Health and Access to Care and Coverage for Lesbian, Gay, Bisexual, and Transgender (LGBT) Individuals in the U.S.

Executive Summary
  1. Institute of Medicine (IOM). (2011). The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding.

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  2. Healthy People 2020: Lesbian, Gay, Bisexual, and Transgender Health.

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  3. Agency for Healthcare Research and Quality. (2012). 2012 National Healthcare Disparities Report.

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The LGBT Community
  1. IOM. (2011). The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding.

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  2. Ibid.

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  3. National Center for Transgender Equality. (2009). Transgender Terminology.

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  4. Gates, G.  (March 22, 2010).  LGBT Demographics:  Presentation to the Institute of Medicine.

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  5. Kaiser Family Foundation analysis of NHIS 2016 data available at: Dawson, L., Kates, J., and Damico, A. (2018). The Affordable Care Act and Insurance Coverage Changes by Sexual Orientation. Available at: https://www.kff.org/disparities-policy/issue-brief/the-affordable-care-act-and-insurance-coverage-changes-by-sexual-orientation/

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  6. Gates, G (2017). Gallup. In U.S., More Adults Identifying as LGBT.

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  7. Where data do not include transgender individuals, LGB (lesbian, gay, bisexual) is used.

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  8. IOM. (2011). The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding.

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  9. Coffman, KB, Coffman, LC & Marzilli Ericson, KM. (2013). The Size of the LGBT Population and the Magnitude of Anti-Gay Sentiment are Substantially Underestimated, NBER Working Paper No. 19508.

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  10. Gates, G (2017). Gallup. In U.S., More Adults Identifying as LGBT.

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  11. Kann, L., et al. 2016. Centers for Disease Control and Prevention. MMWR. Sexual Identity, Sex of Sexual Contacts, and Health-Related Behaviors Among Students in Grades 9–12 — United States and Selected Sites, 2015. 65(9);1-202.

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  12. Flores, A., et al. The Williams Institute. How Many Adults Identify as Transgender in the United States? June 2016. Available at: http://williamsinstitute.law.ucla.edu/wp-content/uploads/How-Many-Adults-Identify-as-Transgender-in-the-United-States.pdf

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  13. Gates, G. Gallup. . (February 6, 2017.). Vermont Leads States in LGBT Identification.

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  14. Ibid.

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  15. Jones, J. Gallup. (June 22, 2017.) In U.S., 10.2% of LGBT Adults Now Married to Same-Sex Spouse.

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  16. Kaiser Family Foundation analysis of the 2016 American Community Survey. Data available here: https://www.census.gov/data/tables/time-series/demo/same-sex-couples/ssc-house-characteristics.html

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  17. Pew Research Center (June 2013). A Survey of LGBT Americans Attitudes, Experiences and Values in Changing Times.

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  18. Badgett, M.V., Durso, L.E. & Schneebaum, A. (2013). New Patters of Poverty in the Lesbian, Gay, and Bisexual CommunityThe Williams Institute.

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  19.  James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality.

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Health Challenges
  1. Agency for Healthcare Research and Quality. (2012). 2012 National Healthcare Disparities Report.

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  2. IOM. (2011). The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding.

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  3. Healthy People 2020: Lesbian, Gay, Bisexual, and Transgender Health.

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  4. Agency for Healthcare Research and Quality. (2012). 2012 National Healthcare Disparities Report.

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  5. Lick, D., Durso, L.E., & Johnson, K.L. (2013). Minority Stress and Physical Health Among Sexual Minorities. Pers on Psychological Sci 8(5): 521-548.

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  6. Denney, J.T., Gorman, B.K. & Barrera, C.B. (2013). Families, Resources, and Adult Health: Where do Sexual Minorities Fit? Journal of Health and Social Behavior 54(1): 46-63.

