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LGBT provisions cut from health care reform bill



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.”



Gilead awards $5 million grant to HRC’s HIV and health equity programs

Money to support efforts to end the epidemic and combat stigma



Human Rights Campaign headquarters in D.C.(Washington Blade photo by Michael Key)

The Human Rights Campaign was awarded a $5 million grant from drugmaker Gilead Sciences to expand the organization’s HIV and health equity programs, supporting efforts to end the HIV epidemic by 2030 while combatting stigma in Black and Latino communities.

Funds will be used over the next three years for the HRC Foundation’s HIV and Health Equity Program, its Historically Black Colleges and Universities Program, and its Transgender Justice Initiative, HRC said in a statement Wednesday announcing receipt of the award, which extends Gilead’s $3.2 million grant to the HRC Foundation in 2021.

The organization said its HIV and Health Equity Program plans to develop a “benchmarking tool for institutions that provide HIV services, helping better evaluate the quality of care and measure racially and socially inclusive approaches” while defining “best practices, policies and procedures to optimize HIV service provision for BIPOC LGBTQ+ communities.”

HRC President Kelley Robinson said, “Since the beginning of the HIV epidemic, racism and anti-LGBTQ+ discrimination have created dangerous hurdles for those seeking prevention or treatment.”

“With the generous support of Gilead Sciences, we’ll be able to continue providing critical
resources to help overcome these hurdles, especially focusing on Black and Latine communities in the U.S. South,” Robinson added. “We’ll also be able to expand our efforts, as we seek to remove institutional barriers often unknowingly created by HIV service providers. We must decrease the disparities that place an unnecessary burden on Black and Latine LGBTQ+ people and people living with HIV.”

Gilead Executive Vice President of Corporate Affairs and General Counsel Deborah Telman said the company “is committed to advancing health equity, particularly in Black communities and other communities of color that are disproportionately affected by HIV.”

“This grant will build on the impactful work HRC has done with community partners and HBCUs to increase awareness of HIV treatment and prevention options and reduce health disparities, combat discrimination and fight stigma,” Telman said.

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New CDC data shows HIV infections dropped, but mostly among whites

Socioeconomic factor into disproportionate rates



Data published Tuesday by the Centers for Disease Control and Prevention shows a significant decline in new HIV infections, but suggests the impact of prevention efforts was far less substantial for Black and Latino populations.

From 2017-2021, as rates of HIV testing, treatment and the use of pre-exposure prophylaxis (PrEP) medication rose, new cases dropped by 12 percent overall and by as much as 34 percent among gay and bisexual males aged 13-24.

The numbers show a “move in the right direction,” CDC Director Rochelle Walensky said in a press release.

However, when broken down by race, the CDC found new infections were down by 27 percent and 36 percent, respectively, among Black and Latino populations, compared with 45 percent of whites.

Similarly, by 2021 about one third of those who are considered eligible were taking PrEP for HIV prevention, but the CDC noted this number includes “relatively few Black people or Hispanic/Latino people” despite the significant increase in prescriptions up from just 13 percent in 2017.

“Longstanding factors, such as systemic inequities, social and economic marginalization and residential segregation,” Walensky noted, continue to act as barriers “between highly effective HIV treatment and prevention and people who could benefit from them.”

She added, “Efforts must be accelerated and strengthened for progress to reach all groups faster and equitably.”

Robyn Neblett Fanfair, acting director of the CDC’s Division of HIV Prevention, said that “At least three people in the U.S. get HIV every hour — at a time when we have more effective prevention and treatment options than ever before.”

“These tools must reach deep into communities and be delivered faster to expand progress from some groups to all groups,” she said.

The HIV+Hepatitis Policy Institute issued a press release following the CDC’s announcement of the new data, noting both the encouraging progress and need for improvement.

“It appears that our investments in HIV prevention are providing some positive results, but the persistent high number of new diagnoses and the low usage of PrEP among the communities most impacted by HIV point to the need for increased resources, particularly for a national PrEP program,” said the group’s executive director, Carl Schmid.

President Joe Biden’s FY24 budget requested $237 million for a national PrEP program along with $850 million to support the U.S. Department of Health and Human Services’ “Ending the HIV Epidemic in the U.S.” initiative.

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Officials eye mpox prevention, vaccination initiatives for this summer’s LGBTQ events

New cluster of cases reported in Chicago



Drs. Robert Fenton and Demetre Daskalakis, coordinator and deputy coordinator for the White House national mpox response, during a briefing in August 2022 (Official White House Photo by Cameron Smith)

Federal health agencies, in coordination with their state and local counterparts and community partners, are exploring opportunities to offer mpox prevention initiatives and vaccinations at LGBTQ events this summer, Dr. Demetre Daskalakis said on Thursday.

Daskalakis, the deputy coordinator for the White House’s national mpox response, described these deliberations in response to a question from the Washington Blade during a media telebriefing on mpox that was hosted by the Centers for Disease Control and Prevention.

The CDC on Monday issued a Health Alert Network Health Update on the potential risk for new mpox cases.

Since the peak of about 460 cases per day in August 2022, new cases have steadily declined, but following the cluster recently reported in the Chicago area, the update warns, “spring and summer season in 2023 could lead to a resurgence of mpox as people gather for festivals and other events.”

“We have the vaccine, and we have organizations that are willing to do it,” Daskalakis said during Thursday’s call, adding that resources are available and can be deployed flexibly because they are built into existing “HIV and STI funding to allow for this work.”

And the Mpox Crisis Response Cooperative Agreement, Daskalakis said, “provides even more resources locally for such efforts.”

Daskalakis and CDC Mpox Response Incident Manager Dr. Christopher R. Braden also briefed reporters on findings from new studies on the efficacy of the JYNNEOS vaccine for the prevention of mpox.

That data, per the CDC’s Morbidity and Mortality Weekly Report, reveals that “Among gay, bisexual, and other MSM and transgender adults aged 18-49 years, two doses of the JYNNEOS vaccine were 86 percent effective against mpox, indicating substantial protection against mpox.”

Additionally, “All routes of vaccine administration provided similar protection.”

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