Medicaid Expansion and LGBT Iowans

Why should you care about the ongoing battle around Medicaid expansion in Iowa? Does it matter whether we go with the Governor's Healthy Iowa Plan, or Medicaid expansion? Let’s look at the facts. 

Did you know that 17 percent of Iowans are enrolled in Medicaid and, of that number, approximately 90 percent are in managed care? The Medicaid expansion would increase the number of those covered by 150,000 Iowans, reaching many more low-income Iowans who need and depend on Medicaid. Additionally, in 2014, Section 1115 of Medicaid increases coverage to those living with HIV or AIDS before they become so sick that they are deemed disabled.

One Iowa is the state's largest lesbian, gay, bisexual and transgender (LGBT) advocacy organization. We look at Medicaid expansion through the lens of what makes sense for our constituencies. 

Medicaid expansion and new guidelines (under 133 percent of the federal poverty line) will add significant numbers to its coverage. So why does this matter to the LGBT community?

According to a recent Willliams Institute report, lesbians and bisexual women report a poverty rate of 24 percent, significantly higher than their heterosexual counterparts. A report by the National Gay & Lesbian Task Force indicates that among the transgender population, individuals making $10,000 or less per year are at twice the national average. Statistics show that only 57 percent of transgender Americans have health insurance, compared with approximately 82 percent of heterosexual adults and 77 percent of LGB adults. And as many as 2 million children living in LGBT families face significant challenges to accessing adequate health care as a result of bias, stigma, and barriers to access.

Another barrier facing the LGBT community, and particularly transgender people, is high rates of unemployment and employment discrimination. Because we still do not have federal protections against discrimination in the workplace, transgender people face higher rates of termination, bias, and harassment, contributing to lower rates of employer-provided health-insurance coverage. Difficulties accessing comprehensive and affordable insurance, and “spend-down restrictions” for gay and lesbian couples compound the problem. These restrictions apply to long-term care Medicaid recipients who, together, must spend down their assets in order to access coverage at a certain level. Heterosexual married couples have enjoyed a much higher spend down threshold meaning that they don’t have spend down to the point of destitution. Under Medicaid expansion rules from the Department of Health and Human Services, states will have the opportunity to address this discrepancy which will have a profound impact on low-income LGBT seniors. Will the Governor’s plan address this discrepancy for legally married gay and lesbian couples in his state?

Long-term care, especially for the elderly, is also of some significance to aging LGBTQ populations, who experience higher than average poverty rates with aging lesbians at 9.1 percent and gay men at 4.9 percent. Family members often provide long-term care, but LGBT elders are up to four times less likely to have children to care for them.

If we are truly committed to creating a healthier Iowa for all people, then I urge you to learn as much as you can—and then voice your opinion. On Tuesday, April 16, you can be heard on this matter. A public hearing on the integrated care models for the delivery of health care is sponsored by the House Appropriations Committee on Tuesday, April 16, 2013, from 5:30 PM – 7:00 PM in the Iowa House of Representatives Chamber at the State Capitol.

Just go to the Legislative Information Office (Room G-16) or call 515-281-5129 to sign up.  If you cannot attend, testimony can be sent to housechiefclerk@legis.iowa.gov and put the word, 'testimony' in the subject line.

Hard-working families, including Iowa’s LGBT families need the security of quality health coverage to get the care they need when they need it without facing huge medical bills. Please take action today.