Impact of Healthcare Reform on LGBT Elders

Harley, Debra A.

doi:10.1007/978-3-319-03623-6_19

Debra A. Harley³

70k Accesses

Abstract

The purpose of this chapter was to examine the impact of healthcare reform in the USA on LGBT elders, especially the Affordable Care Act (ACA). Attention is given to health disparities and coming out risk factors for LGBT elders, health systems challenges for LGBT elders, advantages and disadvantages of healthcare reform on LGBT elders, and future directions of healthcare reform in the USA. Where appropriate, discussion from an international perspective is included, especially Canada and the UK. It is not the intent of this chapter to endorse any point of view over the other or to be advisory about healthcare issues. The intent is to present multiple perspectives concerning the benefits and debates of healthcare reform on seniors, especially LGBT elders.

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References

Annual Statistical Supplement. (2011). Medicaid program description and legislative history. Retrieved February 5, 2015 from http://www.ssa.gov/policy/docs/statcomps/supplement/2011/medicaid.html.
An, R., Huang, C., & Baghbabian, A. (2015). Health policy analysis. In E. Mpofu (Ed.), Community-oriented health services: Practices across disciplines (pp. 17–40). New York, NY: Springer.
Google Scholar
Ard, K. L., & Makadon, H. J. (2012). Improving the health care of lesbian, gay, bisexual, and transgender (LGBT) people: Understanding and eliminating health disparities. Boston: The Fenway Institute. Retrieved January 30, 2015 from www.lgbthealtheducation.org/wp-content/uploads/12-054_LGBTHealtharticle_v3_07-09-12.pdf.
Baker, K., & Krehely, J. (2011). Changing the game: What health care reform means for gay, lesbian, bisexual, and transgender Americans. Washington, DC: Center for American Progress. Retrieved January 29, 2015 from http://www.americanprogress.org/issues/2011/03/aca_lgbt.html.
Baker, K., & Krehely, J. (2012). How health care reform will help LGBT elders. Public Policy and Aging Report, 21(3), 19–23.
Article Google Scholar
Barua, B., & Clemens, J. (2014, June 13). Canada not a good example of universal health care. Retrieved February 10, 2015 from http://www.fraserinstitute.org/research-news/news/display.aspx?id=21499#.
Barua, B., & Esmail, N. (2013, December 20). Seeking relief outside Canada’s borders. Retrieved February 10, 2015 from http://www.fraserinstitute.org/research-news/news/display.aspx?id=20716#.
Berkleman, R. (2012). The United States government’s response to HIV/AIDS today: ‘Test and Treat’ as prevention. Journal of Public Health Policy, 33(3), 337–343.
Article Google Scholar
Beschloss, M. (2006). Our documents: 100 milestone documents from the National Archives. New York, NY: Oxford University Press.
Google Scholar
Botek, A. M. (2015). For seniors, a new model to deliver “accountable care”. Retrieved February 5, 2015 from http://www.agingcare.com/Articles/accountable-care-organization-help-seniro-health-care-150489.htm.
Brotman, S., Ryan, B., & Meyer, E. (2006). The health and social service needs of gay and lesbian elders: Final report. Montreal, Canada: McGill University School of Social Work.
Google Scholar
