President Obama has demonstrated that his vision for a brighter future includes greater equality for lesbian, gay, bisexual and transgender (LGBT) Americans. The President and his Administration are dedicated to eliminating barriers to equality, fighting discrimination based on sexual orientation and gender identity, and engaging LGBT communities across the country.
As part of the Obama Administration's commitment, the Department of Health and Human Services (HHS) continues to engage in a concerted effort to improve the health and well-being of all Americans, including LGBT Americans. Secretary Kathleen Sebelius has led these efforts to promote equal treatment of LGBT Americans, provide enhanced resources for LGBT health issues, and develop better information regarding LGBT health needs.
To ensure the consideration of LGBT concerns throughout HHS's activities, Secretary Sebelius established a committee of senior representatives from each division of HHS. This committee coordinates LGBT-related policies across the department and recommends future action that HHS can take to improve the health and well-being of LGBT communities.
These efforts stemmed from President Obama's Memorandum on Hospital Visitation, which, in addition to addressing the rights of hospital patients to designate visitors regardless of sexual orientation or gender identity, directed Secretary Sebelius to explore additional steps HHS could take to improve the lives of LGBT people and their families.
The Affordable Care Act
The Affordable Care Act is greatly improving access to health coverage for LGBT Americans. Studies have shown that health disparities related to sexual orientation and gender identity are due in part to lower rates of health coverage. The Affordable Care Act will give all Americans, including LGBT Americans, improved access to health coverage through an expanded, stronger Medicaid program and new Affordable Insurance Exchanges, marketplaces for quality, affordable health insurance. Moreover, thanks to the Affordable Care Act, insurance companies will no longer be able to deny individuals coverage or charge them more based on pre-existing conditions — meaning that all Americans will have the security of knowing that they can access affordable, quality health coverage even if they lose their jobs, switch jobs, move, or become sick.
Other notable parts in the Affordable Care Act that will benefit LGBT Americans — like all Americans — are the provisions that permit individuals to remain on their parents' health plans until age 26 and enhance the availability of preventive services for women in new health plans and seniors on Medicare.
As the Affordable Care Act is implemented, HHS has taken significant steps to help improve the health and well-being of LGBT Americans.
Equal Rights for LGBT Americans
In the past, many same-sex domestic partners were denied the ability to visit their loved ones in the hospital. At the direction of President Obama, HHS has taken action to ensure equal rights for LGBT Americans to visit their partners in the hospital. The Centers for Medicare & Medicaid Services (CMS) issued new rules in November 2010 for hospitals that participate in Medicare and Medicaid that require them to respect the right of all patients to choose who may visit them when they are hospitalized.
In September 2011, at the same time that CMS stepped up enforcement of hospital visitation rights, it also clarified that same-sex couples have the same rights as other couples in terms of naming a representative who can make medical decisions on a patient's behalf. Existing rules protect the rights of hospital patients to have representatives who can act on their behalf. HHS has updated the guidance explaining these rules to make it easier for family members, including same-sex partners, to make informed care decisions for loved ones who have become incapacitated.
CMS has also issued guidance to states making clear that same-sex partners may be afforded treatment comparable to other spouses when it comes to receiving long-term care, such as care in a nursing home, under Medicaid. Federal law protects assets, such as a couple's home, in the event that a married individual must receive nursing home care through Medicaid. In June 2011, CMS clarified that states have the flexibility to extend this protection to same-sex partners.
Secretary Sebelius has also strengthened internal policies at HHS to help ensure that LGBT individuals have equal access to HHS programs and employment opportunities. In April 2011 the Secretary issued a new policy explicitly requiring employees to serve all individuals eligible for HHS programs without regard to non-merit factors, including sexual orientation and gender identity. In addition, in March of 2011, the Secretary updated and clarified HHS's equal employment policy — which already protected against unfair treatment based on a person's sexual orientation — to also include gender identity and genetic information.
Stronger Resources to Improve LGBT Health and Well-Being
HHS has taken many steps to strengthen the health resources available to LGBT Americans over the first three years of the Obama Administration.
In 2010, HHS established the nation's first national resource center for older LGBT individuals. This center, funded by the Administration on Aging (AoA), supports communities across the country as they aim to serve the estimated 1.5 to 4 million LGBT individuals who are 60 and older. The center provides information, assistance and resources for both aging services, LGBT organizations, and providers at the state and community level to assist them in the development and provision of culturally sensitive supports and services.
