If you walked around our office last Thursday morning, you would have found nearly everyone’s eyes glued to SCOTUSBlog, awaiting the Supreme Court’s decision on the Defense of Marriage Act (DOMA) and the Proposition 8 case from California. And then, at precisely 10:00 AM, you would have heard cheers erupting throughout the building.
Last week’s decisions on DOMA and Proposition 8 move us in the right direction when it comes to limiting health disparities, as many LGBT 
families will now be able to benefit equally from new benefits made possible by the Affordable Care Act.
What does DOMA mean for health care coverage?
While we don’t yet know the full ramifications of the ruling, the two major effects of the decision, thus far, are:
1. Married same-sex couples residing in states with marriage equality can receive a tax deduction on dependent employer-sponsored coverage.
2. Same sex married couples--most likely regardless of the state in which they live--will be able to jointly apply for federal tax subsidies when purchasing health insurance through the State-Based, Partnership, or Federal Marketplaces, as created by the Affordable Care Act. While we continue to wait on the IRS to issue rulings on whether they will look to the state where the couple resides versus the one in which they are married (defined as the place of residency versus the place of celebration), the Obama administration has indicated that they are committed to advancing equal access to coverage for LGBT families.
As the Washington Post suggests, same sex couples who can now file their taxes jointly may be eligible for federal tax subsidies, as two people face a lower income threshold to qualify for tax credits than individuals. Additionally, as the Center for American Progress points out, “Under the current federal tax code, Americans can’t be taxed on the amount of money that their employer puts toward covering the cost of their spouse’s premium. But, while DOMA stood… LGBT couples who were legally married ended up being taxed more for their health care than straight couples who were legally married.”
Now, as a result of the Court’s decision, same sex married couples won’t pay the federal government more for the same health plan as comparable, heterosexual married couples. For additional information about the projected effects of the DOMA decision, check out this collection of fact sheets prepared by our partners at the Center for American Progress.
Meanwhile, we’re continuing to wait, alongside our national and state partners, to find out from the Department of Justice exactly what additional effects the Supreme Court’s decisions will have on the implementation of the Affordable Care Act. In the meantime, there’s significant action to be taken with regards to education, outreach, and ultimately, enrollment in health insurance.
Time for Action!
Now is the time for consumer health advocates and LGBT advocates to capitalize on the energy surrounding the DOMA and Proposition 8 decisions, and collaborate to ensure that those LGBT individuals and families who have been uninsured or underinsured have access to the health care coverage they have long deserved. Neither family status nor income should prevent someone from getting the care they need. Hopefully, the Supreme Court’s rulings provide an opportunity for marriage equality advocates to partner with consumer health advocates and educate constituents on ACA benefits, encouraging enrollment on October 1, and identifying LGBT-friendly enrollment assistance and culturally competent materials.
Impact of SCOTUS Voting Rights Act decision on health access
Finally, while we’re celebrating the opportunities these rulings create for LGBT individuals and their families, we would be remiss to ignore the ramifications of Supreme Court’s decision on the Voting Rights Act. With stricter voter registration standards immediately put in place as a result of last Wednesday’s SCOTUS ruling, six states - Texas, South Carolina, North Carolina, Mississippi, Alabama, and Florida - have already limited access to the democratic process, and with it, limited the voices of many low-income communities and people of color, including LGBT people.
We know that low-income people and people of color will be disproportionately singled out. And with limitations to their abilities to vote come additional real and perceived limitations to accessing health care. For example, without a voice in the democratic process, citizens in states where their governors still refuse to expand Medicaid are more limited in their power to vote for a change in leadership. In more ways than one, the Supreme Court’s decisions last week provide both a friendly and simultaneously stark reminder of the need to work with coalitions and collaborate on advancing access to health care for all types of individuals and families.