A report by RMPBS Reports partner, Health Policy Solutions
For other stories from Health Policy Solutions and additional news, visit RMPBS Reports.
By Katie Kerwin McCrimmon
Every second counted.
The baby boy was having trouble breathing. So, his parents raced to an urgent care clinic in Fort Collins where they were visiting family over the weekend.
Jacobb Prussman, then about a year old, was becoming listless as triage nurses looked on. But his parents said the nurses refused to care for him until a clinic worker finished checking them in.
And the worker kept insisting on knowing Jacobb’s mother’s name and her financial information even though his two legal parents stood before her with their son.
“We were pretty concerned and anxious because he was gasping for air at that point. It got really scary. We’re it. We’re just two dads. It was a surreal experience,” said Jason Cobb, one of Jacobb’s fathers. “He should have received care immediately. It was terrifying. Instead of focusing on our son, the focus turned to our relationship.”
Colorado’s civil unions bill — which died after a vitriolic showdown on the House floor Tuesday night but will come back to life in a special session starting as soon as Friday — would have had far-reaching health policy implications for families with same sex partners.
The fight over civil unions in Colorado and President Barack Obama’s endorsement of gay marriage today have sharpened the focus on same sex partnerships, medical rights and children like Jacobb who are the center of thousands of non-traditional families in Colorado.
During a rally at the Capitol on Tuesday, advocates pledged that civil unions will prevail in Colorado. Governor John Hickenlooper on Wednesday afternoon got choked up as he said the issue was extraordinarily important and merited a special session.
“Everyone deserves the same legal rights in this country,” Hickenlooper said. “This is a circumstance where we are depriving people of their civil rights.”
Regardless of the outcome of the special session, activists expect civil unions to pass eventually.
“No matter what happens today or tomorrow, the unspoken truth in this whole debate is we will win,” said Jace Woodrum, deputy director for One Colorado, the state’s largest advocacy organization representing the lesbian, gay, bisexual and transgender (LGBT) community.
“Whether it is today or tomorrow or next year or the next, we will win. Gay and lesbian couples in this state will have full protection under the law. We all know it, and everybody in this building knows it,” he said.
So what was lost when the bill died Tuesday?
Security and automatic recognition by medical institutions for gay and lesbian partners and parents will have to wait. And, experts on health insurance say a civil unions bill would have a dramatic effect on reducing the number of uninsured people in Colorado. Today, an estimated 800,000 people in Colorado have no insurance and one in three Coloradans, or 1.5 million people are either uninsured or underinsured, meaning health costs are gobbling up more of their income than they can afford, according to the Colorado Health Access Survey.
For Jason Cobb and his partner, Jason Prussman, passage of civil unions would have brought great relief. Both Denver lawyers, they have for years carried proof of Jacobb’s adoption and their designated beneficiary agreement, spelling out their wishes in case of a medical emergency.
“It’s my security blanket,” Cobb said of the trove of papers he keeps close, especially when he’s traveling. He and Jacobb don’t look alike. So he has always felt vulnerable to questioning.
“If you get pulled over for speeding or something, you don’t want your child to end up in protective services. These are the kinds of things that keep gay parents awake at night. All parents worry about their kids. But there’s an extra level of anxiety that comes with being a gay parent. You don’t know when something is going to happen.”
On that day in Fort Collins, when the unexpected did happen, a supervisor finally intervened to get the family medical help. Jacobb apparently had a respiratory infection that worsened fast. He received treatments and recovered fully. He is now 5. Still, his dads had no power to force the health care worker to recognize them as Jacobb’s parents and give them equal treatment. The computer system had a space for one mom and one dad, not for a second dad. The worker either didn’t know how to accommodate a non-traditional family or wasn’t willing.
Executive order banned hospital discrimination
Blatant discrimination is supposed to be banned across the country.
In April of 2010, President Barack Obama issued an executive order that requires any medical institution that receives Medicare or Medicaid funding to give partners of gay men and lesbians visitation rights and respect patients’ choices about who may make critical health decisions for them.
But Colorado hospitals and medical facilities each have their own policies for how they deal with same sex couples, bisexuals and transgender people.
Activists say the right to create civil unions would have made protections for them automatic and would have helped people understand their relationships.
The law would have afforded same sex partners the same protections that married spouses do under all “laws, policies or procedures relating to emergency and non-emergency medical care and treatment and hospital visitation.”
Senate Bill 12-02 also provides additional protections related to health care including access to health insurance benefits; domestic violence protection; visitation rights in medical, mental health facilities and jails; the right to declare or withdraw medical treatment orders; eligibility for family leave; and the right to decide about organ donation for a partner.
But the greatest change would come in dramatically increasing access to health care.
“Civil unions would extend coverage. Period,” said Dr. Mark Thrun, a physician at Denver Health, who has two sons with his partner and serves as an expert advisor to One Colorado. Because Denver Health offers domestic partner benefits, Thrum is able to obtain health insurance for his partner and their sons.
But many other people in same-sex relationships don’t qualify for health insurance through their partner’s employer.
“If my relationship is legally recognized by the state, payers will need to treat me equitably relative to all other legally recognized relationships,” Thrun said.
LGBT people refused medical care
It is unclear exactly how many of the hundreds of thousands of uninsured people in Colorado are gay, lesbian, bisexual or transgender. But the “Invisible” survey of nearly 1,200 people in Colorado’s LGBT community, found that more than 30 percent of bisexual Coloradans had no health insurance while 27 percent of transgender people did not have insurance. That was about double the rate for people who are heterosexual, lesbian or gay.
