The House has voted to pass the Democrat led health-care reform bill, but what will the bill do to change disparities in health care coverage for lesbian, gay, bisexual and transgender (LGBT) Americans? Will the Defense of Marriage Act mean that, yet again, LGBTs are denied their full rights, even in health care? And how does the Senate version of the bill compare?
The LGBT Friendly Provisions of the House Health Care Bill
The bill, called the Affordable Health Care for America Act (H.R. 3962), passed the House on Saturday with a vote of 220-215. The bill tackles specific areas in which LGBT Americans suffer disparities in tax and health care implementation under the current health care structure, and attempts to change them.
Here are six things the health care bill does for LGBTs:
However, there is a potential problem with H.R. 3962.
The Defense of Marriage Act and the Problem of Interpretation
It is clear that the health care reform bill attempts to be inclusive. However, it has been constructed from language, that, because of the Defense of Marriage Act (DOMA), could be interpreted so as to leave out LGBTs in several sections.
Simply put, DOMA prevents the federal government from recognizing same-sex marriages. With this in mind, the health care reform bill’s reliance on terms such as “spouse”, “dependent” and “family” become problematic.
Brian Moulton, chief legislative counsel to the gay rights group the Human Rights Campaign, commented:
“Certainly, there is some use of the term ‘spouse’ in the bill in some of the provisions, and certainly DOMA would control that definition of spouse… I think there are some areas where there’s a potential there won’t be access to some of the benefits… I wouldn’t say it’s conclusive because I don’t know how the term ‘families’ and ‘dependent’ are actually going to end up being defined.”
“H.R. 3962, Affordable Health Care for America Act, does have the potential to interact with DOMA and affect the LGBT community… Whether that is positive or negative, however, depends almost entirely on the administration.”
It would seem redundant to incorporate LGBT specific provisions in the bill only to have them undercut by DOMA, but the issue remains a matter of the administration’s interpretation, unless someone intervenes before the bill’s passage (see below).
The Senate Version of the Health Care Reform Bill
Currently, the U.S. Senate version of the Affordable Health Care for America Act has the same problem as H.R. 3962 when it comes to a possible conflict with DOMA.
This problem is compounded by the fact that the Senate version of the bill has none of the LGBT inclusive provisions added to it that the House version of the health care reform bill includes (which was done by merging several bills into the Affordable Health Care for America Act).
There is a separate bill in the Senate at the moment similar to the Tax Equity for Health Plan Beneficiaries Act which would serve to iron out some of the inequality in how domestic partners are treated in terms of health care coverage, but this does not contain such provisions as ending discrimination in health care on the basis of sexuality or gender identity.
That said, Sen. Olympia Snowe (R-Maine) did introduce an amendment during the Senate Finance Committee debate that would allow for HIV/AIDS claimants to receive prescription drugs under Medicaid Part D.
I wouldn’t expect any gay rights/LGBT themed amendments to be made to the Senate version of the bill when it is brought to the floor, simply because there aren’t any other LGBT friendly health care bills currently in the Senate to borrow from in order to add language to the Affordable Health Care for America Act. Besides, doing so at this stage would most probably increase resistance to the overall health care reform package.
The greater hope is that the LGBT friendly provisions in the House version of the Affordable Health Care for America Act will be preserved when the bill goes to conference, where the House and Senate versions of the bill will be combined.
The Stupak amendment – as unnecessary and potentially dangerous for women’s rights as it is – may help in this instance for the simple reason that debate over health care reform and abortion rights will take attention away from the LGBT provisions of the bill, a need that is lamentable but real.
In my opinion, the greatest danger to the act’s LGBT provisions is that conservatives will call for an amendment to the bill’s definitions of “marriage” and “spouse” so as to reinforce DOMA’s restrictions on federal health care benefits for domestic partnerships and civil unions, ensuring that they aren’t treated the same as a federally defined marriage.
That said, no one voiced particular objections to the Affordable Health Care for America Act’s LGBT friendly provisions during the House debate. This does serve to show, however, the pressing need to repeal the Defense of Marriage Act so as to ensure that inequalities such as this do not persist.
In related news, the American Medical Association has ruled that both DOMA and the military ban on lesbian and gay service personnel being open about their sexuality, called the Don’t Ask, Don’t Tell policy, is detrimental to the health of LGBTs, adding more weight to the argument for both to be repealed.
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