LESBIAN, GAY, BISEXUAL AND TR ANSGENDER ADULTS in California face significant barriers in accessing health care, despite having similar or better rates of health-insurance coverage than heterosexual or cisgender adults, a new UCLA report shows. These barriers include a lack of timely access to needed care, not having a usual source of care, having trouble finding providers and experiencing unfair treatment, according to researchers from UCLA’s Center for Health Policy Research and the Williams Institute in the UCLA School of Law.
Using data f rom the center’s California Health Interview Survey from 2015 to 2020, the researchers tracked health care access and insurance coverage by sexual orientation and gender identity. They found that bisexual men and women were the most likely of all groups to report not having a usual source of health care (27% and 24%, respectively), and that rates of delaying or not getting needed medical care were considerably higher among bisexual women (33%) and lesbian women (23%) than among straight women (16%).
The study also found that transgender adults experienced greater barriers to care than cisgender adults — those whose gender identity matches the sex they were assigned at birth — in a number of areas. Rates of delaying or not getting needed medical care, for example, were more than twice as high among transgender adults (33%) as among cisgender adults (14%).
“These findings emphasize the importance of looking more closely at differences within LGBT populations so that actions may be taken to close gaps in health care access and improve health outcomes for sexual and gender minorities,” says Susan Babey, PhD, codirector of the center’s chronic-disease program and an associate researcher in the UCLA Fielding School of Public Health.
Bisexual women (20%) were twice as likely as straight women (11%) to report having trouble finding a medical specialist. Bisexual men (22%) and gay men (18%) had higher rates than straight men (12%) of delaying or not getting needed medica l ca re. Transgender adults (37%) were more likely than cisgender adults (21%) to have Medi-Cal or other public insurance. They also were more likely than cisgender adults to report not having a preventive-care visit in the past year (39% vs. 28%) and to having trouble finding a specialist (29% vs. 11%).
Among transgender adults, transportation problems and insurance not being accepted or not covering care were cited as the main reasons for delaying or not getting needed care, the researchers say.
Members of the LGBT community were also more likely to experience unfair treatment when getting medical care, with higher rates of lesbian women (44%), bisexual women (45%) and gay men (32%) reporting such experiences than straight women (32%) and men (23%). Previous negative experiences or discrimination may add to some of the barriers reported by LGBT adults, the study authors note. “The report provides further evidence that barriers remain to receiving gender- affirming care, and continued advocacy and support is needed to increase access,” says Jody Herman, PhD, Reid Rasmussen Senior Scholar of Public Policy at the Williams Institute. — Elaiza Torralba
“Gaps in Health Care Access and Health Insurance Among LGBT Populations in California,” UCLA Center for Health Policy Brief, February 2022