• Photo for The Haves and Have Nots: Fit Gay Men and Healthcare Reform
    Photo Credit: Nicolas Smith

The Haves and Have Nots: Fit Gay Men and Healthcare Reform

By Russ Klettke

Editor's Note: This is the first in a two-part series on gay men and healthcare reform. Today's piece provides an introduction to gay men's special situation in terms of insurance and reform. Once there is an actual bill ready for a vote, we will run another piece breaking down how the finished legislation might impact gay men. Keep your eyes on RealJock for the next installment.

More Americans support healthcare reform legislation than oppose it—40 percent favor, 36 percent oppose and 24 percent are unsure, according to a Gallup Poll survey in early October—but who supports it and what they want from reform varies according to age, current access to affordable healthcare and other factors. The perspectives of gay men were not extracted from this and other, similar surveys. But given the facts of our current system, we basically fall into one of two broad categories: the Haves and the Have Nots.  

You are a Have if you have employer-sponsored medical insurance—supplied with affordable premiums, low deductibles and co-pays, pharmaceutical coverage and maybe even domestic partner benefits. You are a Have Not if you work for a company that does not provide health insurance benefits or you are self-employed and lack a partner with such benefits. Worse, if you have a pre-existing medical condition (as serious as HIV or sometimes as simple as asthma or HPV, the human papilloma virus), it’s nearly impossible to get affordable comprehensive medical coverage outside of a large employee pool.

  In other words, healthcare access is a function of where you work or whom you love. Otherwise smart choices—made with passion for livelihood and life itself—might be big mistakes relative to health and financial security. 

  The Journey From Having to Having Not
It doesn’t take much to fall from being a Have into a Have Not. The partner with the employer-sponsored policy might lose his job or simply decide to change jobs to a company that does not provide partner benefits. According to studies by the Human Rights Campaign (HRC), 83 percent of Fortune 100 companies provide partner benefits, but the numbers drop as companies get smaller: only 57 percent of Fortune 500 and 39 percent of Fortune 1000 companies provide those same benefits. Or, the relationship may end (yes, it happens sometimes) or both partners might decide to pursue an entrepreneurial venture. 

Interestingly, the larger issues discussed in healthcare reform have not touched on gay issues to a noticeable degree. Anti-reform voices have rallied against “death panels,” abortion funding and suggestions of socialism, not touching the myriad ways in which reform could significantly impact gay Americans.

  Also, the fact that millions of people lack an opinion (that 24 percent undecided in the Gallup poll) suggests a great deal of confusion, ignorance or disinterest exists on the issue. Healthcare costs currently consume 16 percent of the GDP in the U.S., more than double what it was 40 years ago. Insurance premiums alone average $2000 per year per person of personal income, before paying for actual medical expenses not covered by insurance. Since 2000, costs for health insurance premiums have increased four times faster than personal income. For anyone, gay or straight, who falls into the “unsure” category in the Gallup Poll, maybe it’s time to start think about how accidents or illness can affect you and your friends. 

Working Hard, Working Out—and Still Vulnerable 
Representing all stripes of the LGBT community, HRC lobbies for healthcare reform measures that include affordable, comprehensive benefits for all Americans. In addition to equitable benefits and tax policies relating to those benefits, it argues for several initiatives: 

  1. Decision-making authority for partners: This would give, for example, a long-term boyfriend primary say on a course of medical treatment over that of a distant parent or sibling.
  3. “Culturally competent” health care providers: mandatory training for doctors, nurses and other professionals on gay health issues and the role of partners.
  5. Safeguards on electronic medical records: Such records, while beneficial, also need to protect patients’ privacy.
  7. Information gathering: Increase collection of data by federal health agencies on gay health issues.
  9. Progress on HIV/AIDS: Development of a cohesive and comprehensive national AIDS strategy, including increased funding for HIV prevention.
  Incidentally, most of these add very little cost and arguably reduce healthcare expenses in the long term. 

The point on data collection may be more important than one first imagines. In researching this article, I was unable to identify what percent of gay men are self-employed or work for small businesses that lack healthcare benefits. This information could further influence policy, if the data could confirm my own hypothesis that gay men disproportionately live in Have Not conditions. “Degrees of Equality,” another HRC report on gays in the workplace, finds that 51 percent of LGBT people interviewed are not out at their jobs—suggesting their employment is difficult given their gay status. It’s not a far stretch to imagine they would prefer to work under different circumstances, even start their own business—but risk loss of affordable healthcare if they do. 

The Devil in the Details
With this and any other sweeping legislation, adverse and serious consequences may emerge from provisions that sound innocuous. For example, an employer mandate to provide insurance if the employee receives none elsewhere might seem worthwhile. But such a requirement might cause employers to prefer hiring married people over singles—making the assumption a spouse’s plan would be better—particularly if they prejudicially think a gay person is prone to expensive diseases. 

A European-style, single-payer plan would circumvent all of these concerns, but is politically unfeasible. A “public option” might work, depending on how exactly that would be defined. As of now, such a measure is far from guaranteed in the 2009 bill—despite 50 to 70 percent support from Americans, according to various polls. 

Where does preventive health and fitness fit in healthcare reform? It’s discussed, generally lumped in with expensive diagnostic testing (colonoscopies, MRIs, etc.). Suggestions that overweight Americans—two thirds of the adult population—go on diets and start exercising are discussed as well, but mandates are considered draconian. Yet the Centers for Disease Control says that three-quarters of healthcare spending treats “preventable chronic diseases,” including $147 billion spent on obesity, $116 billion on diabetes and billions more for cardiovascular diseases and cancers related to lifestyle. 

All of which really makes you wonder why so many fit, athletic gay men still fall into the Have Not category. Instead of treating us as a problem, those employers and insurance companies should be recruiting members. Reform can’t come soon enough. 

About Russ Klettke: Russ Klettke is a fitness and business writer, past member of the Human Rights Campaign Board of Governors and author of “A Guy’s Gotta Eat, the regular guy’s guide to eating smart” (with Deanna Conte, MS RD LD, DaCapo Press 2004).