Health Care Access and Financial Barriers Among LGBT People Amidst Looming Health Care Cuts – KFF

Report on Healthcare Affordability for LGBT Adults: Implications for Sustainable Development Goals

This report analyzes the state of healthcare affordability for LGBT adults in the United States, based on data from the May 2025 KFF Health Tracking Poll. The findings highlight significant disparities that challenge the advancement of several key Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being), SDG 10 (Reduced Inequalities), and SDG 1 (No Poverty).

Legislative Context and Threats to SDG 3 and SDG 10

Recent legislative actions, including the reconciliation bill signed into law on July 4, 2025, are projected to undermine progress towards universal health coverage and exacerbate existing inequalities. These policy changes pose a direct threat to achieving core SDG targets.

• Reduced Access to Healthcare: The new law is expected to cause millions of low- and moderate-income individuals to lose Medicaid coverage, directly contravening the principles of SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages.
• Disproportionate Impact on Vulnerable Groups: Given that LGBT adults exhibit higher rates of Medicaid coverage compared to non-LGBT adults, these changes are poised to disproportionately harm this community, thereby widening the gap and hindering progress on SDG 10 (Reduced Inequalities).
• Exacerbation of Health Disparities: Increased cost barriers for a community already experiencing a wide range of health disparities threaten to worsen health outcomes, moving further away from the goals of ensuring equitable health access.

Key Findings: Economic and Healthcare Disparities

The survey data reveals profound disparities in economic stability and healthcare affordability between LGBT and non-LGBT adults, underscoring the interconnectedness of SDG 1, SDG 3, and SDG 10.

Economic Vulnerability and SDG 1 (No Poverty)

LGBT adults report significantly higher rates of difficulty affording basic necessities, a key indicator related to poverty and economic instability.

• Struggle with Necessities: 51% of LGBT adults reported problems paying for essentials like food and housing in the past year, compared to 30% of non-LGBT adults.
• Healthcare Affordability Issues: 36% of LGBT adults faced challenges paying for healthcare, a rate substantially higher than the 21% reported by non-LGBT adults.
• Income-Related Disparities: Among LGBT adults with household incomes under $40,000, 63% struggled to pay for basic necessities, highlighting a severe challenge to achieving SDG 1.

Barriers to Healthcare Access and SDG 3 (Good Health and Well-being)

Cost-related barriers prevent LGBT adults from accessing necessary medical care, directly impacting health outcomes and undermining the objective of universal health coverage.

1. Postponement of Care: 51% of LGBT adults have skipped or postponed needed health care due to cost, compared to 34% of non-LGBT adults. This trend persists across income levels within the LGBT community.
2. Deteriorating Health: As a direct consequence, 25% of LGBT adults report that their health worsened after postponing care due to cost, compared to 18% of non-LGBT adults.
3. Prescription Medication Rationing: To manage costs, a significant portion of the LGBT community has resorted to measures that compromise treatment efficacy.
   • 44% of LGBT adults have taken at least one cost-saving action, such as not filling a prescription (26%) or cutting pills in half (23%). This compares to 32% of non-LGBT adults.

Widespread Concern and Impact on Well-being

The constant financial pressure and difficulty accessing care contribute to significant worry and stress, affecting the overall well-being targeted by SDG 3.

• High Levels of Worry: Over two-thirds of LGBT adults are worried about affording unexpected medical bills (68%) and health costs (66%).
• Broad Financial Anxiety: Compared to non-LGBT adults, LGBT adults express greater worry about affording fundamental needs such as rent/mortgage, food, and transportation, further illustrating the challenges to achieving SDG 1 and SDG 10.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article highlights issues that are directly and indirectly connected to several Sustainable Development Goals. The analysis below identifies the most relevant SDGs based on the article’s focus on health care affordability, income disparities, and the disproportionate impact of policy on the LGBT community.

• SDG 1: No Poverty

  The article connects directly to SDG 1 by discussing the financial hardships faced by low- and moderate-income individuals, particularly within the LGBT community. It highlights problems paying for basic necessities like food and housing, which are core elements of poverty measurement. The text states, “Half (51%) of LGBT adults say that in the past year, they or a family member living with them has had problems paying for food, housing, transportation, or other necessities.”

• SDG 3: Good Health and Well-being

  This is the central SDG addressed in the article. The entire text revolves around health care access, affordability, and outcomes. It discusses the impact of losing Medicaid, the unaffordability of insurance premiums, challenges in paying for health care, and the consequences of skipping medical care and prescription drugs due to cost. The article notes, “as LGBT people experience a wide range of health disparities, cost barriers may serve to exacerbate these differences.”