Brotman, S., Ryan, B., Collins, S., Chamberland, L., Comier, R., Julien, D., et al. (2007). Coming out to care: Caregivers of gay and lesbian seniors in Canada. The Gerontologist, 47(4), 490–503.
Article Google Scholar
Chance, T. F. (2013). “Going to pieces” over LGBT health disparities: How an amended Affordable Care Act could cure the discrimination that ails the LGBT community. Journal of Health Care Law and Policy, 15(2), 375–402.
Google Scholar
Cherry, B., & Trotter Betts, V. (2005). Health policy and politics: Get involved. In B. Cherry & S. Jacobs (Eds.), Contemporary nursing: Issues, trends, and management (pp. 211–233). St. Louis, MO: Elsevier.
Google Scholar
Congressional Budget Office. (2012). Updated estimates for the insurance coverage provisions of the Affordable Care Act, Updated for the recent Supreme Court Decision 13. Retrieved January 30, 2015 from http://www.cbo.gov/sites/default/files/cbofiles/attachments/43472-07-24-2012-CoverageEstimates.pdf.
Feder, J. L. (2014, April 22). Ugandan health workers could become front-line enforcers of Anti-homosexuality Act. Retrieved February 9, 2015 from http://www.buzzfeed.com/lesterfeder/updated-ugandan-guidelines-could-make-health-workers-front-l#.ul51yZP3n.
Federal Information & News Dispatch. (2015, February 5). Rep. Conyers and 44 House democrats reintroduced “The Expanded and Improved Medicare For All Act”. Retrieved February 10, 2015 from http://www.insurancenewsnet.com/oarticle/2015/05/rep-conyers-and-44-house-democrats-reintroduce-the-expanded-and-improved-medi-a-591393.html#.VNrmm8bysk.
Feldman, J. (2010). Medical and surgical management of the transgender patient: What the primary care clinician needs to know. In H. J. Makadon, L. Mayer, J. Potter, & H. Goldhammer (Eds.), The Fenway guide to lesbian, gay, bisexual, and transgender health. Philadelphia, PA: American College of Physicians.
Google Scholar
Fredriksen-Goldsen, K. I., Kim, H. J., Emlet, C. A., Muraco, A., Erosheva, E. A., Hoy-Ellis, C. P. et al. (2011). The aging and health report: Disparities and resilience among lesbian, gay, bisexual, and transgender older adults. Retrieved January 1, 2015 from http://caringandaging.org/wordpress/wp-content/uploads.2011/05/Full-Report0FINAL-11-16-11.pdf.
Friedman, G. (2013, July 31). Funding HR 676: The expanded and improved Medicare for All Act—How we can afford a national single-payer health plan. Retrieved February 10, 2015 from www.pnhp.org/sites/default/files/FundingHR676_Friedman_7.31.13.pdf.
Greenesmith, H., Cray, A., & Baker, K. (2013, May 23). The Affordable Care Act and LGBT families: Everything you need to know. Retrieved January 23, 2015 from www.familyequality.org/_asset/5gqpft/FEC-CAP-LGBT-ACA-Families-Guide.pdf.
Institute of Medicine. (2011, March). The health of lesbian, gay, bisexual, an transgender people: Building a foundation for better understanding. Report Brief. Washington, DC: Author.
Google Scholar
Kaplan, R. L. (2011, February 8). Elder law expert: Health care reform act a mixed bag for seniors. Retrieved February 5, 2015 from http://phys.org.news/2011-02-elder-law-expert-health-reform-html.
Kaufman, R. (2010). Introduction to transgender identity and health. In H. J. Makadon, K. H. Mayer, J. Potter, & H. Goldhammer (Eds.), The Fenway guide to lesbian, gay, bisexual, and transgender health. Philadelphia, PA: American College of Physicians.
Google Scholar
