Respond to each classmate post with respect 100 words APA format and in cite text. Use at least 1 peer reviewed journal as references.

Patricia

According to Fredriksen-Goldsen and Espinoza (2014), “LGBT older adults are restricted from full participation in many societal institutions, though the number of states that have legalized same-sex marriage continues to grow at a rapid rate. Currently, more than thirty states and the District of Columbia grant same-sex marriages, with legislation pending in all other states” (p. 97-98). In fact, “the 2013 Windsor v. United States ruling was contradictory, because it extended federal benefits to LGBT adults in legally recognized same-sex marriages; then

it recognized the right of states to not allow same-sex marriage; and to refuse recognition of

marriages performed in states where they are legal” (Fredriksen-Goldsen & Espinoza, 2014, p. 98).

To assist with discrimination, “the Affordable Care Act (ACA) prohibits health insurers from denying coverage or charging higher premiums based on a person’s sexual orientation or gender identity, or a pre-existing condition, such as HIV status, which disproportionately affects LGBT people” (Fredriksen-Goldsen & Espinoza, 2014, p. 99). Many efforts in this area have focused on ensuring that LGBT individuals can fully realize the promise of the ACA (Advancing LGBT health and well-being: 2016 report of the HHS LGBT policy coordinating committee, 2016). For example, CMS provides LGBT cultural competency training for Marketplace-approved assisters in federally-facilitated Marketplaces and is working to ensure that LGBT content is integrated throughout the training used for Marketplace consumer support, and SAMHSA published an ACA LGBT Enrollment Toolkit to assist behavioral health providers in enrolling LGBT individuals (Advancing LGBT health and well-being: 2016 report of the HHS LGBT policy coordinating committee, 2016).

There are different reasons to participate in counseling sessions. Some individuals seek counseling prior to surgery because they want to express their feelings to someone who would listen without judgement. Others seek therapy because they are not sure if it’s the decision for surgery is what they really want. In my opinion, counseling is a good thing but the ultimate decision for gender reassignment should be the individual and not the therapist. When a trans person decides to pursue gender reassignment surgery, they are often required to have a mental health evaluation and a letter of support written before receiving hormones or being evaluated for surgery (Murphy, 2015). Coughlin describes this as playing the role of gatekeeper or being the one with the power to determine if the client gets to live an authentic life (Murphy, 2015). Even though these groups are being suppressed and discriminated, I believe that they should not be singled out and become a protected class under law. To promote equality, the law should mandate that they have the same health care privileges.

References

Advancing LGBT health and well-being: 2016 report of the HHS LGBT policy coordinating committee. (2016). Retrieved from U.S. Department of Health & Human Services: https://www.hhs.gov/programs/topic-sites/lgbt/repo…

Fredriksen-Goldsen, K., & Espinoza, R. (2014). Time for transformation: Public policy must change to achieve health equity for LGBT older adults. Generations, 38(4), 97-106. Retrieved from https://prx-herzing.lirn.net/login?url=https://sea…

Murphy, S. N. (2015). Partners in transition. Retrieved from Counseling Today: https://ct.counseling.org/2015/01/partners-in-tran…

DQ7

Karen’s response

What will be the impact of state policy choices on access and coverage?

A key outstanding issue in assessing the impact of these policy changes is the wide variation in state policy choices, particularly regarding Medicaid expansion and recognition of same sex marriage. Because about half the states do not plan to expand Medicaid at this time, the estimated number of LGBT uninsured adults who will qualify for new coverage is much less than originally expected and many will find themselves in a “coverage gap” – not eligible for Medicaid but too poor to qualify for subsidized coverage in state insurance Marketplaces. Additionally, while the DOMA ruling resulted in federal recognition of same-sex marriages, most states still do not recognize same-sex marriage, which limits the availability of dependent coverage for same-sex spouses in the private insurance market. Despite the potential of the ACA and the Supreme Court ruling to broaden coverage, the impact will be uneven across the country, and raises concern that many LGBT people will remain uninsured (Kates & Ranji, 2014).