• SDG 5: Gender Equality

  While SDG 5 focuses on women and girls, its principle of ending discrimination and achieving equality is relevant to the LGBT community. The article’s core argument is that policy changes and health care costs disproportionately affect LGBT adults, highlighting a significant inequality based on “other status” (sexual orientation/gender identity). The data consistently compares the experiences of LGBT adults to non-LGBT adults, demonstrating systemic disparities.

• SDG 10: Reduced Inequalities

  This SDG is explicitly addressed by the article’s comparative analysis between LGBT and non-LGBT adults. The article demonstrates clear inequalities in income, health coverage, and the ability to afford care. It states that policy changes “could disproportionately impact this community” and provides data showing LGBT adults face more problems with affordability “compared to non-LGBT adults,” directly addressing the goal of reducing inequalities between different population groups.

• SDG 16: Peace, Justice and Strong Institutions

  The article touches upon this goal by discussing the role of government policy and legislation (the “reconciliation bill”) in creating or worsening social inequalities. The signing of a law that is expected to leave millions uninsured and disproportionately harms a specific community raises questions about the justice and non-discriminatory nature of institutional actions, which is a key aspect of SDG 16.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the article’s content, several specific targets within the identified SDGs can be pinpointed.

1. SDG 1: No Poverty

   • Target 1.2: By 2030, reduce at least by half the proportion of men, women and children of all ages living in poverty in all its dimensions according to national definitions. The article addresses this by highlighting the high percentage of LGBT adults (51%) who have “had problems paying for food, housing, transportation, or other necessities,” which is a measure of poverty in its various dimensions.

2. SDG 3: Good Health and Well-being

   • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all. The article directly relates to this target by discussing the loss of Medicaid, unaffordable ACA premiums, and the high percentage of LGBT adults who find it “difficult for them to afford their health care costs” (52%) and have skipped care due to cost (51%). The challenges with affording prescription drugs are also explicitly mentioned.

3. SDG 10: Reduced Inequalities

   • Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status. The article’s focus on the economic and health-related exclusion faced by LGBT adults aligns with this target. It notes that “LGBT adults have lower incomes and higher rates of Medicaid coverage,” making them more vulnerable to policy changes.
   • Target 10.3: Ensure equal opportunity and reduce inequalities of outcome, including by eliminating discriminatory laws, policies and practices. The article discusses a specific policy (the reconciliation bill) that is predicted to create unequal outcomes, as it will “disproportionately impact” the LGBT community, thus working against this target.

4. SDG 16: Peace, Justice and Strong Institutions

   • Target 16.b: Promote and enforce non-discriminatory laws and policies for sustainable development. The article implies that the reconciliation bill is a policy that has a discriminatory effect, even if not in intent, by disproportionately harming low-income individuals and the LGBT community. This runs counter to the principle of enforcing non-discriminatory policies.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article is rich with quantitative data from the KFF Health Tracking Poll that can serve as direct or proxy indicators for measuring progress.

1. For Target 1.2 (Reduce poverty):

   • Indicator: The proportion of the population experiencing problems paying for basic necessities. The article provides specific data: “Half (51%) of LGBT adults say that in the past year, they or a family member living with them has had problems paying for food, housing, transportation, or other necessities. This compares to three in ten non-LGBT adults.”

2. For Target 3.8 (Achieve universal health coverage):

   • Indicator (Financial Risk Protection): The proportion of the population facing difficulties affording health care costs. The article states, “About half (52%) of LGBT adults say it is difficult for them to afford their health care costs.”
   • Indicator (Access to Essential Services): The proportion of the population that skipped or postponed needed health care due to cost. The article reports, “Half (51%) of LGBT adults report that they have skipped or postponed getting the health care they needed in the past year because of the cost.”
   • Indicator (Access to Affordable Medicines): The proportion of the population taking cost-saving measures for prescription drugs. The article finds that “More than four in ten LGBT adults (44%) report taking at least one of these actions [e.g., not filling a prescription, cutting pills]… because of the cost.”

3. For Targets 10.2 & 10.3 (Reduce inequalities):

   • Indicator: Disaggregated data showing disparities between population groups. The entire article serves this purpose by consistently comparing LGBT and non-LGBT adults across various metrics, such as:
     • Problems paying for health care: 36% of LGBT adults vs. 21% of non-LGBT adults.
     • Skipping care due to cost: 51% of LGBT adults vs. 34% of non-LGBT adults.
     • Worsening health due to skipped care: 25% of LGBT adults vs. 18% of non-LGBT adults.
   • Indicator (Income Inequality): The article references income disparities as a root cause of inequality, noting that “LGBT adults generally being younger and having lower household incomes than non-LGBT adults.” It also provides data broken down by income levels (under and over $40,000).

4. Table of SDGs, Targets, and Indicators

Source: kff.org