By Sarah Mapes
Recently, the rights of lesbian, gay, bisexual, and transgender (LGBT) Coloradans have been a major political issue nationally as well as locally. This legislative session, the passage of Senate Bill 13-011legalized civil unions for same-sex couples in Colorado after many prior attempts. In addition, the Division of Insurance made changes to current regulations to prohibit discrimination based on sexual orientation. As we celebrate LGBT Pride Month in June, there are many more new opportunities for Colorados LGBT community than in years past. However, there is still much work to be done to ensure that LGBT Coloradans have access to the care they need to get and stay healthy.
It is estimated that around 135,000 Coloradans identify as LGBTor 2.6 percent of the total state population. That places Colorado below the national average of 3.5 percent.
Due to a number of social and cultural factors, LGBT Coloradans are at a higher risk of poor health. Data show that those who identify as LGBT are more likely to have low incomes, low educational attainment and be unemployed. In fact, LGBT Coloradans are nearly twice as likely to earn less than $35,000 annually and more than twice as likely to be unemployed compared to heterosexual Coloradans. Research has shown that our health is significantly affected by social conditions such as these, so it is not surprising that 21 percent of LGBT Coloradans are in fair or poor health, compared to 12 percent of heterosexual Coloradans.
Compounding the problem, access to care is more difficult for LGBT individuals and families. Being uninsured is one major barrier to accessing care. While 18 percent of heterosexual Coloradans lack coverage, 23 percent of lesbian, gay and bisexual Coloradans are uninsured; the group most likely to be uninsured is that of transgender Coloradans, with 43 percent lacking coverage.
LGBT Coloradans are also far more likely to delay or forgo care, not get needed prescription medicine and rely on the emergency room for health care services. The reasons for these access issues vary, but are primarily related to both cost and concern that their sexual orientation will affect their coverage and care.
Additionally, LGBT families with and without children may not be able to access some rights related to health care, such as designated beneficiary agreements or medical power of attorney, without legal action. Three out of four LGBT Coloradans view the financial burden of legal fees as a barrier to health care services.
The expansion of Medicaid to Coloradans below 100 percent of the federal poverty level and the new Connect for Health Colorado health insurance marketplace will both improve the coverage options available to LGBT Coloradans; we will need to ensure we are also increasing access to care by minimizing social, cultural, and legal barriers.
Unfortunately, even with full coverage and the affordability and availability of health care services, LGBT Coloradans still may struggle to find culturally-sensitive care.
Over one-fifth of LGBT Coloradans and over half of transgender Coloradans report that health care workers have refused services to LGBT people. In fact, many LGBT Coloradans are not open with their health care providers about their sexual orientation or gender expression because they are concerned their provider will not be supportive or understand their unique health care needs.
The available data show that LGBT Coloradans who perceive their provider to be LGBT-friendly are more likely to have annual check-ups, flu shots and other preventive care; therefore, increasing the number and availability of LGBT-friendly providers across the state will be key to improving the health of the LGBT community.
With the unique challenges LGBT Coloradans face in getting access to health care, it is important that we broaden our idea of what we think of as barriers to care to ensure we are not leaving any groups out of our health systems change work. Together, we can ensure that the social and cultural factors that affect the ability of Colorados lesbian, gay, bisexual and transgender residents to get and stay healthy are minimized, and that all Coloradans can access the care they need, when they need it.
Access the full CCMU infographic on Colorados LGBT population at www.ccmu.org/LGBT.
Sarah Mapes is the director of communications at the Colorado Coalition for the Medically Underserved.