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  7. Lick, D., Durso, L.E., & Johnson, K.L. (2013). Minority Stress and Physical Health Among Sexual Minorities. Pers on Psychological Sci 8(5): 521-548.

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  8. Ibid.

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  9. Centers for Disease Control and Prevention, National Health Statistics Reports. (July 2014). Sexual Orientation and Health Among U.S. Adults: National Health Interview Survey, 2013.

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  10. James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality.

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  11. Massachusetts Department of Public Health. (2009). The Health of Lesbian, Gay, Bisexual, and Transgender (LGBT) Persons in Massachusetts.

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  12. Centers for Disease Control and Prevention. (2016). Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data United States and 6 Dependent Areas, 2015. Vol. 22. No 2. Available at: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-22-2.pdf

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  13. Centers for Disease Control and Prevention. (2016). Diagnoses of HIV Infection in the United States and Dependent Areas, 2016. Vol. 28. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2016-vol-28.pdf

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  14. Centers for Disease Control and Prevention (Feb. 2017). HIV Among Gay and Bisexual Men. https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/cdc-msm-508.pdf

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  15. Centers for Disease Control and Prevention (Sept. 2017), HIV Among Gay and Bisexual Men. https://www.cdc.gov/hiv/group/msm/index.html

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  16. Baral SD, et al. (2013). Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. The Lancet Infectious Disease. 13(3): 214–222.

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  17. Centers for Disease Control and Prevention (2006). MMWR. Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-Care Settings. 55(RR14); September 2006.

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  18. Kaiser Family Foundation, HIV/AIDS In The Lives Of Gay And Bisexual Men In The United States, 2014.

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  19. Centers for Disease Control and Prevention. (2016). Monitoring Selected National HIV Prevention and Care Objectives by Using HIV Surveillance Data United States and 6 Dependent Areas, 2015. Vol. 22. No 2. Available at: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-22-2.pdf

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  20. Centers for Disease Control and Prevention. (2014).  Likely Female-to-Female Sexual Transmission of HIV- Texas, 2012.

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  21. Centers for Disease Control and Prevention. (2016). https://www.cdc.gov/nchhstp/newsroom/2016/std-surveillance-report-2015-press-release.html

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  22. Centers for Disease Control and Prevention. (2012). Viral Hepatitis: Information for Gay and Bisexual Men. https://www.cdc.gov/hepatitis/Populations/PDFs/HepGay-FactSheet.pdf

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  23. Centers for Disease Control and Prevention (2013). HPV-Associated Cancers Statistics.

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  24. Centers for Disease Control and Prevention. (2012). HPV and Men- Fact Sheet.

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  25. Lick, D., Durso, L.E., & Johnson, K.L. (2013). Minority Stress and Physical Health Among Sexual Minorities. Pers on Psychological Sci 8(5): 521-548.

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  26. Cochran, S.D., Sullivan, J.G. & Mays, V.M. (2003). Prevalence of mental disorders, psychological distress, and mental health services use among Lesbian, Gay, and Bisexual adults in the United States. Journal of Consulting and Clinical Psychology 71(1): 53-61.

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  27. Institute of Medicine. (2011). The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding.

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  28. Substance Abuse and Mental Health Services Administration. (2012). Top Health Issues for LGBT Populations: Information & Resources Kit.

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  29. Ford, Z. (December 3, 2012). APA Revises Manual: Being Transgender is no Longer a Mental Disorder. Think Progress.

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  30. Lick, D., Durso, L.E., & Johnson, K.L. (2013). Minority Stress and Physical Health Among Sexual Minorities. Pers on Psychological Sci 8(5): 521-548.

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  31. Lee J, Griffin G, Melvin C (2009). Tobacco use among sexual minorities in the USA, 1987 to May 2007: a systematic review. Tob Control. 18:275-282.

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  32. Cochran, S.D., Sullivan, J.G. & Mays, V.M. (2003). Prevalence of mental disorders, psychological distress, and mental health services use among Lesbian, Gay, and Bisexual adults in the United States. Journal of Consulting and Clinical Psychology 71(1): 53-61.

