Opinions
The ongoing march for LGB health care equality
Turning Supreme Court victories into real change


(Washington Blade photo by Michael Key)
By TIMOTHY M. WESTMORELAND
& JEFFREY S. CROWLEY
Two Supreme Court rulings this summer helped assure that the lesbian, gay, and bisexual (LGB) community reaches health care equality with their non-LGB peers.
The King v. Burwell case upheld the federal subsidies created by the Affordable Care Act (ACA) to help all income-eligible people access affordable private plan insurance in the ACA’s health care marketplaces. Consequently, nearly nine out of 10 LGB adults (88.9 percent) now have some form of health insurance up from just 78.2 percent before the ACA was implemented. These gains mirror those made across other segments of the population.
The ACA also includes provisions that prevent insurers and providers from discriminating against people based on sexual orientation or gender identity. This provision was not directly under question in the King v. Burwell case. If, however, the Court had ruled in favor of the law’s opponents, it is likely these protections would have reached far fewer people.
The second case, Obergefell v. Hodges—which established a Constitutional guarantee for marriage equality across the United States—also had an impact on health care in the LGB community. For the first time for many same-sex couples, a legally recognized marriage meant having access to a spouse’s health insurance. This is to say nothing of what the ruling clears up for same-sex couples when it comes to hospital visits, do-not-resuscitate orders, and the general effects on an individual’s mental and physical health of not having to worry about whether or not the government accepts the validity of a couple’s relationship.
But as was evident from the court battle over a Kentucky clerk’s responsibilities to issue marriage licenses to same-sex couples, compliance with the Supreme Court’s rulings does not always come immediately or easily. Further, despite the newfound marriage equality enshrined in law, the LGB community still faces barriers to accessing health care at equal rates as straight individuals. A new study of survey data, published in the October issue of Health Affairs and authored by researchers at the Urban Institute in Washington, D.C., illustrates that despite recent landmark cases moving the needle on LGB rights and quality, there is still work to be done.
The authors of the study find that even with the increase in the number of LGB adults with health insurance, nearly a quarter of all LGB adults (24.4 percent) reported having problems accessing care over the past year compared to just 16.1 percent of non-LGB adults reporting the same problems. This could be because many of the newly insured had yet to find a doctor or they had so many health issues that went untreated while they were uninsured that it has simply taken more than 12 months to access all the care that they require. Even more troubling is the finding that more than four in 10 LGB adults (42.6 percent) reported having an unmet care need as a direct result of costs over the last twelve months, compared to just 32.4 percent on non-LGB adults reporting the same problem.
While these gaps may lessen, this is no time for complacency. Now that the barrier of health coverage has been reduced, the LGB community and their providers must refocus efforts on eliminating other access barriers in order to eliminate disparities in knowledge of HIV status; adapting the health system to promote widespread, affordable access to pre-exposure prophylaxis to prevent HIV infection; working to ensure early and sustained access to antiretroviral therapy that leads to viral suppression; and routinely screening and treating for other sexually transmitted infections. It also means addressing a broader array of issues directly affecting LGB people including access to breast and cervical cancer screening and tobacco cessation services, among others. Before we turn our attention away from making the ACA work more effectively, however, ongoing advocacy and awareness-raising efforts are also needed in the LGB community about what health insurance options are available, and which plans best suit different individuals and families and their specific health needs.
Though the federal government and the court system have written some aspects of equality into law, the march is not over yet. It is now time to turn law into reality.
Timothy Westmoreland is professor from practice at the Georgetown University Law Center, as well as a senior scholar at the Law Center’s O’Neill Institute for National and Global Health Law. Jeffrey S. Crowley is a distinguished scholar and program director of the National HIV/AIDS Initiative at the O’Neill Institute.
Opinions
USAID’s demise: America’s global betrayal of trust with LGBTQ people
Trump-Vance administration dismantled agency after taking office

The U.S. Agency for International Development — proudly my institutional home for several years of my international development career and an American institutional global fixture since November 1961 — is no more.
How will USAID’s closure impact LGBTQI+ people around the world, especially in poor, struggling countries (“the Global South”)? Time will tell, but “dire,” “appalling,” and “shameful” are appropriate adjectives, given the massive increase in HIV/AIDS deaths that follow the callous, abrupt, and unspeakably cruel cut-off of funding for USAID’s health and humanitarian programming in HIV/AIDS prevention, treatment, and care.
Regarding LGBTQI+ people and issues, USAID worked in a tough neighborhood. In Africa alone, more than 30 countries in which USAID had programming still criminalize same-sex relationships, often to the point of imposing the death penalty. These fiercely anti-LGBTQI+ countries share harsh anti-LGBTQI+ punishments with most countries in the Middle East and North Africa. Other countries where USAID formerly worked retain colonial-era sodomy laws.
Where did USAID fit into all this turbulence? The agency was not allowed to transgress local laws, so how could it support the human rights of local LGBTQI+ people? USAID did so by building close and trusting relationships with local LGBTQI+ civil society, and by “superpower advocacy” for the universal human rights of all people, including those of us in the queer community.
