Access to Health Care Not Tied to Medicare Expansion in LGBTQ+ Adults

Expansion of Medicare eligibility is associated with improved self-reported health status but not improved health care access among LGBTQ+ adults compared with heterosexual adults, according to study findings published in the Journal of American Medical Association Health Forum.

Individuals who identify as LGBTQ+ have markedly greater financial spending for health care services, larger uninsured rates, and overall reduced health outcomes compared with individuals who identify as heterosexual. Although previous research findings demonstrate an association between improved health care access and the expansion of Medicare eligibility, this association remains unclear among LGBTQ+ adults.

To assess the link between Medicare eligibility and health disparities on the basis of sexual orientation and gender identity, researchers conducted a cross-sectional study using a regression discontinuity design. Data was sourced from the 2014 to 2021 Behavioral Risk Factor Surveillance System, a national survey of US household information on health risks, behaviors, and care.

Individuals aged 51 to 79 years who identified as lesbian, gay, bisexual, another sexual minority identity, and transgender or gender diverse (TGD) were eligible for inclusion. The main outcomes were health insurance coverage, access to health care, and self-reported health status.

The study included a total of 927,952 respondents (mean [SD] age, 64.4 [7.7] years; female, 56.6%; male, 43.4%), of whom 3.03% identified as a sexual minority and 0.35% identified as TGD. The investigators observed no between-group differences in demographic characteristics (with the exception of employment rate) among respondents younger and older than 65 years of age.

Medicare eligibility at 65 years of age was associated with greater improvements in insurance coverage among respondents who identified as heterosexual (percentage-point increase, 4.2; 95% CI, 4.0-4.4) than those who identified as a sexual minority (percentage-point increase, 3.6; 95% CI, 2.3-4.8).

Moreover, individuals aged 65 years and older who identified as heterosexual, compared with a sexual minority, demonstrated greater improvements for access to care, cost barriers, and influenza vaccination rates.

The analysis demonstrated greater improvements in self-reported health for sexual minority respondents (percentage-point increase, 2.6; 95% CI, -0.4 to 5.6) compared with heterosexual respondents (percentage-point increase, 1.1; 95% CI, 0.3-1.9).

Limitations of the study include a lack of generalizability to other measures of insurance coverage and limited statistical power.

“Our findings highlight the possible scope for US federal policy that promote health equity in places where disparities may be tied to harmful state or local policies. These findings also underscore that an expansion of Medicare coverage may be just a first step toward advancing health equity for LGBTQI+ populations, who experience health inequities driven by a broad set of structural factors,” the researchers concluded.

This article originally appeared on Endocrinology Advisor