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  33. Grant JM, Mottet LA, Tanis J, Harrison J, Herman JL, Keisling M. (2011). Injustice at Every Turn: A Report of the National Transgender Discrimination Survey. Washington, DC: National Center for Transgender Equality and National Gay and Lesbian Task Force.

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  34. Ostrow, D.G. & Stall, R. (2008) Alcohol, tobacco, and drug use among gay and bisexual men. In Wolitski, R.J., Stall, R., & Valdiserri, R.O., Unequal opportunity: Health disparities affecting gay and bisexual men in the United States. New York: Oxford University Press.

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  35. Centers for Disease Control and Prevention. (2009). Sexual Violence: Consequences.

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  36. Human Rights Campaign, (2011).  A Guide to State Level Advocacy Following Enactment of the Matthew Shepard and James Byrd, Jr. Hate Crimes Prevention Act.

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  37. Pew Research Center (June 2013). A Survey of LGBT Americans Attitudes, Experiences and Values in Changing Times.

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  38. Centers for Disease Control and Prevention. (2013). The National Intimate Partner and Sexual Violence Survey: 2010 Findings on Victimization by Sexual Orientation.

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  39. U.S. Department of Justice Federal Bureau of Investigation, (2016).  Hate Crime Statistics 2016.

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  40. Herek, G.M. (2009). Hate Crimes and Stigma-Related Experiences Among Minority Adults in the United States: Prevalence Estimates from a National Probability Sample. Journal of Interpersonal Violence.

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  41. Ibid.

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  42. Lombardi E, et al. (2002). Gender violence: Transgender experiences with violence and discrimination. J Homosex 42(1).

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  43. National Coalition of Anti-Violence Programs. (2013).  Lesbian, Gay, Bisexual, Transgender, Queer, and HIV-Affected Hate Violence in 2012.

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  44. Human Rights Campaign. (2012). National Coming Out Day Youth Report.

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  45. Kann L, Olsen EO, McManus T, et al. Centers for Disease Control and Prevention. Sexual Identity, Sex of Sexual Contacts, and Health-Related Behaviors Among Students in Grades 9–12 — United States and Selected Sites, 2015. MMWR. 2016;65(No. SS-9):1–202. Available at: http://dx.doi.org/10.15585/mmwr.ss6509a1

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  46. Kann L, Olsen EO, McManus T, et al. Centers for Disease Control and Prevention. Sexual Identity, Sex of Sexual Contacts, and Health-Related Behaviors Among Students in Grades 9–12 — United States and Selected Sites, 2015. MMWR. 2016;65(No. SS-9):1–202. Available at: http://dx.doi.org/10.15585/mmwr.ss6509a1

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  47. Kann L, Olsen EO, McManus T, et al. Centers for Disease Control and Prevention. Sexual Identity, Sex of Sexual Contacts, and Health-Related Behaviors Among Students in Grades 9–12 — United States and Selected Sites, 2015. MMWR. 2016;65(No. SS-9):1–202. Available at: http://dx.doi.org/10.15585/mmwr.ss6509a1

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  48. Kann L, Olsen EO, McManus T, et al. Centers for Disease Control and Prevention. Sexual Identity, Sex of Sexual Contacts, and Health-Related Behaviors Among Students in Grades 9–12 — United States and Selected Sites, 2015. MMWR. 2016;65(No. SS-9):1–202. Available at: http://dx.doi.org/10.15585/mmwr.ss6509a1

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  49. Kann L, Olsen EO, McManus T, et al. Centers for Disease Control and Prevention. Sexual Identity, Sex of Sexual Contacts, and Health-Related Behaviors Among Students in Grades 9–12 — United States and Selected Sites, 2015. MMWR. 2016;65(No. SS-9):1–202. Available at: http://dx.doi.org/10.15585/mmwr.ss6509a1

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  50. Centers for Disease Control and Prevention. (2011). Lesbian, Gay, Bisexual, and Transgender Health: Youth.

