBT Marylanders.
Leslie Calman is executive director of the Mautner Project. Suzanne Schlattman is community outreach and development director of the Maryland Health Care for All coalition.