LGBTQ+ adults are significantly more likely to face challenges accessing and paying for necessary healthcare, according to a new survey released last Thursday from the Kaiser Family Foundation (KFF), a health policy research non-profit.

Out of over 2,600 LGBTQ+ adults surveyed, 58% said they skipped or postponed necessary healthcare in the past year compared to 38% of non-LGBTQ+ people. The two main reasons included costs and inability to get an appointment. Even among those with health insurance and those who make more than $100,000 a year, LGBTQ+ people were more likely to say they skipped or delayed care in the past year.

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When they did seek care, 30% of LGBTQ+ adults surveyed said they struggled to pay medical bills, compared to 21% of non-LGBTQ+ adults.

LGBTQ+ people with insurance also reported higher rates of insurance companies denying coverage than non-LGBTQ+ people (32% compared to 21%). The percentages rose among LGBTQ+ adults on Medicaid (48%) or who self-purchased insurance (46%). A previous KFF study found that LGBTQ+ adults are both younger and have lower incomes than the general population and are more likely to be on Medicaid (25% compared to 15%). According to the new survey, this may partially explain the disparities in denials and delays in coverage for LGBTQ+ people.

Perhaps unsurprisingly, among LGBTQ+ respondents KFF found that transgender people where disproportionately likely to face obstacles in accessing health care. 

“Compared with other LGBQ+ groups, trans adults report the highest rates of difficulty finding providers with available appointments (53%), not taking prescription medications because of cost (39%), worsening health from postponed care (45%), struggling with medical bills (42%), and experiencing insurance delays or denials (61%),” according to the survey. 

Of the transgender people surveyed, 82% said they had delayed care in the past year because of cost or other issues. Trans people were most likely (61%) among LGBTQ+ respondents to report insurance companies denying or delaying coverage within the past two years and to report significant financial consequences due to medical bills (28% compared to 19% of LGBTQ+ people overall).

Cisgender women who identify as LGBQ+ were also more likely than LGBQ+ cisgender men to report delaying medical care (63% vs. 46%). Half of the LGBQ+ women surveyed said they delayed care due to cost, compared to a third of LGBQ+ men, while 31% of LGBQ+ women said they delayed care because they could not get an appointment (compared to 19% of LGBQ+ men who said the same).

Overall, 29% of LGBTQ+ people said their health got worse due to postponing care.

KFF has previously reported on poorer mental and physical health outcomes for LGBTQ+ people, particularly among trans adults. According to the new survey, access and affordability challenges faced by LGBTQ+ people may be a significant driver of these health disparities.