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  51. The Williams Institute. (2012). Serving Our Youth: Findings from a National Survey of Service Providers Working with Lesbian, Gay, Bisexual, and Transgender Youth who are Homeless or At Risk of Becoming Homeless.

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  52. Gay, Lesbian & Straight Education Network. (2012). 2011 National School Climate Survey.

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  53. Kann L, Olsen EO, McManus T, et al. Centers for Disease Control and Prevention. Sexual Identity, Sex of Sexual Contacts, and Health-Related Behaviors Among Students in Grades 9–12 — United States and Selected Sites, 2015. MMWR. 2016;65(No. SS-9):1–202. Available at: http://dx.doi.org/10.15585/mmwr.ss6509a1.

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  54. William Institute. (2018). Conversion Therapy and LGBT Youth. https://williamsinstitute.law.ucla.edu/demographics/conversion-therapy-and-lgbt-youth/

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  55. American Medical Association. Health Care Needs of Lesbian, Gay, Bisexual and Transgender Populations H-160.991. Available at: https://policysearch.ama-assn.org/policyfinder/detail/H-160.991%20?uri=%2FAMADoc%2FHOD.xml-0-805.xml; American Psychological Association. 2000. Position Statement on Therapies Focused on Attempts to Change Sexual Orientation (Reparative or Conversion Therapies). Available at: http://www.psychiatry.org/File%20Library/Advocacy%20and%20Newsroom/
    Position%20Statements/ps2000_ReparativeTherapy.pdf
    .; and the American Academy of Pediatrics. PEDIATRICS Vol. 92 No. 4 October 1993. Available at: http://pediatrics.aappublications.org/content/pediatrics/92/4/631.full.pdf.

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  56. Center for American Progress. (2013). LGBT Communities and the Affordable Care Act: Findings from a National Survey.

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  57. Clift, J & Kirby J. (2012). Health care access and perceptions of provider care among individuals in Same-Sex Couples: Findings from the Medical Expenditure Panel Survey (MEPS). Journal of Homosexuality 59(6): 839-850.

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  58. Another 41% say they have not encountered this benefits issue and 16% say they do not offer the benefit.

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  59. Dawson, L., Kates, J. and Rae, M. (2017). The Kaiser Family Foundation. Access to Employer-Sponsored Health Coverage for Same-Sex Spouses: 2017 Update. . Available at: https://www.kff.org/disparities-policy/issue-brief/access-to-employer-sponsored-health-coverage-for-same-sex-spouses-2017-update/

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  60. Dawson, L., Kates, J. and Rae, M. (2017). The Kaiser Family Foundation. Access to Employer-Sponsored Health Coverage for Same-Sex Spouses: 2017 Update. . Available at: https://www.kff.org/disparities-policy/issue-brief/access-to-employer-sponsored-health-coverage-for-same-sex-spouses-2017-update/

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  61. Gonzales, G. (2015).  Association of the New York State Marriage Equality Act with Changes in Health Insurance CoverageJAMA.

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  62. Buchmueller, T.& Carpenter C. (2010). Disparities in health insurance coverage, access, and outcomes for individuals in same-sex versus different-sex relationships, 2000-2007. American Journal of Public Health 100(3): 489-495.

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  63. Kerker, B.D., Mostashari, F. & Thorpe, L. (2006). Health care access and utilization among women who have sex with women: Sexual behavior and identity. Journal of Urban Health 83(5): 970-979.

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  64. Cochran, SD, et al. (2001). Cancer-related risk indicators and preventive screening behaviors among lesbians and bisexual women. American Journal of Public Health 91(4): 591-597.

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  65. National Center for Transgender Equality and National Gay and Lesbian Task Force. (2011). Injustice at Every Turn:  A Report of the National Transgender Discrimination Survey.

