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Affordable Care Act Improves Health Care Access for Low-Income and LGBT Individuals

July 19, 2013

By: Rick Mula, Task Force Holley Law Fellow

According to a recently released Department of Health and Human Services (HHS) statement, some proposed insurance premiums for 2014 are up to 18% lower than expected. HHS hypothesizes that greater competition and greater transparency as a result of the Affordable Care Act have stimulated lower pricing.

Preliminary premiums may drop even more before health plans are offered this fall in state exchanges, health insurance “supermarkets” where individuals and organizations can apply for and purchase health insurance. In DC, Oregon, Rhode Island, and Vermont, for instance, final rates were significantly below those proposed earlier in the spring.

HHS states that preliminary rates are affordable even for young men, a group that some expected to experience “rate shock.” According to the research brief released by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) of the Department of Health and Human Services (HHS), “In Los Angeles County (the county with the largest number of uninsured Americans in the nation), the lowest cost silver plan in 2014 for a 25-year-old individual costs $174 per month without a tax credit, $34 per month for an individual whose income is $17,235 (or 150% of the Federal Poverty Level), and a catastrophic plan can be purchased for $117 per month for an individual.”

The ASPE’s brief comes on the heels of dramatic health insurance headlines. The New York Times recently reported that regulators in New York have approved rates for 2014 that are at least 50 percent lower on average than those currently available.

The Affordable Care Act’s (ACA) impact on premiums is welcome news for lesbian, gay, bisexual and transgender (LGBT) individuals and their families. The Williams Institute has found that LGBT individuals and families are disproportionately likely to experience poverty. This is especially true for LGBT people of color.

Besides its impact on premiums, the ACA has a number of LGBT-specific components that will help reduce structural barriers to LGBT health care access like a lack of insurance plans that cover same-sex couples. Same-sex couples can now search for health plans that offer coverage for same-sex domestic partners and spouses through the Health Plan Finder tool at www.healthcare.gov.

Here are a few of the other important ways ACA specifically benefits the LGBT community:

  • For the first time, the health care law extends federal non-discrimination protections on the basis of sex to the health care system. The Department of Health and Human Services has clarified that sex-based discrimination protections include protections for lesbian, gay, bisexual and transgender people.
  • Starting in January 2014, each state will have a Health Benefit Exchange (also known as an Exchange or Marketplace), a health insurance “supermarket” where individuals and families can buy quality health care plans at an affordable price.
  • No state’s exchange may discriminate against consumers on the basis of sexual orientation, gender identity, or other factors such as race, ethnicity, primary language or disability.  This includes protections from discrimination in benefit design, enrollment, marketing or any aspect of the exchange.
  • These same protections apply to any plan that is required to meet the “Essential Health Benefits” Standard – a basic minimum list of coverage requirements for most health plans offered in the country.  This means that the ACA has radically changed the way the insurance industry treats LGBT people.
  • Starting in 2014 insurance companies cannot deny health care coverage simply because you have a pre-existing condition, which will ensure that transgender people and people with HIV will be able to get the health care coverage they need.

Because of the Affordable Care Act, insurers have to spend at least 80 percent of premium dollars on actual medical care as opposed to salaries or advertising. Insurance companies that spend more than 20% of premium dollars on administrative costs have to provide rebates to customers. So far, 8.5 million Americans will on average receive $100 in rebates from their insurance companies this summer. And according to the White House, rebates totaled $500 million last year.

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