How will new protections against discrimination be translated into practice and where do gaps remain?

The ACA’s nondiscrimination protections and insurance reforms broaden LGBT individuals’ access to the insurance market as well as the practice setting. Plans can no longer refuse coverage based on pre-existing conditions, such as HIV, substance abuse or a transgender medical history. The ACA and other federal regulations also provide new non-discrimination protections based on sex, defined to include gender identity and sex stereotypes, in any health program receiving federal funds (such as Medicaid and Medicare), and extend this to include sexual orientation in state marketplaces. In addition, virtually all hospitals and long-term care facilities must guarantee visitation rights to same-sex partners. As important as these protections are, however, they are uneven and do not affect other policies in place, such as the fact that in most states employers can still fire, and thus effectively end health coverage to, an employee because she is LGBT. In addition, as currently interpreted, federal regulations do not prohibit discrimination based on sexual orientation outside of state marketplaces, where many lesbian and gay individuals will continue to get their care and coverage. Beyond these issues, questions remain regarding how providers, payers, and policymakers will utilize these protections to promote access to care (Kates & Ranji, 2014).

Now that gay marriage is legal in most states, is the more conservative institution of healthcare positioned for this change?

In a 2011 report by the Institute of Medicine on the health of LGBT persons identified substantial disparities in health and access to health care for sexual and gender minorities. Many LGBT people of all ages report worse physical and mental health outcomes than heterosexual and non-transgender populations, largely because of the stress caused by being a member of a stigmatized minority group or because of discrimination due to sexual orientation or gender nonconformity. Discriminatory environments and public policies stigmatize LGBT people and engender feelings of rejection, shame, and low self-esteem, which can negatively affect people’s health-related behavior as well as their mental health. LGBT people living in states that ban same-sex marriage, for instance, are more likely than their counterparts in other states to report symptoms of depression, anxiety, and alcohol use disorder (Gonzalez, 2014).

Should this group become a protected class under law?

The ACLU Lesbian Gay Bisexual Transgender Project seeks to create a just society for all LGBT people regardless of race or income. Through litigation, lobbying, public education, and organizing, we work to build a country where our communities can live openly without discrimination and enjoy equal rights, personal autonomy, and freedom of expression and association (LGBT Rights, 2017).

Currently, there is no federal law that explicitly prohibits discrimination against lesbian, gay, bisexual, and transgender (LGBT) people. Title VII of the Civil Rights Act of 1964 outlaws hiring or employment discrimination based on the employee’s “race, color, religion, sex, or national origin,” but does not mention sexual orientation, much less gender identity. Attempts to amend Title VII or to enact new, freestanding federal legislation to prohibit discrimination due to sexual orientation go back almost thirty years. The first such attempt—to add the phrase “affectional or sexual preference”—was made in 1975. Civil Rights Amendments Act of 1975, H.R. 166, 94th Cong. (1975). To date, however, all such legislative attempts have been unsuccessful. No bill specifically prohibiting employment discrimination based on gender identity has been introduced on the federal level (Joslin, 2004).

References

Gonzalez, G. (2014, April 10). Same-Sex Marriage — A Prescription for Better Health. The New England Journal of Medicine, 370, 1373-1376. doi:10.1056/NEJMp1400254

Joslin, C. (2004, Summer). Protection for Lesbian, Gay, Bisexual, and Transgender Employees Under Title VII of the 1964 Civil Rights Act. American Bar Association, 31(3). Retrieved from https://www.americanbar.org/publications/human_rig…

Kates, J., & Ranji, U. (2014, Feb 21). Health Care Access and Coverage for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community in the United States: Opportunities and Challenges in a New Era. Retrieved from Kaiser Family Foundation website: https://www.kff.org/disparities-policy/perspective…

LGBT Rights. (2017). Retrieved from ACLU website: https://www.aclu.org/issues/lgbt-rights#current

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