I am a health policy researcher who studies how state and federal legislation affect public health. Research has shown that the social determinants of health – the opportunities and resources that affect how people live, learn, play, work and age – play a significant role in LGBTQ+ well-being. Newly published work from my colleagues and I show how anti-LGBTQ+ public policies can have lasting effects on everyone’s health.
Same-sex marriage provides a clear example of the direct and indirect ways public policies affect LGBTQ+ health.
Most people in the U.S. have health insurance through their employer, which usually offers coverage for employees and their family, including a spouse and children. A landmark 2015 study found that health coverage significantly increased for adults in same-sex marriages after its legalization in New York state. After same-sex marriage was legalized nationwide, a follow-up study also showed an increase in health insurance coverage among gay and lesbian couples.
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Even among single LGBTQ+ people who did not get married, same-sex marriage may have also improved their health by improving social attitudes toward LGBTQ+ people overall. Researchers found that gay and bisexual men, regardless of whether they were single or married, spent less on medical visits, mental health visits and overall health care spending after Massachusetts legalized same-sex marriage in 2004.
Massachusetts was the first state to legalize same-sex marriage. Victoria Arocho/AP PhotoAccess to gender-affirming care provides another example of how public policies affect the health of LGBTQ+ people.
A 2020 national study of nearly 30,000 transgender and nonbinary people found that suicide attempts and mental health hospitalizations declined in states that passed policies requiring private insurers to equally cover services they already provide for cisgender people for transgender people. No other studies directly analyze how policies regulating access to care affect the health of trans and nonbinary people.
However, a large body of clinical research supports the health benefits of gender-affirming care. A randomized clinical trial and prospective study found that starting gender-affirming hormone therapy reduced depression and suicidality in transgender and nonbinary people. Several recent systematic reviews analyzing 124 peer-reviewed studies conducted over the past 50 years also found that gender-affirming surgery and hormone therapy improved quality of life and mental health.
Policies outside of health care – such as nondiscrimination, education and workplace protections – also affect LGBTQ+ well-being.
For example, transgender and nonbinary people living in states with policies that specifically include gender identity in hate crime and discrimination protections reported better mental health than those in states without protections. Similarly, LGBTQ+ students in schools with designated safe spaces reported lower rates of suicidal thoughts.
However, the surge in anti-LGBTQ+ policies in the U.S., initially focusing on youth, has significantly increased polarization between and within states. For example, while 17 states have implemented guidances to make schools safer and more inclusive for transgender youth, 25 states have banned transgender youth from using bathrooms and playing on sports teams that align with their gender. Meanwhile, South Dakota and Missouri have enacted laws to preempt progressive schools and districts from adding LGBTQ+ student protections and supportive resources.
The Trump administration is also actively targeting resources that support LGBTQ+ students by reducing funding to schools that offer these programs.
Inclusive spaces can help support the health of LGBTQ+ students. Jessica Hill/AP PhotoIn 2020, the Supreme Court ruled 6-3 in Bostock v. Clayton County that federal sex-based nondiscrimination protections in the workplace included discrimination based on gender identity and sexual orientation. Researchers found that LGBTQ+ older adults with co-workers supportive of their gender and sexuality experienced less workplace conflict and cognitive health problems compared with those who did not.
The Trump administration is working to restrict the scope of federal antidiscrimination protections to exclude LGBTQ+ people.
Emerging anti-LGBTQ+ policies could also have consequences for large swaths of the population beyond LGBTQ+ people.
In 2025, the Supreme Court will hear Braidwood v. Becerra, a case arguing that requiring employers to cover PrEP – a once-a-day pill that is highly effective at preventing HIV infection – as part of the insurance plan they offer employees violates their religious freedom. Texas District Judge Reed O’Connor agreed that mandating PrEP coverage requires the plaintiffs to “facilitate and encourage homosexual behavior.”
O'Connor ruled in 2023 to overturn the Affordable Care Act’s requirement that insurers fully cover preventive care. He argues this can be done on the grounds that the U.S. Preventive Services Task Force – a group of physicians and researchers that evaluates the quality and efficacy of preventive services – is unconstitutional. This legal challenge puts free coverage of mammograms, vaccinations and other preventive services into limbo for millions of Americans.
The Trump administration has taken down CDC pages providing information about HIV.The Trump administration has scrubbed federal web pages of resources, programs and documents that reference gender and LGBTQ+ people. This order includes removing datasets that have been continuously updated since the 1980s to track public health issues such as homelessness, bullying in schools, and smoking and drinking, likely because they include LGBTQ+ demographic information.
The administration has also ordered federal health agencies to retract scientific research that may be inclusive of LGBTQ+ people by searching for specific keywords, such as “gender.” The National Science Foundation is also screening active scientific research projects that use words like “women,” “trauma” and “disability.” Removing this data not only hamstrings public health research and programming for LGBTQ+ populations, but also restricts it for all Americans.
These decisions are in stark contrast to countries such as England, Wales, New Zealand and Australia, which have collected or are planning to collect LGBTQ+ demographic data as part of their national census. Including LGBTQ+ people in demographic data reflects best practices that were outlined in the Federal Evidence Agenda on LGBTQI+ Equity issued under the Biden administration. These guidelines have since been removed.
The rapid escalation of anti-LGBTQ+ policies in recent years is already taking its toll on youth, with negative news coverage of LGBTQ+ issues causing spikes in suicidal thoughts.
These policies also have far-reaching consequences for the broader public. Rigorous and long-standing research demonstrates that LGBTQ+-inclusive policies support safer communities and stronger economies for everyone, while exclusionary laws worsen and limit access to essential services.
Ongoing legal battles and policy shifts will shape the future of LGBTQ+ rights, with rippling effects on public health, workplace protections and health care access for all Americans.
Anti-LGBTQ+ policies harm the health of not only LGBTQ+ people, but all Americanswas originally published by The Conversation and is shared with permission.
Dr. Tran is an Assistant Professor of Health Policy and Administration (HPA) in the School of Public Health at the University of Illinois at Chicago.
