By Liz Massey, Jan. 1, 2015.

At the beginning of every New Year, much emphasis is placed on self-discipline in the pursuit of body-based goals, such as losing weight, firming up one’s midsection, eating better and so on.

However, when it comes to making strides toward a healthier lifestyle, the recipe for queer resolution-makers can be more complicated than just summoning up enough willpower.

First, there’s a litany of ways in which LGBT people grapple with health conditions at a much higher rate than the general population. The federal government’s Healthy People 2020 site notes that societal stigma and discrimination fuel higher rates of substance abuse, youth suicide, HIV/STD prevalence, and lower rates of receiving preventive screenings for diseases such as cancer among members of the LGBT community.

According to Hector Vargas, executive director of the Gay and Lesbian Medical Association (GLMA), a lack of education among doctors about common health issues in the LGBT community and a lack of familiarity or comfort in dealing with queer people can add up to health care environments being a very challenging place for those who are not straight or cisgendered.

“Health disparities affecting LGBT populations are significant and well documented,” he said. “The research also indicates health care providers often are not equipped or trained about these health concerns for LGBT people. When you add that health care environments are not always welcoming of LGBT people, and in some cases even hostile, you have a significant crisis in health care for LGBT people.”

As challenging as taking good care of oneself can be, help is available. Arizonans are participating in efforts to get LGBT people enrolled in health insurance offered as part of the Affordable Care Act (ACA, also commonly referred to as Obamacare) by the upcoming annual Feb. 15 deadline, and other advocates are educating health care professionals on both a clinical and social level to help them make their practices more welcoming to people of all sexual orientations and gender identities.

GETTING COVERED

The organization Out2Enroll is reaching out to LGBT Americans needing to select an insurance plan through the site HealthCare.gov. Steering committee member Katie Keith explained that targeting the LGBT community for special assistance became a priority for the U.S. Department of Health and Human Services (HHS) when a survey of low- and middle-income LGBT persons showed that nearly one-third of them were uninsured – a rate that is much higher than that of the general population. Out2Enroll operates an informational website (out2enroll.org) and partners with state and local coalitions to provide training and present live events that help LGBT consumers better understand what the Affordable Care Act provides for them.

Keith said that many who come to Out2Enroll events are unaware that the ACA contains broad protections prohibiting discrimination in health care coverage on the basis of sexual orientation and gender identity. In Phoenix, Out2Enroll has worked with the statewide coalition of Cover Arizona to provide LGBT-specific training for more than 100 “assisters,” who help consumers navigate the often-complicated health plan enrollment process. These assisters have been helping drop-in visitors to the Phoenix Pride LGBT Center on Wednesdays for the past several months.

Robert Hess, a local healthcare consultant who has been supervising the assisters at the center, said that his charges had received more than 40 hours of instruction on how to help LGBT people with enrollment issues specific to them, and continued to receive updates on nuances in the law daily.

Hess and Keith were gearing up at press time for a “town hall” style event at the center later this month, which is designed to address questions or concerns about the enrollment process. Hess said that in addition to a community dialog time, the evening event (tentatively scheduled for Jan. 28) would feature a presentation on “health literacy,” covering basic terms related to enrollment so that consumers could make better-informed choices.

Attendees can also receive assistance related to enrollment at the event.

Hess said that similar town halls held elsewhere in the country had provided valuable feedback to Out2Enroll and the federal government.

“The nice thing is that Out2Enroll has direct access to the White House and HHS,” he said. “Other events have taken unanswered questions to the top, resulting in executive orders being issued by President Obama. We can get issues resolved, and do something with that information.”

Out2Enroll hopes to aid the federal government in achieving its goals of enrolling 16 million persons nationally in ACA-sponsored health plans, including a hoped-for 300,000 persons in Arizona. Keith said that health insurance enrollment wasn’t the answer to all LGBT health issues, but it had the potential to make a significant difference in the health of the community.

“Access to health care is a first step,” she said. “It really helps address our disparities and ensures that we as a community are able to take care of ourselves.”

GETTING CARE

Once an LGBT person has health insurance, the next step is ensuring that he or she receives care from competent, welcoming care providers. Vargas said that a report by the Center for American Progress found that LGB individuals were more likely than their straight peers (29 percent vs. 17 percent) to delay or avoid medical care, in part because of past negative experiences with the healthcare system.

In the case of transgender patients, the situation can be even bleaker; Hess noted that prior to the ACA, some practices refused to admit trans people as clients, even for non-trans-related health concerns. It was also not uncommon for trans patients to arrive at their doctor's office better informed than their provider about the standards of care for hormone therapy and other common trans-related treatments.

Vargas said GLMA uses educational outreach to physicians, including webinars and an annual conference, to help them ask the right clinical questions to address common LGBT-related health issues. The organization also partners with other advocacy groups to increase the amount of LGBT medical content presented at health professional schools.

Beyond clinical competence in gay- or trans-specific health issues, however, Vargas noted it was the way a health provider presented his or her practice to potential LGBT patients that was crucial to letting them know they would be safe there.

"An important aspect in this work is terminology – on forms and in provider-patient interactions, which can be extremely important cues for LGBT people about the welcoming nature and clinical competency of any provider," he said.

On the other side of the exam table, GLMA empowers queer health consumers by providing a searchable provider directory on its website and by publishing “top 10” lists for the subgroups within the LGBT community (lesbian, gay, bisexual, transgender, etc.) with information on what topics they should consider discussing with their physician.

Vargas asserted that coming out to health care providers when a safe and welcoming environment exists was an important first step for queer individuals wanting to advocate for their own best care. And on a societal level, he said, LGBT persons and their allies should start viewing medical issues with the same urgency as they do other equality issues.

"I’d encourage the LGBT community to think of and prioritize healthcare as an LGBT civil rights issue on par with employment non-discrimination and relationship recognition," he said. "There are so many things, especially in terms of addressing policy and education, that can be done on the national, state and local level to address the healthcare needs of LGBT people."