LGBTQ Health Care Issues on the Horizon

One of the issues that many people must consider when going through a divorce is health care costs.  How do you even begin to navigate what you should anticipate for health care costs going forward, especially with the possible reality that obtaining health insurance might be more difficult and expensive then you ever imagined?  Under the current administration, these challenges are heightened for those in the midst of a same-sex divorce, as uncertainty about the continuation of the Affordable Care Act “ACA” has left many people, especially those within the LGBTQ community, concerned.  The concerns are warranted.  The current Republican proposed legislation in both the House and Senate could have significant consequences for the LGBTQ community, as the legislation will directly impact the way LGBTQ Americans access health care through the individual market place.

According to the National Alliance on Mental Illness, LGBTQ people are three times more likely to suffer from mental illness then others. The stress associated with the fear of coming out to loved ones and the discrimination the LGBTQ community faces at large can understandably play a large role in depression, anxiety and other mental illness.  Under the proposed legislation, depression and other mental health issues could likely qualify as a preexisting condition and trigger higher health care prices for obtaining treatment.

According to data from the Department of Health and Human Services, 24% of people with HIV had no health insurance prior to the implementation of the ACA. If states choose to seek waivers from the ACA’s preexisting coverage mandate, they have to set up alternative high risk pools, which will allow insurance companies to charge more for those with preexisting conditions, potentially those with HIV. Moreover, since the ACA includes HIV testing in its coverage; increased costs for such testing could lead many to not be tested, potentially allowing the virus to spread unknowingly through the community at large. Further, the cuts to Medicaid included under the proposed legislation would prevent people from accessing lifesaving treatment since the ACA is the largest source of health coverage for people currently living with HIV.

The transgender community could also be adversely affected by the pending legislation, which opens up a broad range of situations that would now qualify as a preexisting condition.  Depending on the insurer, gender affirmation surgery could now be considered a preexisting condition. Further, the proposed cuts to Planned Parenthood and Medicare will disproportionately affect the transgendered community as almost one third of the respondents to a 2015 US Transgendered Survey reported they were living in poverty, compared to 14% in the general US population.

So, how does a LBGTQ person even begin to navigate what they should anticipate for health care costs going forward, and how do they face the possible reality that obtaining health insurance might be more difficult and expensive than ever imagined?

The only answer we have at this point is good planning.  When confronting these issues in a divorce, if you are unable to obtain health insurance through an employer, do not leave the negotiations regarding the amount of money you will need for health insurance coverage as an afterthought. Confirm with your spouse’s employer what the exact cost of you obtaining COBRA will be, and compare these costs to the coverage you can currently obtain on the Illinois exchange.  One great tool for doing this is www.healthcare.gov, where you can enter your income level to see how much plans might cost after tax credits and view your preferred hospitals and doctors to see if they are in-network on each plan. Once you have confirmed these costs, work with your attorney to make sure that these costs are accurately reflected on your Financial Affidavit so that the number you use for this expense reflects the actual costs you will face on your own, and you are not left with insufficient funds to cover the cost of your medical insurance. Remember that if you do elect COBRA, it is only an option for 36 months, and therefore, you will be faced with a new plan down the road.

Beyond the financial planning that you need to consider, an examination of your current doctors and whether they will be covered on your new plan is crucial. In fact, only one insurer, Blue Cross and Blue Shield, is offering PPO plans on the Illinois exchange next year, down from five this year.

The world of health insurance is complicated and changing fast.  Making sure your attorney accurately reflects this cost in negotiations is one of the smartest investments you can make both to your physical health and financial health as you move forward post-divorce.

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Anne Prenner Schmidt

About Anne Prenner Schmidt

Anne Prenner Schmidt uses her acute business acumen to guide individuals through the complex division of retirement plans regarding family law matters. Prior to joining Schiller DuCanto & Fleck in 2015, Anne focused her practice on compliance of employee benefit plans and executive compensation arrangements. She frequently advised clients on Internal Revenue Code, ERISA, HIPAA, COBRA, the Affordable Care Act and other federal statutes. Anne understands the importance of retirement plans in association with divorce and helps clients navigate the multifaceted issues involved.

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