Legal and policy issues

Lesbian, gay, bisexual, transgender, and intersex (LBGTI) people continue to experience discrimination throughout the U.S. health system. There is a lack of content about LGBTI health issues in medical education and training. Some states such as California have enacted legislation prohibiting discrimination based on sexual orientation and gender identity in health care and requiring education and training on LGBTI health. Several states have also taken administrative action on LGBTI health, including advancing data collection on sexual orientation and gender identity and prohibiting health insurance exclusions that deny coverage to transgender individuals. The achievement of marriage equality nationwide in 2015 will have a beneficial impact on the health of LGBT individuals and their families. The federal government, especially under the Obama Administration, has begun to highlight LGBTI health issues and integrate them in data collection and reporting, cultural competency, nondiscrimination, quality improvement, and disparities reduction initiatives. The Affordable Care Act also includes significant provisions that expand health insurance coverage to, and prohibit discrimination against, LGBTI individuals. Data collection and analyses based on patient sexual orientation and gender identity is a vital first step to improved understanding about LGBTI health and health disparities. Other reforms to improve quality and reduce costs are additional opportunities to integrate LGBTI health issues.