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NCLR Responds to Supreme Court Decision Upholding the Affordable Care Act

Statement by NCLR Executive Director Kate Kendel
Today, in a 5-4 decision, the United States Supreme Court upheld the Patient Protection and Affordable Care Act (ACA), and ruled that the individual mandate, which requires most individuals to buy health insurance, is constitutional. The Court upheld the ACA’s expansion of Medicaid eligibility, but also ruled that states that do not comply with the expanded Medicaid provisions cannot be denied existing Medicaid funds.

Today’s decision will have an enormous impact on access to high quality care for lesbian, gay, bisexual, and transgender (LGBT) people and their families. The ACA represents the largest reform to the healthcare system in over 40 years, and the most significant effort ever undertaken to address health disparities for LGBT patients seeking care. The law makes a number of changes designed to increase access to care. These changes, such as covering preventative care and setting a new national threshold for Medicaid eligibility, make it substantially easier for low-income people and people with pre-existing conditions to access care, issues that are crucially important for the LGBT community.

The law includes numerous provisions designed to prevent discrimination in healthcare settings. The state exchanges set up by the ACA—which create a marketplace for people to purchase health insurance—prohibit discrimination based on sexual orientation and gender identity in those exchanges. In addition, the law extends federal nondiscrimination protections to the healthcare system, including protecting people from discrimination based on disability status (including HIV/AIDS status) and discrimination based on sex, which has often been interpreted to include gender identity and gender nonconformity.

In addition to nondiscrimination protections, the ACA also creates services and programs that prioritize issues that are crucial to LGBT people. For example, the ACA grants the Department of Health and Human Services (HHS) the authority to collect data about demographic information for the purposes of targeting health disparities in certain communities. HHS Secretary Kathleen Sebelius has already announced that HHS will exercise its authority under this provision to collect data on sexual orientation and gender identity in addition to the already required categories of race, ethnicity, primary language, sex, and disability status. As Health and Human Services (HHS) Secretary Kathleen Sebelius has stated, “the Affordable Care Act may represent the strongest foundation we have ever created to begin closing LGBT health disparities.”

Importantly, the Supreme Court’s narrow reading of the Medicaid expansion may have an adverse impact on the ability of low-income people to access care, which will disproportionately affect the LGBT community. The ACA’s Medicaid expansion drastically increases the number of low-income individuals eligible to access Medicaid. Without HHS having the ability to compel states to comply with these new provisions, low-income people in states that refuse to participate will face continued barriers to obtaining needed care.

Statement by NCLR Executive Director Kate Kendell, Esq.:

“Today is a banner day for all Americans who care about fixing our broken healthcare system. By upholding the centerpiece of the Affordable Care Act, the Supreme Court has ensured that millions of uninsured people will finally gain access to affordable care and enable the federal government to begin addressing the shameful disparities that lesbian, gay, bisexual, and transgender people face in gaining access to healthcare. At the same time, the Court’s ruling puts the healthcare of low-income people at risk. Much work remains to be done to ensure that all Americans have access to quality care.”

The National Center for Lesbian Rights is a national legal organization committed to advancing the human and civil rights of the lesbian, gay, bisexual, and transgender community through litigation, public policy advocacy, and public education. www.NCLRights.org

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