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  66. Center for American Progress. (2012). FAQ: Health Insurance Needs for Transgender Americans.

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  67. Lambda Legal, “When Health Care Isn’t Caring:  Lambda Legal’s Survey on Discrimination Against LGBT People and People Living with HIV”.

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  68. The Fenway Institute. (2008). The Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health.

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  69. Lambda Legal, “When Health Care Isn’t Caring:  Lambda Legal’s Survey on Discrimination Against LGBT People and People Living with HIV”.

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  70. Movement Advancement Project. (2009). Advancing Transgender Equality.

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  71. Tesar, C. & Rovi, S. (1998). Survey on Curriculum on Homosexuality/ Bisexuality in Departments of Family Medicine. Fam Medicine 30(4): 283-287.

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  72. Corliss, H.L., Shankle, M.D. & Moyer, M.B. (2007). Research, Curricula, and Resources Related to Lesbian, Gay, Bisexual, and Transgender Health in U.S. Schools of Public Health. American Journal of Public Health 97(6): 1023-1027.

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  73. GLMA, Health Professionals Advancing LGBT Equality. (2013). Compendium of Health Profession Association LGBT Policy & Position Statements.

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  74. World Professional Association for Transgender Health (2012). Standards of Care for the Health of Transsexual, Transgender, and Gender-Nonconforming People.

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Impact of Changes in the Legal and Policy Landscape on Coverage and Access to Care
  1. L. Dawson, J. Kates, and A. Damico. (2018). Kaiser Family Foundation. The Affordable Care Act and Insurance Coverage Changes by Sexual Orientation. https://www.kff.org/disparities-policy/issue-brief/the-affordable-care-act-and-insurance-coverage-changes-by-sexual-orientation/ 

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  2. Lambda Legal, “When Health Care Isn’t Caring:  Lambda Legal’s Survey on Discrimination Against LGBT People and People Living with HIV”.

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  3. Baker, K. & Cray, A. (2012). Ensuring Benefits Parity and Gender Identity Nondiscrimination in Essential Health Benefits.  Center for American Progress.

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  4. Human Rights Campaign. Health Insurance Discrimination for Transgender People.

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  5. Department of Health and Human Services. Federal Register 77(59): March 27, 2012.

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  6. Department of Health and Human Services. Federal Register 78(37): February 25, 2013.

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  7. K. Keith. Health Affairs Blog. ACA Round-Up: Section 1557 Rule On Horizon; CSR And Medicaid Litigation Updates; Focus On Employer Mandate. February 19, 2018.  https://www.healthaffairs.org/do/10.1377/hblog20180219.671383/full/

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  8. Department of Health and Human Services. Federal Register 78(39): February 27, 2013.

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  9. Centers for Medicaid and Medicare Services (CMS). Frequently Asked Questions on Coverage of Same-Sex Spouses . March 14, 2014.

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  10. Department of Health and Human Services. Federal Register 81(116): June 16 2016.

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  11. Pollitz, K. (2018.) Kaiser Family Foundation. Understanding Short-Term Limited Duration Health Insurance. https://www.kff.org/health-reform/issue-brief/understanding-short-term-limited-duration-health-insurance/

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  12. HHS. 83 FR 2802. “Statement of Organization, Functions, and Delegations of Authority,” January 19, 2018. Available at https://www.gpo.gov/fdsys/pkg/FR-2018-01-19/pdf/2018-00820.pdf; HHS. 83 FR 3880. “Protecting Statutory Conscience Rights in Health Care; Delegations of Authority.” January 26, 2018. Available at https://www.gpo.gov/fdsys/pkg/FR-2018-01-26/pdf/2018-01226.pdf.

