Legally-married same-sex couples aren't receiving consistent treatment under the Affordable Care Act when it comes to individual market health plan enrollment, Kaiser Health News reported. These couples may or may not be able to buy family coverage depending on same-sex marriage laws in the state where they live.
Federal rules say legally-married same-sex couples should receive the same treatment as opposite-sex couples in terms of premium tax credits and insurance subsidies, the article noted. But without a clear federal definition of who constitutes a spouse and family for health insurance purposes, states and payers define these terms differently. Experts say same-sex couples living in states that recognize their marriages shouldn't have problems buying family coverage, KHN noted. But elsewhere, payers deny family coverage applications and offer couples two, equally-priced individual policies instead.
The Centers for Medicare & Medicaid Services is considering how to address this issue next year, agency spokesperson Aaron Albright told KHN.
Blue Cross and Blue Shield of North Carolina already has dealt with the issue: The insurer planned to offer individual market family coverage to domestic partners and same-sex married couples in 2015; but in response to concerns from advocacy groups and couples whose plans were canceled, BCBSNC worked with CMS and state regulators to make family coverage available to same-sex couples this year, KHN reported.
Alleged insurance discrimination against underserved groups has made headlines before: HIV/AIDS advocates asked the government to investigate exclusion of HIV drug benefits in ACA plans. And hormone treatment benefits for Americans with gender dysphoria may not be available.
Against the backdrop of this news, U.S. Attorney General Eric Holder called lesbian, gay, bisexual and transgender (LGBT) equality "a defining civil rights challenge of our time" in a speech Monday to the Human Rights Campaign. Holder described the extension of "significant benefits" to Americans in same-sex marriages, including enrollment of same-sex spouses and their families in federal health insurance programs. "Neither tradition nor fear of change can absolve us of the obligation we share to combat discrimination in all its forms," Holder told HRC members.