Louisa Baidoo, Research staff
insurance, healthcare access, health disparities, sexual and gender minorities, race and ethnicity, assigned female at b... [Read full text] insurance, healthcare access, health disparities, sexual and gender minorities, race and ethnicity, assigned female at birth, transgender, LGBT youth [Shorten text]
Background: According to the 2016 US Census, as many as 28.1 million Americans (8.8%) report being uninsured. High insurance costs are cited as the most common reason for lack of insurance among adults (National Health Interview Survey, 2016). Furthermore, insurance coverage rates vary demographically. In 2016, people of color reported significantly lower rates of insurance coverage relative to White individuals (Barnett and Berchick, 2017). Transgender individuals also have a complex relationship with insurance. A disproportionate reliance on Medicaid and the existence of categorical exclusions for transition-related care leaves transgender individuals at high risk for being uninsured (Rosh, 2017). Due to the dearth of knowledge of sexual and gender minority (SGM) populations, this project seeks to determine if the health disparities present in the general population are reflected in SGM populations assigned female at birth (AFAB). First, investigators examined racial and gender identity differences in insurance coverage. They also examined rates of unmet medical need. Finally, investigators analyzed differences in perceived barriers to healthcare. Methods: Chi-squared and Fisher’s exact tests were used to analyze a racially diverse sample of 488 LGBTQ AFAB people ages 16-31. Participants are part of FAB 400, a Chicago area longitudinal cohort study of SGM AFAB individuals. Participants were categorized as either cisgender or non-cisgender, which includes individuals who self-identify as transgender, gender-nonconforming, non-binary, and genderqueer. Participants were also categorized as either Black, White, Latinx, or Other. 75.4% of participants were people of color and 26.2% were non-cisgender. Results: 9.6% of the sample reported not having insurance. Additionally, over a quarter (26.2%) reported that there was a time within the past 12 months when they did not receive medical care that they needed. Many of the healthcare disparities within the general population exist within the sample. Within the sample, people of color were significantly less likely to have health insurance than white people and cisgender participants were less likely than non-cisgender participants to receive the care they needed. Across race/ethnicity and across gender identity, the most frequently identified barrier to receiving healthcare was cost. Non-cisgender individuals were more likely than cisgender individuals to cite a lack of LGBT-friendly doctors, a lack of health seeking behavior, and personal responsibilities as barriers to care. Conclusion: There are significant relationships between healthcare access, race/ethnicity, and gender identity. Racial and ethnic health insurance disparities persist throughout LGBTQ AFAB communities. Additionally, non-cisgender participants face barriers which cisgender individuals do not. Future studies should explore these relationships in LGBTQ adults over 26 to understand the effects of parental insurance status.