Health Care, Taxes, and the LGBT Community

This week marks the eighth annual LGBT Health Awareness Week. LGBT people face a host of health care hurdles, from outright bias by medical or insurance personnel to a lack of knowledge about our health risks and needs.

As we begin to assess the implications of the recent health care reforms, however, and head into the final stretch of tax season, it seems appropriate to take a look at the unfair burdens that same-sex couples face when it comes to health insurance.

As Anya Martin of CBS MarketWatch explained in a recent piece, even in states where same-sex couples can marry, employers don’t necessarily have to cover the same-sex spouses of employees. Not only that, but even if they do, employees must pay federal taxes on them as if they were income -- a burden opposite-sex spouses do not share. A measure to change this did not make it into the final package of health care reforms that President Obama just signed. (Martin overlooked one small loophole, which is that if a same-sex partner is a qualifying dependent, the employee does not have to pay taxes on her or his health benefits -- but that doesn’t change the fact that many same-sex couples are unfairly taxed.)

Of course, as Martin noted, only 21 percent of U.S. employers even offer same-sex partner benefits, versus 31 percent that cover unmarried opposite-sex partners. Larger firms and ones in the west and northeast are more likely to offer such benefits, but far from all do so.

Not only that, but many people who need insurance for a same-sex partner hesitate to ask for it because they fear losing their jobs. In 29 states, it is still legal for employers to discriminate against an employee on the basis of sexual orientation. (In an additional nine, it is also legal to discriminate on the basis of gender identity.) Military families are particularly at risk here, because gay and lesbian servicemembers can be dismissed no matter where they are stationed.

Lose a job, because of discrimination or any other reason, and one can choose to have employer-provided health insurance continued for up to 36 months under the federal COBRA program. This covers the former employee and beneficiaries, including opposite-sex spouses -- but not same-sex spouses or partners, even if they had been covered under the employer's plan.

Sen. Barbara Boxer (D-Calif.) last week introduced the “Equal Access to COBRA Act of 2010” (S. 3182), which would provide COBRA benefits to same-sex partners as well. The bill has just been referred to the Senate Committee on Health, Education, Labor, and Pensions. Click here, or use the widget underneath the photo, to send a message to your senators asking them to co-sponsor this legislation, and to vote for it if they are on the committee.

The challenges that LGBT people face in medical care itself is a subject for another piece. Solutions must happen at all levels of the system. It is worth noting, however, that the original House version of the health care reform bill included a ban on discrimination in health care based on sexual orientation and gender identity. It was not part of the final bill.

One bright spot, however, is that the National Academies’ Institute of Medicine (IOM) in early March formed its first-ever committee on LGBT matters, the “Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities.” That’s a start.

Photo credit: House of Sims