Potential COVID-19 Vulnerabilities in Employment and Healthcare Access by Sexual Orientation

The 2019 coronavirus (COVID-19) pandemic has led to more than 235,000 deaths and 9 million reported positive cases in the United States. Most of the country implemented stay-at-home orders to prevent the spread of COVID-19, which has led to job losses and more than 40 million claims for unemployment insurance. The objective of this study was to estimate the potential impact of COVID-19-related closures in employment and healthcare access by sexual orientation. We used data from the 2015 to 2018 National Health Interview Survey and employment industry codes to describe the working adult population who may be vulnerable to COVID-19 job losses by sexual orientation. Multivariable logistic regression models identified the risk factors for working in a COVID-19-sensitive industry and differences in healthcare access by sexual orientation. We estimate that there may be approximately 1.7 million sexual minorities and 36.6 million heterosexual adults employed in industries that make them vulnerable to unemployment, uninsurance, and limited access to care. Nearly two-thirds of working adults—regardless of sexual orientation—are at risk of severe illness should they become infected with COVID-19. Almost half of the sexual minority and heterosexual adults in industries sensitive to COVID-19 may remain or become uninsured during the pandemic. Approximately 60% of sexual minorities and 40% of heterosexual adults in COVID-19-sensitive industries are renting their home or apartment (rather than owning their home). Because sexual minority adults vulnerable to the COVID-19 pandemic are renting or within family income ranges for premium tax credits in the individual insurance marketplaces, policymakers should consider expanding protections for renters and broadening special enrollment periods for people seeking coverage in the federal and state-based marketplaces.