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Thursday, January 11
Thu, Jan 11, 9:00 AM - 10:45 AM
Yellow Topaz
Medicaid and the Affordable Care Act

Disparities in access to care among sexual minority adults in the United States: National Health Interview Survey, 2014 - 2015 (304209)

*Sarah MacCarthy, RAND Corporation 
Megan Beckett, RAND Corporation 
Steven Martino, RAND Corporation 
Q Burkhart, RAND Corporation 
Mark Schuster, Children’s Hospital Boston 
Denis Agniel, RAND Corporation 
Nathan Orr, RAND Corporation 
Denise Quigley, RAND Corporation 
Judy H. Ng, National Committee for Quality Assurance 
Paul Guerino, Centers for Medicare & Medicaid Services 
Marc Nathan Elliott, RAND Corporation 

Keywords: sexual minority men and women, health disparities, access to care

While insurance coverage has increased during ACA implementation and marriage equality expansion, sexual minority adults experience substantial health disparities relative to heterosexual peers. Moreover, the conclusions of some studies may be sensitive to analytic decisions about small groups. Multivariate analyses of 2014-2015 NHIS data compared 7 barriers to care among 67,023 heterosexual and 2,080 sexual minority adults. Within sex strata we compared all sexual minority adults to heterosexual peers and sexual minority subgroups (e.g., lesbian/gay, bisexual adults) to heterosexual adults and each other, evaluating statistical power issues in several common approaches in the literature. Some barriers were 2x as likely among sexual minorities than for heterosexual peers, and 1.5x as likely when controlling for health and sociodemographics. There were few statistically-significant adjusted differences between gay/lesbian and bisexual adults, given small subgroup sample sizes. This finding contrasts with some previous studies that focused on differences in statistical significance when comparing 2 small sexual minority groups to heterosexual counterparts.