Primary Submission Category: Health equity
Changes in Sexual Orientation and Gender Identity Disparities in Access to Care and Health at Age 65
Authors: Kyle Gavulic Jacob Wallace
Presenting Author: Kyle Gavulic*
Background Although access and health disparities are widely documented among LGBTQ populations, there is limited knowledge of the benefits of Medicare eligibility for LGBTQ versus cisgender, heterosexual people. Recognizing the inequities faced by LGBTQ populations, in 2023, the Biden Administration published the first federal evidence agenda to advance LGBTQ equity. Given the knowledge gaps, we aimed to assess whether aging into Medicare at 65 years is associated with a narrowing of access and health disparities among LGBTQ versus cisgender, heterosexual US adults.
Methods We used data from the 2014-2021 Behavioral Risk Factor Surveillance System. To compare disparities in access and health by sexual orientation and gender identity before and after 65, we performed regression discontinuity analyses for insurance, access, and health status outcomes.
Results At age 65, we found that the share of people with insurance coverage and a usual source of care increased more for heterosexual respondents than sexual minority (SM) respondents, widening the disparities that existed below 65 for both outcomes. While Medicare was associated with small reductions in disparities in cost barriers to accessing care and in self-reported health status, SM individuals were not able to close the gap on either of these measures. Relative to cisgender people, gender minorities (GM) had worse access to care and health status, as well as a slightly lower share of insurance coverage under age 65. Medicare was associated with GMs attaining the level of health insurance coverage of cisgender people, and a narrowing of the disparity in having a usual source of care.
Conclusions Medicare eligibility at age 65 was associated with smaller gains in several coverage and access outcomes for sexual and gender minorities relative to heterosexual and cisgender people. These results highlight the importance of looking behind coverage expansion when aiming to root out inequities in the US healthcare system.