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Jul 24, 2014

Equality NC Contributes to New Report on LGBT Health Care Needs Under the Affordable Care Act

Washington, DC, July 24, 2014 — Equality NC is featured in a new report released today from Out2Enroll, a nationwide campaign dedicated to connecting LGBT people with their health coverage options, that outlines lessons from LGBT outreach and education surrounding new health care options under the Affordable Care Act (ACA). The organization shared valuable insights, reviewed findings, and contributed thoughtful commentary on effective strategies for ensuring that the benefits of health reform reach LGBT communities across the country.

The ACA's initial open enrollment period offered significant opportunities to reach lesbian, gay, bisexual, and transgender (LGBT) consumers, but the visibility and effectiveness of these efforts varied significantly by state. According to the Out2Enroll report, variation largely resulted from the level of formal marketplace commitment to LGBT inclusion and the extent to which LGBT community and allied organizations were able to participate in the health reform effort.

The report, "Key Lessons for LGBT Outreach and Enrollment under the Affordable Care Act," is being released in conjunction with a White House briefing on July 24, 2014. As part of the launch, Equality NC's Chris Sgro will appear on a White House panel to present key lessons learned from the organization's work on the ground in North Carolina.

FULL REPORT: http://www.out2enroll.org/key-lessons-for-lgbt- outreach-enrollment/.

Because of the current inequitable patchwork of marriage equality and relationship recognition laws across the United States, some legally married same-sex couples have faced barriers to enrolling in family coverage. As outlines in the report, the issue was first raised in North Carolina after a same-sex couple was told that the family policy they had purchased together through the marketplace was invalid because the policy’s definition of “spouse” did not include same-sex couples.

Equality NC and key local partners helped elevate this issue and the insurance carrier eventually decided to cover legally married same- sex couples. The issue received attention in national media outlets such as the Washington Post and LGBT-specific publications such as the Advocate. In response, HHS issued guidance in Spring 2014 requiring insurers in every state to make spousal coverage equally available to same-sex and different-sex spouses starting on January 1, 2015.

Specifically, Equality NC connected the LGBT community with assisters across the state, including in conservative rural areas, and distributed health reform information at its community events. The organization also took to Twitter in early 2014 to highlight insurance discrimination that was preventing same-sex couples from enrolling in family coverage through the marketplace. Through these efforts, the state’s largest insurer reversed its policies and covered same-sex couples. Similar tactics were then used to secure changes in coverage in states across the country.

"We are particularly proud to be cited in this new report that shows how North Carolina's LGBT community took the lead in helping extend coverage to its own, and, in doing so, contributed to positive change for the nation's LGBT populations as a whole," said Chris Sgro. "It is heartening to know that what began here in North Carolina with our fight for family health coverage for same-sex couples, not only spread to places like Ohio and Pennsylvania, where insurance companies also changed their policies to make coverage more fair and equitable, but also catalyzed clarifications in ACA policy on the federal level as well. I'm thrilled Equality NC could play a part."

Overall, the report found that effective efforts to reach LGBT communities included:

  • Development of LGBT-specific messaging and education materials;
  • Targeted efforts to engage LGBT people via outreach and enrollment events; and
  • A consistent presence at LGBT community venues.

The report also concludes that LGBT outreach was complicated in many states by uncertainty surrounding outstanding policy issues. Specifically, stakeholders in a variety of states reported significant confusion about:

  • Relationship recognition, including the treatment of legally married same-sex spouses, domestic partners, and people in civil unions;
  • Transgender health needs, including the continued prevalence of transgender-specific insurance exclusions;
  • Discriminatory practices, including insurance carrier practices that discourage enrollment of those with chronic conditions such as HIV; and
  • Plan transparency, including the lack of accessible information providing adequate details on coverage limitations.

Some state-based marketplaces, for example, clearly identified LGBT communities as an underserved population, engaged LGBT organizations in conducting outreach and enrollment, and included LGBT families in marketplace advertisements. In states with a federal marketplace, some state assister coalitions directly included LGBT organizations, and others made specific efforts to engage trusted LGBT organizations to promote outreach and enrollment.

“Given the significant health disparities that affect the LGBT population—and the fact that one in three low- and middle-income LGBT people were uninsured in 2013—efforts to engage LGBT communities are critical,” said Out2Enroll Steering Committee Member Kellan Baker. “We are encouraged to see the creative and innovative ways that stakeholders across the country are working to reach LGBT people.”

According to the report, federal and state officials have taken steps to address some—but not all—of these issues. “LGBT consumers continue to raise concerns about issues such as discriminatory coverage practices and the need to understand the plans they are purchasing through the marketplace,” said Out2Enroll Steering Committee Member Katie Keith. “Resolving these issues should be a priority for state and federal officials to help ensure that the Affordable Care Act meets the needs of LGBT communities.”

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