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  13. Lambda Legal. January 2018. Trump Administration Plan to Expand Religious Refusal Rights of Health Professionals: Legal Issues and Concerns. Available at: https://www.lambdalegal.org/sites/default/files/2018-01- 18_lambda_legal_analysis_re_hhs_ocr_special_religious_refusal_unit_jcp_issued.pdf

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  14. Department of Health and Human Services. (2013). HHS LGBT Issues Coordinating Committee 2013 Report.

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  15. Cahill, S., Geffen, S., and Wang, T. The Fenway Institute. One year in, Trump Administration amasses striking anti-LGBT record  2018. http://fenwayhealth.org/wp-content/uploads/The-Fenway-Institute-Trump-Pence-Administration-One-Year-Report.pdf

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  16. Cahill, S., Geffen, S., and Wang, T. The Fenway Institute. One year in, Trump Administration amasses striking anti-LGBT record  2018. http://fenwayhealth.org/wp-content/uploads/The-Fenway-Institute-Trump-Pence-Administration-One-Year-Report.pdf

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  17. The Fenway Institute. (2012). Policy Focus: How to gather data on sexual orientation and gender identity in clinical settings.

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  18. IOM. (2011). The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding.

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  19. National Institutes of Health. National Institute on Minority Health and Health Disparities. Director’s Message. “Sexual and Gender Minorities Formally Designated as a Health Disparity Population for Research Purposes” October 6, 2016.  Available at: http://www.nimhd.nih.gov/about/directors-corner/message.html.

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  20.   Supreme Court of the United States, United States v. Windsor, June 26, 2013.

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  21. Their marriages were recognized as long as legally valid where performed and not dependent on whether the state they lived in recognized their marriage.

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  22. Where the couple lived when seeking the benefit.

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  23.   Supreme Court of the United States, Obergefell v. Hodges, June 26, 2015.

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  24. Internal Revenue Service, Rev.Rul.2013-17.

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  25. Internal Revenue Service, Application of Windsor Decision and Rev. Rul. 2013-17 to Employment Taxes and Special Administrative Procedures for Employers to Make Adjustments or Claims for Refund or Credit

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  26. How Supreme Court Gay Marriage Ruling Affects Employee Benefit Plans, Insurance Journal, June 26 ,2015.

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  27. U.S. Office of Personnel Management, Guidance on the Extension of Benefits to Married Gay and Lesbian Federal Employees, Annuitants, and their Families, June 28, 2013.

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  28. The White House, Executive  Order 13672, Further Amendments to Executive Order 11478, Equal Employment Opportunity in the Federal Government, and Executive Order 11246, Equal Employment Opportunity, July 21, 2014.

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  29. Department of Labor, Frequently Asked Questions:  EO 13672 Final Rule, July 21, 2014.

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  30. Department of Defense, Extending Benefits to the Same-Sex Spouses of Military Members, August  13, 2013.

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  31. U.S. Department of Veterans Affairs, Statement Following Supreme Court Ruling in Obergefell v. Hodges, June 29, 2015.

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  32. Equal Employment Opportunity Commission (EEOC), Cote v. Walmart Stores, East, L.P., Notice of Right to Sue, May 29, 2015

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  33. Hall et al v. BNSF Railway Company, No. 2:2013cv02160 - Document 37 (W.D. Wash. 2014).

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  34. EEOC, Opinion in Appeal No. 0120133080, July 15, 2015.

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  35. Department of Labor, Technical Release No. 2013-04, September 18, 2013.

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  36. Movement Advancement Project.  Healthcare Laws and Policies.

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  37. Movement Advancement Project.  Healthcare Laws and Policies.

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  38. Ibid.

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  39. Movement Advancement Project.  Employment Non-Discrimination Laws.

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  40. Department of Health and Human Services, Guidance on Internal Revenue Ruling 2013-17 and Eligibility for Advance Payments of the Premium Tax Credit and Cost-Sharing Reductions , September 27, 2013.

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  41. Department of Health and Human Services, State Health Officer # 13-006, September 27, 2013.

