The health care package President Obama signed into law Tuesday drew mixed reactions from LGBT rights advocates who praised the legislation for bringing sweeping reform, but expressed disappointment at the exclusion of some LGBT and HIV/AIDS provisions.
After he signed the $940 billion package in the East Room of the White House, Obama touted that the bill would set up insurance exchanges to extend coverage to 32 million uninsured Americans.
“But now what we’re going to do is create exchanges all across the country where uninsured people — small businesses — they’re going to be able to purchase affordable, quality insurance,” he said. “They will be part of a big pool, just like federal employees are part of a big pool.”
Rea Carey, executive director of the National Gay & Lesbian Task Force, praised the legislation. In a statement, she called it “a historic step toward ensuring access to health care for roughly 32 million people.”
“Millions of people across the country are suffering from a lack of adequate, affordable health care and experience unfair, inhumane treatment at the hands of the health insurance industry,” she said. “Lesbian, gay, bisexual and transgender people and our families are among those affected by this broken and imbalanced health care system, which this law aims to fix.”
But the legislation that made its way to the president’s desk lacked any of the LGBT-specific or HIV/AIDS language passed last year in the House version of the bill.
Gone from the final package was a provision eliminating the tax paid on domestic partner health benefits received under an employer plan, as well as language authorizing states to cover low-income people with HIV before they develop AIDS. Also missing is language providing for non-discrimination in health care and a provision authorizing the federal government to collect health care data on the LGBT population.
In a statement, Terry Hamilton, board chair of the Log Cabin Republicans, lambasted Obama and Congress for excluding those provisions from the final health care bill.
“It is disheartening to see the Democratic congressional majority continue to sideline LGBT agenda items — especially critical health care issues — in the name of political expediency,” Hamilton said. “How much longer do they expect gays and lesbians to support them as they continue to take a pass on every opportunity to support our community?”
Acknowledging the lack of those provisions, Carey said the Task Force would continue to fight for additional health care reform that specifically targets LGBT people and disadvantaged groups.
“Every April 15, same-sex couples and our families write an extra check to the [Internal Revenue Service] to pay for domestic partner and spousal benefits — the very same benefits opposite-sex married couples get tax free,” she said. “The federal government must add sexual orientation and gender identity-specific questions to all national health surveys in order to get a more accurate picture of the community’s needs.”
A House Democratic leadership aide, who spoke on the condition of anonymity, said the early treatment for HIV and data collection provisions weren’t included in the final bill because they had no budgetary implications and thus were ineligible under parliamentary rules.
Congress is passing health care reform through the reconciliation process so that only 51 votes are required in the Senate for passage for the final bill as opposed to the 60 that would be needed to overcome any filibuster. Under this process, any changes the House wanted to make to the previously approved Senate bill had to be part of a sidecar reconciliation package. But under reconciliation, only matters related to the budget are eligible for a vote.
As for the domestic partner tax elimination provision, which may have budgetary implications because it deals with taxation, the House aide deferred to the White House on why the provision wasn’t included in the final bill. A White House spokesperson declined to comment.
Although the LGBT and HIV/AIDS provisions unique to the House legislation weren’t included in the reconciliation package, the final bill has one provision aimed to help to HIV/AIDS community that was included in both the House and Senate versions of the legislation.
The language would enable AIDS Drug Assistance Program expenditures to count toward out-of-pocket expenses under Medicare Part D. People with HIV/AIDS on Medicare who receive help purchasing HIV drugs would thus have a lightened burden for other prescription drug costs.
Other provisions in the final bill — less explicitly directed at people with HIV/AIDS — would assist people living with the disease.
The final health bill eliminates discrimination based on health status or pre-existing conditions, such as HIV/AIDS. Additionally, the bill expands Medicaid eligibility for people with incomes below 133% of the federal poverty level, allowing more low-income people with HIV to access Medicaid and its prescription drug coverage.
Although the House LGBT provisions were missing from the final bill, advocates on Capitol Hill pledged to work to pass this language through other legislative vehicles.
In a statement, Jerilyn Goodman, spokesperson for lesbian Rep. Tammy Baldwin (D-Wis), an advocate of the LGBT legislative language, said the lawmaker looks forward to passing the health care bill and pursuing “every available option to pass the other LGBT provisions.”
In a message on the Human Rights Campaign web site, Brian Moulton, HRC’s chief legislative counsel, said his organization was “deeply disappointed” the LGBT language was omitted. Still, he noted that HRC would continue working for the provisions.
“While we are saddened that the House has abandoned provisions that would make care more accessible and affordable to our community, we recognize that the health reform measure will still help all Americans, including LGBT people,” he said. “Important reforms like eliminating pre-existing condition limitations and expanding Medicaid will significantly impact people living with HIV and AIDS.”