Porthole
Effect of state-level health insurance non-discrimination policies on gender minority mental health (306702)
*Alex McDowell, Harvard UniversityAna M. Progovac, Cambridge Health Alliance
Julia Raifman, Boston University School of Public Health
Sherri Rose, Harvard Medical School
Keywords: State policy, evaluation, causal inference, gender minority
Since 2012, many states have implemented policies prohibiting discrimination based on gender identity among private health insurers. Such policies have important implications for access to care and health outcomes among gender minority (i.e. transgender and gender nonbinary) populations. This study evaluates the effect of these policies on gender minority mental health. Using a large private health insurance claims database, we construct a sample of enrollees with gender minority-related diagnosis codes in 2009-2017. We employ a difference-in-differences design to compare changes in mental health outcomes (including mental health diagnoses, inpatient hospitalization, and suicidality) among gender minority enrollees before and after states implemented non-discrimination policies. The number of gender minority enrollees in all states ranged from 6,456 in 2009 to 13,203 in 2017. The proportion of gender minority enrollees with mental health diagnoses, inpatient hospitalization, and suicidality also increased during the study period. Results regarding the differential change in these outcomes before and after policy implementation in select policy and non-policy states are forthcoming.