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  42. Department of Health and Human Services, Impact of United States v. Windsor on Skilled Nursing Facility Benefits for Medicare

    Advantage Enrollees, August 29, 2013.

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  43. Social Security Administration. Program Operations Manual System (POMS): GN 00210.002 Same-Sex Marriage - Determining Marital Status for Title II and Medicare Benefits. TN 10 (06-14).  Social Security Administration. Program Operations Manual System (POMS): GN 00210.706 Same-Sex Marriage – HI Premium Reduction for Aged and Disabled Individuals. TN 8 (05-14).

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  44. Social Security Administration. Program Operations Manual System (POMS): GN 00210.700 Same-Sex Marriage - Eligibility for Medicare Special Enrollment Period (SEP). TN 6 (04-14).

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  45. Department of Labor, Wage and Hour Division, Fact Sheet #28F: Qualifying Reasons for Leave under the Family and Medical Leave Act, August 2013.

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  46. Department of Labor, Wage and Hour Division, Fact Sheet: Final Rule to Amend the Definition of Spouse in the Family and Medical Leave Act Regulations, February 2015.

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  47. Department of Health and Human Services, Medicare finalizes new rules to require equal visitation rights for all hospital patients, November 17, 2010.

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  48. CMS. (2014). Medicare and Medicaid Program Revisions to Certain Patient’s Rights of Conditions of Participation and Conditions for Coverage.

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  49. CMS. (2013). Reminder: Access and Visitation Rights in Long Term Care (LTC) Facilities.

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  50. Department of Health and Human Services.  Medicare and Medicaid Programs; Revisions to Certain Patient’s Rights Conditions for Participation and Conditions for Coverage; Withdrawal. Federal Register 82(191).

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  51. Mongan, E. October 4, 2017. “CMS withdraws proposal requiring LTC facilities to afford spousal rights to same-sex couples.” McKnight’s Long- Term Care News & Assisted Living.

    https://www.mcknights.com/cms-withdraws-proposal-requiring-ltc-facilities-to-afford-spousal-rights-to-same-sex-couples/printarticle/697715/

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  52. National Gay and Lesbian Task Force, Nondiscrimination Laws Map, June 21, 2013.

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  53. CMS. (2011).  State Medicaid Director Letter:  Same Sex Partners and Medicaid Liens, Transfers of Assets, and Estate Recovery.

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  54. Department of Health and Human Services, Departmental Appeals Board, Appellate Division. NCD 140.3, Transsexual Surgery, Docket No. A-13-87, Decision No. 2576, May 30, 2014.

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  55. Office of Personnel Management, FEHBP Program Carrier Letter No. 2015-12, June 23, 2015.

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  56. Human Rights Campaign. (2013).  Corporate Equality Index.

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Tables
  1. Department of Health and Human Services. Federal Register 77(59): March 27, 2012.

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  2. Department of Health and Human Services. Federal Register 81(96): May 18, 2016.

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  3. Department of Health and Human Services. Federal Register 77(59): March 27, 2012.

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  4.   Department of Health and Human Services. Federal Register 78(39): February 27, 2013.

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  5. CMS. Frequently Asked Questions on Coverage of Same-Sex Spouses. March 14, 2014.

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  6. Supreme Court of the United States, United States v. Windsor, June 26, 2013.

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  7. Supreme Court of the United States, Obergefell v. Hodges, June 26, 2015.

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  8. Department of Justice, Attorney General Lynch Announces Federal Marriage Benefits Available to Same-Sex Couples Nationwide, July 9, 2015.

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  9. U.S. Department of the Treasury, All Legal Same-Sex Marriages Will be Recognized for Federal Tax Purposes, August 29, 2013.

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  10. U.S. Office of Personnel Management, Guidance on the Extension of Benefits to Married Gay and Lesbian Federal Employees, Annuitants, and their Families, June 28, 2013.

