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LGBT health experts: High stakes at High Court

The Affordable Care Act, if it stands a Supreme Court test, will help close the health care gap for LGBT Americans, say health experts who closely monitored the top court’s three days of arguments over the controversial legislation.

The Court arguments, held March 26-28, occurred nearly two years to the day after President Barack Obama signed his landmark legislation into law. Almost immediately after the White House signing, a series of constitutional challenges were filed.

The central component of the law now being examined by the Court is the so-called individual mandate, which will require that uninsured people purchase health coverage – with government help for those who can’t afford the premiums. The Court question: Does the U.S. Constitution allow the government to require Americans to obtain insurance or pay a penalty?

The Court also is exploring whether, with an expansion of Medicaid, the federal government is unconstitutionally forcing states to spend more on health care for the poor. And the Court has heard arguments on the fate of the act if its key components are struck down.

Outside the Court building, demonstrators talked about “Obamacare” derisively and admiringly, depending on their political persuasion.

Court experts speculated that the decision likely will hinge on Republican appointees John Roberts and Anthony Kennedy, who showed strong reservations about the mandate during arguments.

A ruling from the Justices is expected in June, coming just before their summer recess and guaranteeing that health care reform, a central issue in the 2008 election, will be key to the 2012 election. The decision also likely will spark a debate over the composition of the Supreme Court.

The Court arguments over ACA coincided with the 10th annual observance of the National Coalition for LGBT Health’s LGBT Health Awareness Week, which traditionally yields studies, lectures, seminars and campaigns focused on the unique health needs of LGBT people and disparities in care. This year, the week focused on the ACA and its impact on LGBT citizens.

In observing the week, U.S. Health and Human Services Secretary Kathleen Sebelius said, “When this administration took office, the health care system wasn’t working for a lot of Americans. But it was especially broken for LGBT Americans. That wasn’t right. All Americans, regardless of where they live or their age, sex, race, sexual orientation or gender identity, have a basic right to get the care they need.”

The Affordable Care Act provides for:

• A National Prevention Strategy that says, “All Americans should have the opportunity to live long, healthy, independent, and productive lives, regardless of their … sexual orientation or gender identity; geographic location; or other characteristics.”

• Data collection, beginning in 2013, to better understand LGBT health disparities.

• A Patient’s Bill of Rights to end insurance company abuses. The law ended lifetime limits on coverage in 2010 and by 2014 will phase out annual limits on coverage, which is seen as critical to quality care for people living with HIV and cancer.

• Expanding Medicaid eligibility so that adults under age 65 and earning less than $15,000 a year become eligible. Studies show that LGBT people, with discrimination in employment and relationship laws, are disproportionately more likely to make less than $15,000 a year and be uninsured.

• Creating a health insurance exchange in 2014 that offers subsidies to small employers and individuals earning $15,000 to $43,000 a year to purchase coverage. The law prohibits discrimination on the basis of sexual orientation and gender identity in coverage and requires that benefits include drugs, hospital stays, mental and behavioral health services.

• Publishing Web-based resources that help same-sex couples find plans that include domestic partner coverage.

• Tripling the size of the health service corps in underserved areas of the country, expanding community health centers and increasing support for LGBT sensitivity training from Health and Human Services.

• Prohibiting, beginning in 2014, insurance companies from denying or canceling coverage on the basis of a pre-existing conditions, including HIV or gender dysphoria.

• Making HIV/AIDS drugs more affordable and eliminating the requirement that people with HIV wait for an AIDS diagnosis before qualifying for Medicaid.

• Prohibiting insurance companies from charging co-pays or other fees for preventive services recommended by a U.S. task force, including testing for HIV and STDs, depression screening, vaccinations, cholesterol and blood-pressure screening.

“The Affordable Care Act is one of the greatest opportunities we have ever had to begin to close the LGBT health disparities gap,” said Jeff Krehely, vice president of LGBT research for the Center for American Progress.

The ACA has “enormous potential to impact the domestic AIDS epidemic,” added Scott Schoettes, HIV project director for Lambda Legal.

In 2010, when the Affordable Care Act was enacted, 17 percent of Americans with HIV/AIDS had private insurance coverage, and nearly 30 percent had neither private nor public insurance. Health experts expect those percentages to go down as the ACA is phased in.

Looking to Massachusetts, where Mitt Romney signed a health reform bill into law that expanded the pool of the insured in part by enacting an individual mandate, the number of uninsured has declined dramatically, along with a decline in HIV infections. Between 2005 and 2008, after Massachusetts enacted its health reform law, the state saw a decrease in HIV infections of 38 percent. At the national level, infections increased 8 percent.

Lambda Legal, a leading LGBT civil rights group, joined with 130 other organizations in filing a friend-of-the-court brief supporting the Affordable Care Act. Others that signed the brief include the AIDS Interfaith Network, National Alliance of State & Territorial AIDS Directors, National Black Women’s HIV/AIDS Network, Queer People’s Health Collective, Racial and Ethnic Health Disparities Coalition and the Gay and Lesbian Medical Association.

The brief supports the administration’s position that the ACA’s minimum coverage requirement – the individual mandate – is constitutional under the Commerce Clause and the Necessary and Proper Clause.

The brief also supports the argument that the individual mandate is necessary because insurers need a larger pool of customers, including young healthy people, in order to spread out risk and cover the sick.

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