Compounding the problem of health disparities in the LGBT population is a tenuous relationship with the health care system. LGBT people are less likely to have health insurance than our heterosexual counterparts, partially because most employers do not offer coverage for unmarried domestic partners. Transgender people have the lowest insurance rates of all groups. Studies have shown that women in same sex relationships are less likely than women in heterosexual relationships to visit a doctor or have a regular source of health care, and are more likely to report experiencing unmet medical needs as a result of cost issues.
For LGBT people with health insurance, gaining access to the appropriate care can still pose difficulties. For instance, a transgender individual will not be covered for any procedure or cancer screenings that are inconsistent with the gender marked on the insurance card, such as a pap smear for a transgender man with an intact cervix.
LGBT patients often face a combination of ignorance and discrimination in accessing health care. While homophobia and transphobia among healthcare providers is declining, it is still very much in existence. One out of 5 transgender patients has been turned away by a health care provider. Even well-meaning providers have little training or experience with the LGBT population and our health risks. On average, medical students receive under 5 hours of training on LGBT issues in their entire medical education.
Previous or feared negative responses from health care providers frequently keep too many LGBT individuals from seeking routine care and cancer screening. Gay men who are not out to their medical providers are less likely to be screened for cancers less prevalent in the heterosexual population, such as anal cancer. Lesbians who do not have an established, trusted relationship with a reproductive health physician report lower rates of mammography, colonoscopy, and Pap smears than heterosexual women, suggesting that inaccessible health care together with the preponderance of discrimination and homophobia in the health care system contribute to decreased screening rates, putting LGBT individuals at a greater risk of late stage cancer diagnosis.