In this study published by Health Affairs, we found that enrollment in high deductible health plans is common among Americans, but the adoption of health savings accounts is concentrated among high income households. Financial barriers to medical care were higher for gay, lesbian, and bisexual adults enrolled in high-deductible health plans, both compared to straight adults on similar high-deductible plans, and gay, lesbian, and bisexual adults with other types of insurance plans.

In this viewpoint published by the Journal of the American Medical Association (JAMA), we review current collection of sexual orientation and gender identity as demographic characteristics in state Medicaid enrollment forms. We suggest policy frameworks to ensure data security, improve health system performance, and scale up adoption of demographic data best practices.

In this study published by Social Science & Medicine - Population Health, we found that lesbian, gay, and bisexual men and women were much more likely to report declines in their cognitive health and that their declines were more severe and impacting their ability to live independently, compared to heterosexual adults. More than a quarter of lesbian, gay, and bisexual women needed help to live indepenently but did not get it compared to heterosexual peers, and we found no difference for gay and bisexual men compared to peers. 

In this study published by Health Services Research, we found that among nearly 1000 LGBTQ+ patients that 34% reported affirming care, 60% reported neutral care, and 6% reported discriminatory care. Patients with affirming health care experiences were the most likely to receive preventive services like cancer screenings, flu vaccinations, and HIV testing. States with more health systems participating in the Healthcare Equality Index had higher rates of LGBTQ+ patients reporting affirming care. These results demonstrate that affirming LGBTQ+ patients goes beyond patient satisfaction by also improving health outcomes.

In this study published by JAMA Psychiatry, we found that lesbian, gay, bisexual, and other queer adults reported higher odds of all adverse childhood experiences (ACE) compared to heterosexual adults, with the largest disparity in emotional and sexual abuse. ACE exposure associated with poorer mental health in adulthood. LGBQ+ youth need additional protections in school, public, and at home to reduce the lifelong consequences of ACE.

In this study published by the American Journal of Preventive Medicine, we found that LGBTQ+ patients with affirming providers (doctors, NPs, PAs) had better preventive care (flu shot, cancer screenings, HIV testing) and chronic disease (mental health condition) outcomes than those with non-affirming providers. Health systems can participate in the Healthcare Equality Index to improve their LGBTQ+ cultural competency.