HHS makes it easier for domestic partners

... but more must be done to promote equal access to health insurance for gay, transgender populations

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  • By
  • LGBT Health Care Analyst, Center for American Progress
  • February 12, 2012
same sex health coverage

A HealthCare.gov update makes it easier to find health plans on the non-group market that offer coverage for domestic partners. It’s a great step forward.

Consumers are now able to search for insurance plans offering domestic partner coverage on HealthCare.gov, the one-stop shop maintained by the Department of Health and Human Services for all things related to health care reform.
The web site, which was one of the consumer-friendly reforms required by the Affordable Care Act, includes a Health Plan Finder tool that allows consumers shopping for coverage to compare plan details such as cost sharing, enrollment, and benefit design in order to choose the option that best meets their needs. The new filter helps same-sex couples, many of whom do not have access to health insurance through their own or their partner’s employer, find plans in the non-group market that offer coverage for domestic partners.

Small businesses can also use the filter to search for coverage for their employees. According to a recent study, 51 percent of small businesses currently offer equal benefits to employees with same-sex partners or spouses, and 50 percent of those who do not say they would like to offer such benefits in the future. HealthCare.gov now links these employers with an easily searchable menu of options for providing the families of their gay employees with affordable coverage.

employers and insurers: take note.

More employers should take note. The majority of Americans with private insurance receive coverage through their own or their spouse’s employer. Companies that do not extend benefits to the families of employees with same-sex spouses or partners are increasingly uncompetitive against companies with broad diversity policies and inclusive benefits packages. Fundamentally, policies that promote a diverse workforce are good for the bottom line: they maximize the talent in the hiring pool and help retain happier, healthier, and more productive employees.

Insurers should also take note. A healthy, middle-aged man living in Kansas City, Missouri who needs to buy health insurance has 72 options available on HealthCare.gov. Using the filter for same-sex partner coverage slashes that number by almost 80 percent, to only 17 plans. As insurance market reforms under the Affordable Care Act kick into high gear over the next several years, it will become increasingly unacceptable to leave same-sex spouses and domestic partners out in the cold without access to affordable coverage through the individual market.

According to Health and Human Services Secretary Kathleen Sebelius, the web site update is part of her department’s commitment to be more responsive to the needs of gay and transgender people and their families. In a memo released last spring, the department committed itself to making the change as part of a list of recommended actions to improve gay and transgender health.

web site update is only one step

As important as this change is for addressing disparities in health insurance coverage for same-sex couples and advancing a shift in the perception of domestic partner benefits from fringe to mainstream, there is much more that must be done to promote equal access to affordable, comprehensive insurance coverage for gay and transgender people.

In particular, HealthCare.gov does not yet incorporate a filter allowing consumers and employers to search for plans that do not target transgender people with arbitrary and discriminatory coverage exclusions. Such exclusions, which specifically exclude coverage for services rendered to transgender people, are frequently interpreted to deny coverage to transgender people for a wide range of medically necessary health care services, including many that are routinely covered for non-transgender people.

Right now the vast majority of private insurance plans sold in the U.S. incorporate such exclusions. However, a sea change driven by the same kind of employer commitment that is driving the broader adoption of domestic partner benefits is also happening for transgender-inclusive policies. According to the 2012 Corporate Equality Index, which tracks employee benefits at hundreds of major companies, more than 20 percent of Fortune 1000 companies now offer fully inclusive health insurance policies for their transgender employees.

Alongside the updated filter showing options for domestic partners, HealthCare.gov now incorporates numerous other filters showing benefits for services such as home health services, in- and out-patient rehabilitation services, skilled nursing facilities, hospice services, dental care, infertility treatments and weight loss programs. Adding information pointing out plans that contain unfair and clinically unsound exclusions targeting transgender people will go a long way toward driving these exclusions out of the market. HealthCare.gov should not just follow trends in the health insurance market – it should help set them.


Kellan Baker is a Health Policy Analyst with the LGBT Research and Communications Project at the Center for American Progress, where his work includes strategically advocating for LGBT inclusion in the implementation of the Affordable Care Act, improving data collection on LGBT health and health disparities, and working with the Department of Health and Human Services on a broad range of LGBT health issues.