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Background <p>Millions of Americans have medical debt and/or defer care due to cost. Few studies have examined the association of such health-related financial problems with sexual orientation or gender identity, and whether state-level policies protecting sexual and gender minority (SGM) people&#xa0;affect disparities in such problems.</p> Objective <p>To examine the relationships between SGM status, state-level SGM protections, and health-related financial problems.</p> Design <p>Cross-sectional analysis.</p> Participants <p>Nationally-representative sample of U.S. adults in the 2021 National Financial Capability Study.</p> Main Measures <p>Prevalence of medical debt and/or deferred care; adjusted odds ratios (aORs) by SGM status and residence in a state with fewer SGM protections.</p> Key Results <p>Of 25,170 survey respondents, 3.7% were gay/bisexual men, 4.3% lesbian/bisexual women, and 0.6% transgender people. Among lesbian/bisexual women, 39.4% had medical debt, the highest proportion of any group. Accounting for sociodemographic and personal-financial factors, women and all lesbian/gay/bisexual persons (vs. straight men) more often experienced medical debt (aOR [95% CI]: straight women 1.28 [1.16, 1.41], gay/bisexual men 1.55 [1.23, 1.94], lesbian/bisexual women 1.80 [1.50, 2.10]) or deferred care (e.g., 1.80 [1.51, 2.16] for lesbian/bisexual women). Transgender people vs. cisgender men were more likely to defer care (aOR = 2.58 [1.54, 4.30]). Living in a state with fewer SGM protections was associated with higher rates of health-related financial problems for most groups, especially cisgender women and lesbian/bisexual women.</p> Conclusions <p>Lesbian/gay/bisexual, female, and transgender adults experience more health-related financial problems, especially in states lacking SGM protections, underlining the importance of universal, comprehensive insurance coverage (including for services unique to SGM&#xa0;people), ending bans on gender-affirming care, and closing the male–female pay gap.</p>

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Cross-Sectional Evaluation of State-Level Protections, Medical Debt, and Deferred Care Among Sexual and Gender Minority People

  • 期刊论文

  • 发表日期：

    2025年1月2日

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  • Emily Lupton Lupez,
  • Steffie Woolhandler,
  • David U. Himmelstein,
  • Samuel Dickman,
  • Elizabeth Schrier,
  • Lenore S. Azaroff,
  • Chris Cai,
  • Danny McCormick

摘要

Background

Millions of Americans have medical debt and/or defer care due to cost. Few studies have examined the association of such health-related financial problems with sexual orientation or gender identity, and whether state-level policies protecting sexual and gender minority (SGM) people affect disparities in such problems.

Objective

To examine the relationships between SGM status, state-level SGM protections, and health-related financial problems.

Design

Cross-sectional analysis.

Participants

Nationally-representative sample of U.S. adults in the 2021 National Financial Capability Study.

Main Measures

Prevalence of medical debt and/or deferred care; adjusted odds ratios (aORs) by SGM status and residence in a state with fewer SGM protections.

Key Results

Of 25,170 survey respondents, 3.7% were gay/bisexual men, 4.3% lesbian/bisexual women, and 0.6% transgender people. Among lesbian/bisexual women, 39.4% had medical debt, the highest proportion of any group. Accounting for sociodemographic and personal-financial factors, women and all lesbian/gay/bisexual persons (vs. straight men) more often experienced medical debt (aOR [95% CI]: straight women 1.28 [1.16, 1.41], gay/bisexual men 1.55 [1.23, 1.94], lesbian/bisexual women 1.80 [1.50, 2.10]) or deferred care (e.g., 1.80 [1.51, 2.16] for lesbian/bisexual women). Transgender people vs. cisgender men were more likely to defer care (aOR = 2.58 [1.54, 4.30]). Living in a state with fewer SGM protections was associated with higher rates of health-related financial problems for most groups, especially cisgender women and lesbian/bisexual women.

Conclusions

Lesbian/gay/bisexual, female, and transgender adults experience more health-related financial problems, especially in states lacking SGM protections, underlining the importance of universal, comprehensive insurance coverage (including for services unique to SGM people), ending bans on gender-affirming care, and closing the male–female pay gap.