Monday, October 20, 2014
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The Supreme Court's decision may bring big changes for LGBT health care

In a major victory for gay rights, the Supreme Court last month struck down part of the Defense of Marriage Act (DOMA), the federal law that had limited recognition of marriage to one between a man and a woman. This judicial move may herald major changes for the gay community with regard to health care access and cost.

The Supreme Court’s decision may bring big changes for LGBT health care

In a major victory for gay rights, the Supreme Court last month struck down part of the Defense of Marriage Act (DOMA), the federal law that had limited recognition of marriage to one between a man and a woman. This judicial move may herald major changes for the gay community with regard to health care access and cost.

The decision in the case of United States v. Windsor found Part 3 of DOMA to be unconstitutional because it denies legally married same-sex couples equal treatment under federal law. One of the clear effects of this ruling is that same-sex spouses of federal employees can receive coverage through the Federal Employees Health Benefits Program for civilians and the Tricare program for military personnel.

Dr. Ardis D. Hoven, the president of the American Medical Association told CBSNews.com that overturning the DOMA will help eliminate health disparities in same-sex households by ensuring that they are afforded the same health care rights as others.

DOMA had barred federal recognition of same-sex marriages for the purpose of determining spousal benefits for programs such as Social Security survivors' benefits and government employee health insurance and in other areas such as immigration status and joint tax filing. Now, all federal spousal benefits, including those under Medicare and Medicaid will be available.

The ruling also means that children and spouses of same-sex couples can receive survivor benefits.  As a result, in states where same-sex marriage is legal, if a non-biological parent in a same-sex couple passes away, the couple’s child is now eligible for Social Security survivor benefits. Gay spouses will also now qualify for the Family and Medical Leave Act, which grants employees time off to care for an ill spouse or child.

The ruling also means that when a gay married couple obtains health care through one of the partners’ jobs, the employer contribution is excluded from income tax, as it is for other married couples.

On the other hand, the Court’s decision also has negative implications for same-sex spouses who enroll in insurance plans through the new insurance exchanges created by Obamacare. The subsidies that are available for low and moderate income families will be based on a same-sex couple's joint income, rather than the income of each spouse individually. This could disqualify some same-sex spouses from receiving this financial assistance.

It is important to bear in mind that the Supreme Court’s decision affects only same-sex marriages and does not apply to civil unions. This distinction is significant because currently same-sex couples can legally marry in only 13 states and the District of Columbia (including nearby Delaware and New York).

It is also still unclear how the decision will affect couples who are legally married in one state but living in another where same-sex marriage isn’t recognized. Although President Obama has stated that he believes couples married in one state should be treated as married in all 50 states, it is yet to be seen how states that are resistant to same-sex marriage will respond to the changes.

The court’s decision will clearly require some legal adjustments, but it will eventually transform the landscape for health care in the LGBT community.


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About this blog

The Field Clinic reports and analyzes health care laws, government policies, and political trends that are transforming the care we receive and the way we pay for it. Read more about our panel of bloggers here.

This blog is produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente. Portions of this blog may also be found on Inquirer.com and in the Inquirer's Sunday Health Section.

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Robert I. Field, Ph.D., J.D., M.P.H. Professor, School of Law & Drexel School of Public Health
Jeffrey Brenner, MD Founder of the Camden Coalition of Healthcare Providers, Medical Director of the Urban Health Institute at Cooper University Healthcare
Andy Carter President & CEO, The Hospital & Healthsystem Assoc. of Pa.
Robert B. Doherty Senior Vice President of Governmental Affairs & Public Policy American College of Physicians
David Grande, MD, MPA Assistant Professor of Medicine at the University of Pennsylvania
Tine Hansen-Turton Chief Strategy Officer of Public Health Management Corporation
Drew A. Harris, DPM, MPH Director of Health Policy Program at the Jefferson School of Population Health
Antoinette Kraus Director of the Pennsylvania Health Access Network
Laval Miller-Wilson Executive Director of the Pennsylvania Health Law Project
David B. Nash, MD, MBA Founding Dean of the Jefferson School of Population Health
Mark V. Pauly, Ph.D. Professor of Health Care Management, Business Economics and Public Policy at The Wharton School
Howard J. Peterson, MHA Managing Partner of TRG Healthcare, a national healthcare consulting firm
Donald Schwarz, MD, MPH Deputy Mayor for Health & Opportunity and Health Commissioner for the City of Philadelphia
Paula L. Stillman, MD, MBA Healthcare consultant with special expertise in population health and disease management
Elizabeth A. W. Williams Senior Vice President & Chief Communications Officer for Independence Blue Cross
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