KFF research reveals ongoing barriers to healthcare for LGBTQ+ adults

Access to cancer prevention, screening and treatment depends on access to health care. New research from KFF shows that LGBTQ+ adults continue to encounter significant barriers to getting and paying for care, with potential implications across the cancer continuum.

The KFF Survey of Health Access and Caregiving found that LGBTQ+ adults were more likely than non-LGBTQ+ adults to postpone or skip needed health care, struggle with medical bills and encounter insurance delays or denials. The challenges were particularly pronounced among transgender adults, younger LGBTQ+ adults, people with lower incomes and those without health insurance.

Although the survey examined health care broadly rather than cancer care specifically, its findings highlight barriers that can affect cancer prevention and control. Regular interactions with health care providers can create opportunities to discuss cancer risk, receive recommended vaccinations, assess family history and determine when cancer screening is appropriate. Delayed or forgone care can mean missed opportunities for those conversations.

Six in 10 LGBTQ+ adults, 58%, said they had skipped or postponed needed health care during the previous year, compared with 38% of non-LGBTQ+ adults. Cost was a major factor: 43% of LGBTQ+ adults said they had skipped or delayed care because of cost, compared with 26% of non-LGBTQ+ adults. Another 28% of LGBTQ+ adults said they had tried to get care but could not find a clinician with an available appointment.

Those barriers matter for cancer control because many prevention and early detection services depend on timely access to health care. Cancer screening is intended to find some cancers earlier, when treatment may be more effective, and some screening tests can identify precancerous changes before cancer develops.

Barriers to routine care can also affect opportunities for clinicians and patients to discuss which screenings are appropriate based on age, personal and family history and other risk factors.

Access challenges were particularly common among transgender adults. Eighty-two percent reported putting off needed care in the past year. More than half said they had postponed care because of cost, while 53% reported being unable to find a clinician with available appointments. KFF noted that previous research has identified additional barriers for transgender adults, including a lack of healthcare professionals appropriately trained to meet their health care needs.

Insurance coverage alone doesn't eliminate barriers

Having health insurance can help people access preventive care and cancer screening, but the KFF findings show that coverage does not necessarily guarantee timely access.

Among LGBTQ+ adults younger than 65, 59% of those with insurance said they had missed or delayed care for at least one reason during the previous year. Among uninsured LGBTQ+ adults, that figure increased to 77%. Nearly three-quarters of uninsured LGBTQ+ adults, 74%, specifically reported postponing needed care because of cost.

Insurance itself can also create delays. Four in 10 insured LGBTQ+ adults said their insurer had delayed or denied coverage for a health care service, treatment or medication prescribed by a doctor during the previous two years, compared with 26% of insured non-LGBTQ+ adults. Among transgender adults, 61% reported experiencing a delay or denial.

Experiences varied by insurance type. Among LGBTQ+ adults younger than 65, 48% of those covered by Medicaid and 46% with self-purchased insurance reported a delay or denial. Thirty-nine percent of those with employer-sponsored coverage reported the same.

For cancer control efforts, the findings reinforce the importance of looking beyond whether someone is insured. Coverage, affordability, clinician availability and the ability to navigate insurance requirements can all influence whether people ultimately receive recommended care.

Health care affordability can also affect more than whether someone schedules an appointment.

Three in 10 LGBTQ+ adults reported having difficulty paying or being unable to pay medical bills during the previous year, compared with 21% of non-LGBTQ+ adults. Nineteen percent said they had cut back on necessities such as food, clothing or other household items to pay health care costs. Among transgender adults, 42% reported difficulty paying medical bills and 28% said they had reduced spending on household necessities to cover health care costs.

Cost also affected whether people took prescribed medications. Twenty-two percent of LGBTQ+ adults said they had cut pills in half, skipped doses or decided not to fill a prescription because they could not afford it, compared with 12% of non-LGBTQ+ adults. The percentage rose to 39% among transgender adults.

These findings demonstrate how financial barriers can compound. Someone deciding whether they can afford an appointment may also be balancing prescription costs, medical bills and everyday household expenses.

Delayed care can have consequences

The survey also found that postponing care was associated with worsening health.

Twenty-nine percent of LGBTQ+ adults said their health had worsened because they did not receive or postponed care, about twice the 14% reported among non-LGBTQ+ adults. Among transgender adults, 45% said their health had worsened because of postponed care.

The survey does not establish how many of those experiences involved cancer prevention, screening or treatment. Still, the broader access patterns are relevant to cancer control efforts designed to help people receive preventive services, complete recommended screenings and move through follow-up care without unnecessary delays.

What this means for cancer control

The KFF findings emphasize that increasing cancer screening is not simply a matter of telling people to get screened and ensuring they have health insurance. People must also be able to find a clinician, secure an appointment, afford their care and navigate their insurance coverage.

They also show why cancer control strategies should consider differences within the LGBTQ+ population rather than treating the community as a single group. KFF found substantial differences based on gender identity, age, income and insurance status. The researchers also cautioned that LGBTQ+ adults differ demographically from the overall U.S. population, including being younger on average, having lower incomes and being somewhat more likely to be uninsured.

However, the analysis found that LGBTQ+ adults remained more likely to skip or delay care even after controlling for factors including age, income, education, insurance coverage, race and ethnicity.

For cancer control organizations, health care providers and community partners, addressing these barriers can mean pairing education about cancer prevention and screening with efforts to improve navigation, connect people with affordable services and create health care environments where patients can access appropriate care.

The goal of cancer screening is not simply to recommend a test. It is to help people get the right screening at the right time and ensure they can access the follow-up care they need.

This article created with the assistance of AI and edited by NCC staff. This is for informational purposes only. For medical advice or diagnosis, consult a professional.