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  11. The White House, Executive  Order 13672, Further Amendments to Executive Order 11478, Equal Employment Opportunity in the Federal Government, and Executive Order 11246, Equal Employment Opportunity, July 21, 2014.

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  12. Secretary of Defense, Extending Benefits to Same-Sex Spouses of Military Members, August 13, 2013.

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  13. Department of Veterans Affairs, Statement Following Supreme Court Ruling in Obergefell v. Hodges, June 29, 2015.

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  14. Department of Health and Human Services, Guidance on Internal Revenue Ruling 2013-17 and Eligibility for Advance Payments of the Premium Tax Credit and Cost-Sharing Reductions, September 27, 2013.

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  15. Department of Health and Human Services, State Health Officer # 13-006, September 27, 2013.

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  16. Social Security Administration. Program Operations Manual System (POMS): GN 00210.002 Same-Sex Marriage - Determining Marital Status for Title II and Medicare Benefits. TN 10 (06-14).  Social Security Administration. Program Operations Manual System (POMS): GN 00210.706 Same-Sex Marriage – HI Premium Reduction for Aged and Disabled Individuals. TN 8 (05-14).

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  17. Social Security Administration. Program Operations Manual System (POMS): GN 00210.700 Same-Sex Marriage - Eligibility for Medicare Special Enrollment Period (SEP). TN 6 (04-14).

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  18. Department of Health and Human Services, Impact of United States v. Windsor on Skilled Nursing Facility Benefits for Medicare

    Advantage Enrollees, August 29, 2013.

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  19. Department of Labor, Wage and Hour Division. Federal Register 80(37): February 25, 2015.

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  20. Office of the Press Secretary, Presidential Memorandum- Hospital Visitation, April 15, 2010.

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  21. CMS. (2010).  Medicare and Medicaid Programs: Changes to the Hospital and Critical Access Hospital Conditions of Participation to Ensure Visitation Rights for all Patients.

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  22. CMS. (2013).  Access and Visitation Rights in Long Term Care (LTC) Facilities.

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  23. CMS. (2011).  State Medicaid Director Letter #11-006:  Same Sex Partners and Medicaid Liens, Transfers of Assets, and Estate Recovery.

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  24. Department of Health and Human Services, Departmental Appeals Board, Appellate Division. NCD 140.3, Transsexual Surgery, Docket No. A-13-87, Decision No. 2576, May 30, 2014.

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  25. Office of Personnel Management, FEHBP Program Carrier Letter No. 2015-12, June 23, 2015.

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  26. National Institutes of Health. (January 4, 2013).  Statement by NIH Director Francis S. Collins, M.D., Ph.D., on opportunities for advancing LGBT health research.

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  27. The White House. Presidential Executive Order Promoting Healthcare Choice and Competition Across the United States. October 12, 2017.  https://www.whitehouse.gov/presidential-actions/presidential-executive-order-promoting-healthcare-choice-competition-across-united-states/; HHS 83 FR 7437. “Short-Term, Limited-Duration Insurance.” February 21, 2018 https://www.gpo.gov/fdsys/pkg/FR-2018-02-21/pdf/2018-03208.pdf

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  28. HHS. 83 FR 2802. “Statement of Organization, Functions, and Delegations of Authority,” January 19, 2018. Available at https://www.gpo.gov/fdsys/pkg/FR-2018-01-19/pdf/2018-00820.pdf; HHS. 83 FR 3880. “Protecting Statutory Conscience Rights in Health Care; Delegations of Authority.” January 26, 2018. Available at https://www.gpo.gov/fdsys/pkg/FR-2018-01-26/pdf/2018-01226.pdf.; Lambda Legal. January 2018. Trump Administration Plan to Expand Religious Refusal Rights of Health Professionals: Legal Issues and Concerns. Available at: https://www.lambdalegal.org/sites/default/files/2018-01- 18_lambda_legal_analysis_re_hhs_ocr_special_religious_refusal_unit_jcp_issued.pdf

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