Among other findings from the survey:
About one in five LGB people surveyed said they had been refused health care.
- More than half —53 percent of transgender respondents — said they had been refused health care.
- Nearly three out of four LGBT Coloradans viewed legal fees and services needed to create designated beneficiary agreements, medical power of attorney or other legal protections for their partners, families and children to be a barrier to seeking health care services.
- Even with legal agreements in place, fewer than half of respondents were satisfied that they could participate in medical decision-making with their partner.
- Only 42 percent of respondents felt that health care providers would understand their legal rights and the rights of their partners despite arrangements made to ensure medical decision-making for themselves and their children.
The Colorado Consumer Health Initiative represents more than 50 health organizations and 500,000 health consumers in Colorado and advocates for affordable, accessible, quality health care for all Coloradans.
The group supported the civil union bill primarily because it would have expanded access to coverage.
“Clearly most people in the country and in the state get their access to health insurance through employer-sponsored insurance,” said Dede de Percin, executive director of CCHI and a member of One Colorado’s health steering committee.
Particularly among low- and moderate-income families, de Percin said, a spouse’s employer plan can be key to getting coverage for the both adults and the children in a family.
De Percin said that employers who offer health insurance to spouses and dependents also would have had to offer that same insurance to civil union partners.
“Companies could block this. They don’t have to offer insurance for dependents or pay for it,” she said. “But they’d have to block it for everyone.”
Individual businesses pay more in general to offer health coverage to dependents of their employees. And some allow access to insurance for spouses and children, but choose not to bear any of the costs. While health care costs have soared in recent years, many employers see good family health insurance benefits as a vital strategy for recruiting and retaining the best employees.
The Colorado Association of Commerce and Industry did not take a position on the civil unions bill. The Colorado Hospital Association has monitored the measure, but does not support or oppose it.
Legal agreements costly
Without the civil union bill, same sex partners in Colorado will continue to have the right to make health care decisions for each other and spell out their role as parents of their children.
But the cost and the complications of creating those agreements are high.
Dr. Rita Lee is an internal medicine doctor at the University of Colorado’s Anschutz Medical Campus and an assistant professor at the CU School of Medicine. She estimates that she and her partner spent more than $7,000 on legal agreements to clarify their relationship with their two sons, ages 22 months and seven months. They had to codify a second parent adoption, create designated beneficiary agreements and living trusts and register as domestic partners.
“LGBT families spend thousands of dollars to cobble together legal protections for their families. Despite doing so, less than half of those (in same sex partnerships) were satisfied with their ability to participate in medical decision-making for their partner,” Lee said, citing findings from the “Invisible” study.
Without the civil union protections, families can spell out many agreements, but they can’t force employers to give their partners health insurance. Nor can they guarantee that medical providers will be educated about their unique health needs and sensitive about caring for them.
Lee teaches a course to medical students on how to take sexual histories of their patients and how to offer better care to members of the LGBT community. The course is relatively short and new at the CU medical school, having been offered for about four years. Lee considers it a cursory introduction to LGBT health needs, but she said it’s a start.
Some health providers are openly hostile to LGBT people. In the past, doctors sometimes told gays and lesbians that they needed to change their sexual orientation or abstain from sex and relationships.
Some providers also never ask their patients about their sexual orientation. They don’t realize that knowing that information is central to offering high-quality care.
“You understand who their families are for decision-making purposes and who to call if there’s a problem,” Lee said.
Also, certain medical treatments are directly related to sexual orientation. For instance, men who have sex with men are supposed to get both the Hepatitis A and B vaccines, Lee said. Transgender people have unique medical needs relating to hormones and surgeries.
Lee has one patient who is transitioning from female to male. He needs both testosterone shots and pap smears. And males who have had surgery to become females will still have a prostate and will need monitoring to prevent prostate cancer.
“If you didn’t know that, you wouldn’t be able to properly take care of them,” Lee said.
Health providers not waiting for new law
Denver pediatrician, Mark Groshek, said that even without a civil unions bill, health care institutions are working to help providers be more sensitive to the needs of non-traditional patients. There is a lot of history of poor care to counteract and members of the LGBT community certainly live in fear of discrimination.
“Even if same sex couples don’t experience anything bad in the health care setting, they worry,” said Groshek, who is also on health steering committee for One Colorado.
“There are these horrible stories, most of them in other states, where something has happened. A couple is on a cruise (for example). One collapses and the partner is not allowed to be there when she dies. These things do happen and there are a lot of people in health care who are interested in not letting that happen,” he said.
Groshek works for Kaiser Permanente, but is not speaking on behalf of the institution. He said training sessions for providers are much more common today. Such continuing education sessions focus on “culturally competent care.” Both additional training and “evolving” views from President Obama to other leaders are changing the dynamic for LGBT in U.S. health care systems.
“What we’re seeing in general across the country — and this depends on how conservative the community is — is that more people in health care and in society in general are becoming supportive of these rights and desires. It’s getting easier for people in the LGBT community to be treated like a spouse,” Groshek said.
Even if the civil unions bill dies again in special session, Groshek said advocates will continue to make progress.
“Things won’t be any different than they are now. People still have to spend a lot more money than people who are legally married to lay out in clear language what their desires are,” he said. “It’s not a step backwards…but many people (in health care) are not waiting for the law. They’re respecting what people want now.”