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Why do fewer bisexual people have employer drug coverage?

Earlier this year, Statistics Canada released a report on gaps in prescription drug coverage in Canada. Eighty per cent of Canadians have some degree of drug coverage through the thousands of private, public, association, or employer-sponsored insurance plans in the country, but inequalities exist in the level and quality of that coverage.

Among the groups lagging behind in adequate access to affordable prescription plans, the report found bisexual people were significantly less likely to have drug coverage from their employer than either heterosexual, gay, or lesbian men and women, and more likely to rely on government-sponsored coverage.

So why is there a marked difference in prescription drug insurance for bisexual men and women compared with other sexual orientations?

The answer involves a complex interplay of factors, but at its core has to do with employment disparities faced by many members of the 2SLGBTQI+ community, said Dr. Jacqueline Gahagan, associate vice-president of research at Mount Saint Vincent University.

“What that means is you see lower rates of full-time employment. And as you see lower rates of full-time employment, you see lower rates of the employer covering drug costs,” Gahagan said.

Underemployment, low income, and discrimination

A study from the University of Toronto’s Dalla Lana School of Public Health in 2023 reviewed existing research and conducted in-depth interviews with workers, service providers, advocates, and employers. The authors noted pervasive workplace discrimination on the basis of sexual orientation and gender identity, and the workforce outcomes this creates varies greatly within the 2SLGBTQI+ community.

“Bisexual men and women have the lowest incomes of any sexual minority group,” the authors write. They are also the least likely of any sexual identity group to be working full-time, and like other sexual and gender minorities, avoid careers where the anticipate facing more discrimination.

Bisexual men, for example, are less likely to be employed in the trades. And bisexual women are less represented in health care than their heterosexual peers.

“As bisexual people are the lowest earners of any sexual minority group, discrimination likely contributes to their income,” the study says.

Need for more focused research

For its report exploring gaps in prescription drug coverage, StatCan analyzed a large, general population survey. With these types of surveys, “there’s always the question of how comfortable people feel with disclosing their sexual orientation,” said Dr. Kristopher Wells, the Canada Research Chair for the Public Understanding of Sexual and Gender Minority Youth.

“It’s an interesting finding, and one that would benefit from more focused research,” he said.

“The stats tell one story, but we really need to go into having some focus group conversations with people within the bisexual community to really dig deeper into their healthcare experiences. This notion of access to prescription drugs is a very narrow slice.”

Gahagan said that along with the limits of this particular general population survey, research on 2SLGBTQI+ people tend to overlook the “structural drivers in the workplace that are making people unwell.”

“We have sort of psychopathologized being gay or being bisexual or being lesbian. To the point where we focus on poor health indicators, as opposed to asking the question, what actually keeps bisexual men well?”

“So instead, we look at a deficit model of there’s not enough drug coverage, there’s not enough employment attachment for bisexual men, and I would argue for bisexual women and lesbians as well. That is the piece we need to actually dig deeper into: what are the elements within, for example, workplace attachment that makes for better health outcomes across the board?”