I served at USAID’s Africa Bureau under the Obama administration, becoming the only openly transgender political appointee in USAID’s history. In that role, I was privileged to have a platform that caught the astounded attention of both queer people and of anti-LGBTQI+ governments around the world. If the president of the United States can elevate a transgender woman to such a senior position within the U.S. government, that open declaration of acceptance, inclusion, worth, and recognition set a precedent that many in the LGBTQI+ community worldwide hoped their countries would emulate.
Serving as an openly queer person at USAID also afforded me the opportunity to meet with many fiercely anti-LGBTQI+ senior politicians and government officials from African countries who sought USAID funding. Uganda’s first woman speaker of the parliament, Rebecca Alitwala Kadaga and her whole delegation came to see me at USAID in Washington about such funding. I had some very frank (and USAID-approved) “talking points” to share with her and her team about President Obama’s strong and secular commitment to equal human rights for all people. My tense meeting with her was also an opportunity to educate her as to the nature of the transgender, nonbinary, and intersex community — we who are simply classified and discriminated against as “gay” people in Uganda and in most countries in the Global South. I also had the chance to represent USAID in the “inter-agency” LGBTQI+ human rights task team led by openly gay U.S. Ambassador David Pressman, whose effective leadership of that Obama-era initiative was inspirational.
Working closely with professional, capable, and caring USAID career employees such as Ajit Joshi and Anthony Cotton, and with the strong and open support of the USAID Deputy Administrator Don Steinberg, I helped to craft and promote USAID’s very first LGBTQI+ policy. Under President Obama, USAID also created the LGBT Global Development Partnership, a public-private partnership supporting LGBTQI+ civil society groups throughout the Global South. USAID funding also increased for programs promoting LGBTQI+ inclusion, anti-violence, and relevant human rights protections. This programming expanded further (albeit never adequately funded) during the Biden administration under the able leadership of USAID Senior LGBTQI+ Coordinator Jay Gilliam and his team.
So what did it all mean? Has USAID left a footprint for the global LGBTQI+ community? Will its absence matter?
In my view, that answer is an emphatic yes. International development and humanitarian response go to the heart of recognizing, respecting, and caring about universal human dignity. USAID converted those ethical commitments into tangible and meaningful action, again and again, and modelled for the world what it means to truly include all persons.
My time serving at USAID was a high point of my career, being surrounded by the best of American civil servants and foreign service officers. For me, “USAID Forever” remains my battle cry. Let’s start thinking of how we will rebuild it, beginning in three years.
Chloe Schwenke is a professor at Georgetown University’s McCourt School of Public Policy.
Opinions
Community comes together to repair WorldPride history exhibition
Vandals damaged pictures, timeline walls on June 22

Earlier this month, vandals shouting homophobic slurs damaged the 8-foot hero cubes and timeline walls of the Rainbow History Project’s (RHP) WorldPride exhibition “Pickets, Protests, and Parades: The History of Gay Pride in Washington.” The week’s incident was the fifth homophobic attack on the exhibition chronicling DC’s LGBTQ+ History, the vandalism damage was only made worse by the storms this past week.
In response, RHP posted a call online for volunteers and donations and over a dozen volunteers showed up on Saturday to repair the exhibition in its final stretch.
It took three hours, but the group assembled during a heat advisory to bend the fences back into place, fix the cubes and zip tie all the materials together to keep them safe. Some of those who came out to volunteer, Slatt said, were known RHP volunteers but most were total strangers who had attended an event here or there or just wanted to get involved for the first time, one was even in D.C. as an out-of-town guest and after seeing the Instagram call, decided to spend their day lifting some heavy fencing back into place.
When asked why they showed up, volunteer Abbey said: “especially during Pride month, it’s so important to come together as a community, not just to celebrate, but to support each other. To know that this historic exhibit is even able to exist right now under this administration is really amazing. The fact that we’re just able to help continue it in its last leg of being out here is really important.”
“Rainbow History Project does a lot of work for the community,” another volunteer Ellie said, “they show up in a lot of ways that I think we really need right now, so in terms of being asked to come out and do a couple hours of lifting, that is something that we can easily support and do.”
“We put out a call asking for support from the community, and so we didn’t know what we’d get,” Slatt continued, “but strangers have shown up. We were upset, we were crying. We were trying to come up with a battle plan and more and more people have shown up with open arms and empty hands to do this. It’s 95 degrees, we are melting in the heat. It’s just amazing the number of people who have come here.”
If anything, the anonymous exhibit designer said, the people who vandalized the exhibit made the community stronger and mobilized members passionate about preserving and sharing our histories. Their efforts backfired in a big way — bringing together people who had only attended one or two RHP events or had read about the organization online to actively contribute to the work.
It’s a meaningful representation of the history of D.C.’s LGBTQ+ community, one that often starts with a small group of people who come together to protest but soon mobilize their communities and enact monumental change in the nation’s capital.
“If Pride in D.C. started with 10 people picketing the White House,” Slatt remarked, “you just got 12 more to join the gay history movement.”