In July 2010, President Obama and Secretary Sebelius announced the National HIV/AIDS Strategy, a rigorous effort to increase access to care and lower the number of new HIV cases in the United States by 25 percent within the next five years. The strategy seeks to reduce HIV-related health disparities with a specific focus on high-risk populations, including certain LGBT populations.
In September 2010, HHS announced that the Centers for Disease Control and Prevention (CDC) allocated $30 million in new resources to support the National HIV/AIDS strategy. These funds, made available by the Affordable Care Act, are providing a boost to states and communities as they focus HIV prevention on high-risk populations. The funds are also helping fill critical gaps in data, knowledge, and understanding of the epidemic.
In September 2010, the Substance Abuse and Mental Health Services Administration (SAMHSA) announced $42.6 million in new grants over a three-year period to provide behavioral health services in communities most impacted by HIV/AIDS. Funding for the "12 Cities" program will be used to develop and expand networks of primary care, HIV/AIDS and behavioral health service providers serving racial and ethnic minorities, including LGBT individuals, with or at high risk for HIV/AIDS.
In October 2010, the Administration for Children and Families (ACF) announced a $13.3 million grant to the Los Angeles Gay and Lesbian Center over five years to help address barriers to permanency and well-being for LGBT foster youth, who are disproportionately represented in the foster care population. This is one of the largest federal grants to an organization that primarily serves LGBT communities.
In March 2011, HHS launched a new website — www.StopBullying.gov — which contains a dedicated section for LGBT youth. The site includes specific resources and assistance for LGBT youth, including examples of community groups that offer support and options to seek counseling. Secretary Sebelius also taped an "It Gets Better" video to address LGBT youth who have been bullied and are at risk of depression and suicide.
In June 2011, ACF announced the creation of a resource center to support resettlement of LGBT refugees who have faced persecution and discrimination in their home countries. The new center will provide resources to resettlement workers who are helping refugees assimilate in America in key locations, and provide training to staff on issues and needs specific to LGBT refugees.
In September 2011, the Health Resources and Services Administration (HRSA) awarded $248,000 to create a National Training and Technical Assistance Center to help community health centers (CHCs) provide improved care for LGBT patients. The center will work in consultation with CHCs across the country — providing training for doctors, nurses, and other employees and developing health information resources specifically for LGBT patients. Additionally, SAMHSA is disseminating training curricula to help providers more effectively provide behavioral health services to LGBT Americans, in particular members of racial and ethnic minority populations.
Better Information on LGBT Health Needs
In June 2011, Secretary Sebelius announced HHS' plans to greatly enhance the collection of health data on LGBT populations. Gathering data on LGBT individuals will help researchers, policy makers, health care providers, and advocates identify and address health disparities affecting the LGBT population.
Additionally, in March 2011, the Institute of Medicine (IOM) released a report commissioned by the National Institutes of Health (NIH) on the state of research and science regarding the health needs of LGBT people. The report provides the scientific community with the first comprehensive overview of health-related research on LGBT health issues — an important step in identifying research gaps and opportunities. To address the IOM's recommendations, NIH formed an internal committee to review the report and determine how NIH can strengthen LGBT health research, and include LGBT Americans in clinical studies.
In October 2011, HRSA released Women's Health USA 2011, the tenth edition of an annual data book identifying priorities, trends and disparities in women's health. For the first time, this report features data on the health of lesbian and bisexual women. Among other things, the report found that health disparities exist by sexual orientation. The full report is available at: www.mchb.hrsa.gov/whusa11/ .
Every ten years, HHS develops national, science-based objectives for promoting health and preventing disease for the following decade. In 2010, as part of this initiative — "Healthy People 2020" — for the first time, a formal workgroup was established to examine scientific literature on LGBT health. The workgroup will propose objectives regarding LGBT health as part of this comprehensive initiative.
Secretary Sebelius and the Department of Health and Human Services are committed to continuing these efforts, including by identifying ways to improve the health and well-being of LGBT Americans, and by coordinating the department's activities around LGBT health.
More information on the department's activities concerning LGBT health can be found at: http://www.hhs.gov/secretary/about/lgbthealth.html
Information on President Obama's commitment to the LGBT community can be found at: http://www.whitehouse.gov/lgbt
http://www.hhs.gov/secretary/about/lgbthealth_update_2011.html
