Cover: The State of Health and Health Care for LGBTQ+ Veterans

The State of Health and Health Care for LGBTQ+ Veterans

Differences Among Sexual and Gender Minority Veterans, by Identity and State Policy Climate, 2015–2021

Published Jun 4, 2024

by Megan S. Schuler, Michael S. Dunbar, Elizabeth Roth, Joshua Breslau

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Research Questions

  1. What are the differences in health care access and health outcomes for LGBTQ+ veterans when compared with their cisgender and heterosexual peers?
  2. How is local LGBTQ+ state policy climate associated with health care access and health outcomes for LGBTQ+ veterans?
  3. What are some of the implications of policies to improve the health and well-being of LGBTQ+ veterans?

The U.S. government has affirmed commitments to improving health and well-being for lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) veterans, who may have distinct needs and challenges when accessing timely and appropriate health care. To date, there are limited data about potential health disparities among LGBTQ+ veterans that examine differences by both sexual identity and gender identity. Understanding the nature and magnitude of disparities among LGBTQ+ veterans is critical for targeted efforts to improve their health and well-being.

The authors of this report use nationally representative data from 2015–2021 from the Behavioral Risk Factor Surveillance System to compare the age-adjusted prevalence of health-related outcomes across multiple domains (health care access and affordability, general health, substance use, and chronic conditions) for sexual and gender minority veterans with that of their heterosexual and cisgender veteran peers. LGBTQ+ veterans showed poorer health-related outcomes in multiple domains than their heterosexual and cisgender peers, including in terms of healthcare affordability, mental health, chronic cardiovascular conditions, and chronic respiratory conditions. The authors also examine associations between state LGBTQ+ policy climates and health-related outcomes among LGBTQ+ veterans. Among LGBTQ+ veterans, living in a state with a more favorable (versus negative) LGBTQ+ policy climate was associated with several health indicators (e.g., having health insurance, lower smoking rates). The authors then discuss implications for ongoing efforts to improve health and well-being for LGBTQ+ veterans, including sustained actions to ensure that all LGBTQ+ veterans are able to access necessary care and use the full scope of benefits for which they are eligible.

Key Findings

Female and male sexual minority veterans, as well as transgender veterans, showed poorer health-related outcomes

  • Among both female and male veterans, those who identify as bisexual or another nonheterosexual identity were significantly more likely to report having been unable to afford medical care in the past year than heterosexual veterans of the same sex.
  • Lesbian or gay female veterans and gay male veterans were significantly more likely to report current cigarette smoking than heterosexual female and male veterans.
  • Male and female sexual minority veterans had significantly elevated odds of reporting a lifetime history of major depressive disorder when compared with their heterosexual peers.
  • Among both female and male veterans, all sexual minority groups were more likely to rate their mental health as "not good" for more than two weeks in the past month than their heterosexual peers were.
  • Lesbian or gay female veterans, gay male veterans, and bisexual male veterans were significantly more likely to have a lifetime diabetes diagnosis than their heterosexual veteran peers were. Transgender veterans were more likely to report a lifetime diabetes diagnosis than cisgender veterans were.

Living in a state with a more favorable LGBTQ+ policy climate was associated with better health-related outcomes

  • State LGBTQ+ policy climate was associated with some indicators of health care access.
  • Few statistically significant associations between state LGBTQ+ policy climate and outcomes were observed in other domains.

Recommendations

  • Targeted efforts to enhance awareness of benefits and available services and ensure accessibility of affordable health care may be needed to address disparities for LGBTQ+ veterans.
  • Actions are needed to raise awareness for LGBTQ+ veterans regarding the U.S. Department of Defense's process to upgrade less-than-honorable discharges under "Don't Ask, Don't Tell," and there is a need to lessen the administrative barriers, costs, and review timelines of this process to ensure that LGBTQ+ veterans receive the full benefits for which they are eligible.
  • Continued support for and expansion of LGBTQ+-affirming services within the Veterans Health Administration are needed to help connect LGBTQ+ veterans with available services in the Veterans Affairs system and in their communities.
  • Additional studies are urgently needed to assess the impact of evolving LGBTQ+ state policy climates on health and related outcomes for LGBTQ+ veterans as the number of anti-LGBTQ+ bills introduced in state legislatures continues to increase.

Unit/Program: EDL/RAND Epstein Family Veterans Policy Research Institute; HC/RAND Health Care RAND Education and Labor RAND Health Care RAND Epstein Family Veterans Policy Research Institute

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