Given the myriad boons to gay rights we’ve seen this decade, it’s easy to overlook the fact that the Affordable Care Act is brimming with new regulations that directly benefit LGBTQ Americans. Indeed, I consider it to be one of the most important pieces of gay rights legislation ever passed. The blessings of the ACA might seem minor in light of the demise of both DOMA and “don’t ask, don’t tell.” But in the long run, I suspect more LGBTQ Americans will be aided by the ACA than by federal marriage equality or open military service.
A new story out of Florida further confirms my suspicion. The Huffington Post reports that two Florida insurance companies are under fire for discriminating against patients with HIV, slapping them with a 40 percent co-pay on each of their HIV drugs, plus a $1,000 deductible per drug per month. (The new regulations limit co-pays to $10, though insurance companies have long endeavored to work around that restriction.) Given the complex cocktail of drugs HIV patients must take, this would quickly bankrupt many patients—and often did in the dark days before Obamacare. Back then, people with HIV were lucky to have insurance at all; the virus was considered a pre-existing condition, and HIV-positive people were frequently denied coverage or dropped from their plans without warning. (Federal programs were left to pick up the slack.) Those with insurance regularly bumped against lifetime and annual limits. Thanks to the ACA, all of that is forbidden. And since HIV still disproportionately targets gay Americans, these regulations translate into a huge gift to the community.
But the perks don’t stop there. The ACA also imposes a strict nondiscrimination policy on the entire health care system—a policy that explicitly protects gay and trans Americans. All insurers, public and private, are forbidden from discriminating against patients due to sexual orientation or gender identity. The act also requires insurance companies to provide coverage to same-sex spouses and their families where they offer such coverage to opposite-sex spouses. (Expect a Hobby Lobby-type challenge to that rule; no doubt some insurance companies believe providing health care to gay families healthy violates their religious beliefs.)
These are deeply important regulations—and they’re really just the beginning. Once the Obamacare-funded collection of data on LGBTQ health care disparities is complete, the Department of Health and Human Services can introduce more guidelines to ensure that gay and trans Americans get access to the treatment and care they need. (Under President Barack Obama, HHS has consistently favored pro-LGBTQ policies; on Friday, it opened the door to Medicare funding for sex reassignment surgery.) What’s more, Obamacare’s Medicaid expansion—defanged by the Supreme Court and stymied in many red states—will help countless impoverished LGBTQ people get health care access for the first time. (For complex reasons, poverty disproportionately affects gay and trans Americans.) A number of other ACA reforms, like better access to treatments for smoking cessation and depression, will also have an inordinately positive impact on the LGBTQ community.
Independently, none of these regulations is as profound or sweeping as marriage equality or open service. Taken together, however, they’ll vastly improve—and, sometimes, save—the lives of gay and trans people. Our health care system still discriminates against LGBTQ Americans in systemic and insidious ways, as the current Florida controversy illustrates. That isn’t going to stop with the stroke of Obama’s pen. The battle for equal treatment will continue—but at least this time around, the law is on our side.