Kelley, A. S., McGarry, K., Fahle, S., Marshall, S. M., Du, Q., & Skinner, J. S. (2013). Out-of-pocket spending in the last five years of life. Journal of General Medicine, 28(2), 304–309.
Article Google Scholar
Library of Parliament Research. (n.d.). Retrieved February 8, 2015 from www.parl.gc.ca/information/library/PRBpublis/944-e.htm.
Mule, N. J. (2007). Sexual orientation discrimination in health care and social service policy: A comparative analysis of Canada, the UK, and USA. In L. Badgett & J. Frank (Eds.), Sexual orientation discrimination: An international perspective (pp. 306–322). New York, NY: Routledge.
Google Scholar
Mule, N. J., Ross, L. E., Deeprose, B., Jackson, B. E., Daley, A., Travers, A. et al. (2009). Promoting LGBT health and wellbeing through inclusive policy development. International Journal for Equity in Health, 8(18). doi:10.1186/1475-9276-8-18.
Google Scholar
National Healthcare Disparities Report. (2012). Lesbian, gay, bisexual, and transgender populations in the 2011 National Healthcare Disparities Report (AHRQ Publication No: 12-M030). Rockville, MD: Agency for Healthcare Research and Quality. Available at http://www.ahrq.gov/qual/qrdr11.htmm.
Navarro, V. (2007). What is a national health policy? International Journal of Health Services, 37(1), 1–14.
Article Google Scholar
Physicians for a National Health Program. (2011). Summary: H.R. 676, The Expanded & Improved Medicare For All Act. Retrieved February 10, 2015 from http://www.pnhp.org/news/2011/february/summary-hr-676-the-expanded-improved-medicare-for-all-act.
Rainbow Health Network. (2008). Trans rights are human rights: Canadian Human Rights Act Amendment (gender identity). Toronto: Rainbow Health Network-Trans Health Lobby Group. Retrieved February 9, 2015 from http://www.rainbowhealthnetwork.ca/files/CHRA%20Trans%20Human%20Rights%20Fact%20Sheet.doc.
Rosenthal, J. (2009, July 27). LGBT issues in health reform: Issues brief on making health reform work for all Americans. Retrieved February 9, 2015 from https://cdn.americanprogress.org/wp-content/uploads/issues/2009/07/pdf/lgbthealth.pdf.
Ruble, M. W., & Forstein, M. (2008). Mental health, epidemiology, assessment, and treatment. In H. J. Makadon, K. H. Mayer, J. Potter, & H. Goldhammer (Eds.), The Fenway guide to lesbian, gay, bisexual, and transgender health (pp. 187–208). Philadelphia: ACP.
Google Scholar
SAGE Matters. (2009). How will the Obama administration affect the issues facing LGBT elders? SAGE matters: The source for news on LGBT aging. New York, NY: Author.
Google Scholar
SAGE. (2012). SAGE health reform issues. Retrieved January 20, 2015 from http://www.sageusa.org/issues/reform.cfm?&print=1.
SAGE. (2014, May). LGBT older adults, HIV and the Affordable Care Act. New York, NY: Author. Retrieved January 31, 2015 from www.lgbtagingcenter.org/resources/pdfs/SAGEIssuesBrief-HIVACAandLGBTOlderPeoplke-May2014.pdf.
Saul, M. (2009, August 23). Expensive without the results: Health care in the U.S. Costs the most, not the best in the world. New York Daily News. Retrieved January 29, 2015 from http://aticles.nydailynew.com/2009-08-23/news/17930526_1_health-care-universal-coverage-primary-care.
World Health Organization. (2012). Global health sector strategy on HIV/AIDS 2011-2015. Available at www.who.int/hiv/pub/hiv_stragegy/en/.