This was especially poignant, another volunteer Mattie said, on the week that the Supreme Court issued a decision allowing Tennessee to ban puberty blockers and hormone therapy for minors seeking gender affirming care. It was a devastating moment for the LGBTQ+ community who mobilized once more in front of the Supreme Court this past Friday.
“It’s been actually really important to see this community come together in the face of direct attack on our history in the wake of direct attacks on our rights,” Mattie said, “and we stand up to that. We come together, and we represent. That is so important to maintaining our strength and our community throughout trying times now and ahead.”
When asked about how community members can support RHP’s work and repair the damage long-term to the exhibit, Slatt urged people to donate to RHP, to volunteer as exhibit monitors, and to come visit the exhibit.
“We’ve been doing this for 25 years. This is our 25th anniversary, and if it weren’t for volunteers donating their time and their talents, if it weren’t for small dollar donors, we would never have gotten anything done,” Slatt said. “I’d say to anyone out there that we are on this plaza all through Independence weekend, we are here through the Smithsonian Folklife Festival, people can come on down.”
Slatt and other volunteers will be leading tours each evening at 7 p.m. at Freedom Plaza, and people can pre-order the exhibition catalog right now, which will be delivered in time for LGBTQ+ History Month in October.
Emma Cieslik is a D.C.-based museum worker and public historian.

Independence Day, commonly known as the Fourth of July, is a federal holiday commemorating the ratification of the Declaration of Independence by the Second Continental Congress on July 4, 1776, establishing the United States of America. The delegates of the Second Continental Congress declared the 13 colonies are no longer subject (and subordinate) to the monarch of Britain, King George III and were now united, free, and independent states. The Congress voted to approve independence by passing the Lee resolution on July 2, and adopted the Declaration of Independence two days later, on July 4.
Today we have a felon in the White House, who wants to be a king, and doesn’t know what the Declaration of Independence means. Each day we see more erosion of what our country has fought to stand for over the years. We began with a country run by white men, where slavery was accepted, and where women weren’t included in our constitution, or allowed to vote. We have come far, and next year will celebrate 250 years. Slowly, but surely, we have moved forward. That is until Nov. 5, 2024, when the nation elected the felon who now sits in the Oval Office.
There are some who say they didn’t know what he would do when they voted for him. They are the ones who were either fooled, believing his lies, or just weren’t smart enough to read the blueprint which laid out what he would do, Project 2025. It is there for everyone to see. There should be no surprise at what he is doing to the country, and the world. Last Friday his Supreme Court, and yes, it is his, the three people he had confirmed in his first term, gave him permission to be the king he wants to be. The kind of king our Declaration of Independence said we were renouncing. A man who with the stroke of a pen can ruin thousands of lives, and change the course of America’s future. A man who has set back our country by decades, in just a few months.
So, I understand why many are suggesting there is nothing to celebrate this Fourth of July. How do we have parties, and fireworks, celebrating the 249th year of our independence when so many are being sidelined and harmed by the felon and his MAGA sycophants in the Congress, and on the Supreme Court. Yes, there are those celebrating all he is doing. Those who want to pretend transgender people don’t exist, and put their lives in danger; those who think it’s alright to take away a women’s right to control her body, and her healthcare; those who think parents should be able to interfere on a daily basis with their children’s schooling and wipe out the existence of gay people for them. Those who pretend there was a mandate in the last election, when it was only won by about 1 percent. Those who think disparaging veterans, firing them, and taking away their healthcare, is ok. Those in the LGBTQ community like Log Cabin Republicans, who think supporting a racist, sexist, homophobe is the right thing to do.
So, what do we, as decent caring people, do this Fourth of July. What do we say to those who are being harmed as we celebrate. What do we say to those trans people, those women, those immigrants who came here to escape their own dictators, and are now finding they have come to a country with its own would-be dictator. I say to them, please don’t give up on America. Don’t give up on the possibility decent loving people in our country will finally wake up and say, “enough.” That the majority of Americans will remember we fought a revolution to escape a king, and we fought a civil war to end slavery. That we moved forward and gave women the right to vote, and gave the LGBTQ community the right to marry. Don’t give up on the people that did all that, and think they won’t rise up again, and tell the felon, racist, homophobe, misogynist, found liable for sexual assault, now in the White House, and his sycophants in congress, and his cult, that we will take back our country in the 2026 midterm elections. That we will vote in large numbers, and demand our freedom from the tyranny that he is foisting on our country.
So yes, I will celebrate this Fourth of July not for what is happening in our country today, but rather for what our country actually stands for. Not for birthday parades, and abandonment of the heroes in Ukraine in support of dictators like Putin. But for the belief the decent people in our country will rise up and vote. That is what I will celebrate and pray for this Fourth of July. That is what I think the fireworks will mean this July Fourth. I refuse to accept defeat the same way our revolutionary soldiers wouldn’t, and the way our troops in the civil war wouldn’t till the confederacy was defeated.
I will celebrate this Fourth of July because I refuse to accept we will not defeat those who would destroy our beautiful country, and what it really stands for.
Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.