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Authors and Affiliations

SAGE, New York, USA
Debra A. Harley

Authors

Debra A. Harley
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Correspondence to Debra A. Harley .

Editor information

Editors and Affiliations

University of Kentucky, Lexington, Kentucky, USA
Debra A. Harley
University of Kentucky, Lexington, Kentucky, USA
Pamela B. Teaster

Appendices

Learning Activities

Self-Check Questions

1.
What is the relationship between Medicaid and Medicare for LGBT elders?
2.
What are the reasons for LGBT elders’ health disparities?
3.
What are the advantages and disadvantages of the Affordable Care Act for LGBT persons?
4.
What are some of the challenges to policy implementation of healthcare reform?
5.
How are health disparities for LGBT populations consistent across different countries?

Experiential Exercises

1.
Interview a healthcare provider to discover their knowledge level in working with LGBT elders. In addition, ask questions to determine the service providers’ comfort working with LGBT population. See whether they are more or less comfortable working with a particular subgroup of LGBT persons.
2.
Imagine yourself as an LGBT elder who now has to decide upon a health insurance plan. What are some questions would you ask?
3.
Volunteer to work with LGBT elders to develop a personalized self-advocacy health strategy.

Multiple-Choice Questions

1.
Which of the following is the payer of last resort for individuals enrolled in both Medicare and Medicaid?
1. (a)
  Medicare
2. (b)
  Medicaid
3. (c)
  Supplemental Security Income
4. (d)
  Social Security Disability Income
2.
Which key component was dropped from the Affordable Care Act?
1. (a)
  Elder Care Assistance
2. (b)
  Independent Living Assurance
3. (c)
  Community Living Assistance Services and Supports
4. (d)
  Fairness Assurance and Community-Based Supports
3.
Which of the following is considered the strongest foundation in closing health disparities for LGBT persons?
1. (a)
  Medicare
2. (b)
  Medicaid
3. (c)
  Americans With Disabilities Act
4. (d)
  Affordable Care Act
4.
Which of the following is the most recent addition to the options for managing health care for older Americans?
1. (a)
  Private-Fee-for-Service
2. (b)
  Preferred Provider Organizations
3. (c)
  Accountable Care Organizations
4. (d)
  Health Maintenance Organizations
5.
Which of the following law can hold healthcare workers, their facilities, or researchers accountable for “promoting homosexuality”?
1. (a)
  Ugandan Anti-Homosexuality Act
2. (b)
  International Gay Protection Act
3. (c)
  Canadian Anti-Sodomy Law
4. (d)
  Universal Human Rights Law
6.
What is a disadvantage of health information technology for LGBT persons?
1. (a)
  May expose too much information about a person’s sexual identity to providers who do not need to know
2. (b)
  May expose an LGBT person to discrimination by healthcare providers in certain situations
3. (c)
  All of the above
4. (d)
  None of the above
7.
Canada has which of the following type of healthcare system?
1. (a)
  Socialized
2. (b)
  Universal
3. (c)
  Medicare
4. (d)
  Medicaid
8.
From which type of perspective in most parts of the world has been the inclusion of LGBT persons in health and well-being initiatives?
1. (a)
  Illness based
2. (b)
  One-dimensional
3. (c)
  Oppressive analysis
4. (d)
  All of the above
5. (e)
  None of the above
9.
Which of the following is a criticism of the comprehensiveness of the Affordable Care Act for LGBT persons?
1. (a)
  Fails to remedy the stigma that results in lower quality care
2. (b)
  Discourages improved data collection to better identify and address health disparities
3. (c)
  Decreases access to free wellness checkups and prevention services
4. (d)
  Fails to crack down on frivolous cancellations of policies
10.
Which of the following statements most accurately reflect the government and service providers’ data collection on the health of LGBT persons?
1. (a)
  They collect data every 10 years with the Census
2. (b)
  They rarely track health data
3. (c)
  They will violate HIPPA in so doing
4. (d)
  They prioritize type of data collected

Key

1-b
2-c
3-d
4-c
5-a
6-c
7-b
8-d
9-a
10-b

Resources

Advancing Effective Communication, Cultural Competence, and patient-and-Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community: A Field Guide (The Joint Commission): http://www.jointcommission.org/assets/1/18/LGBTFieldGuide.pdf

Affirmative Care for Transgender and Gender Non-Conforming People: Best Practices for Front-line Health Care staff: http://www.lgbthealtheducation.org/wp-content/uploads.13-017_TransBestPracticesforFrontlineStaff_v9_04-30-13.pdf

Agency for Healthcare Research and Quality: www.ahrq.gov/

Center for American Progress- The Affordable Care Act and LGBT Families: Everything You Need to Know: www.fafilyequality.org/_asset/5gqpft/FEC-CAP-LGBT-AVA-Families-Guide.pdf

Do Ask, Do Tell: Talking to your provider about being LGBT: http://www.lgbthealtheducation.org/wp-content/uploads/COM13-067_LGBTHAWbrochure_v4.pdf

Fenway Health/National LGBT Health Education Center: www.lgbthealtheducation.org

LGBT Training Curricula for Behavioral Health and Primary Care Practitioners: www.hrsa.gov/LGBT/lgbtcurricula.pdf

Medicare.org: www.medicare.org

National Resource Center on LGBT Aging: www.lgbtagingcenter.org

Optimizing LGBT Health Under the Affordable Care Act: Strategies for Health Centers: http://www.lgbthealtheducation.org/wp-content/uploads/Brief-Optimizing-LGBT-Health-Under-ACA-FINAL-12-06-2013.pdf

Rainbow Health Ontario (RHO): www.rainbowhealthontario.ca

The ACA and LGBT Older Adults Discussion Guide: www.issues.com/lgbtagingcenter/doc/affordablecareactandlgbtolderadults

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Harley, D.A. (2016). Impact of Healthcare Reform on LGBT Elders. In: Harley, D., Teaster, P. (eds) Handbook of LGBT Elders. Springer, Cham. https://doi.org/10.1007/978-3-319-03623-6_19

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DOI: https://doi.org/10.1007/978-3-319-03623-6_19
Published: 06 August 2015
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-03622-9
Online ISBN: 978-3-319-03623-6
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