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Will health reform make AIDS groups obsolete?

HIV clinics face new competition as clients obtain insurance by 2014

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‘Health care reform has been a real motivator around us improving the quality of what we do because we know we’re going to have to get better,’ said Don Blanchon, executive director of Whitman-Walker Clinic. (Washington Blade photo by Michael Key)

When the AIDS epidemic burst on the scene in the 1980s, a cadre of volunteers –many from the LGBT community — emerged to provide compassionate and dedicated care for the sick and dying, services that government agencies and existing charitable groups were not providing.

Since that time, the mostly volunteer-driven, community-based AIDS clinics and advocacy groups created back then have evolved into professionally run facilities receiving millions of dollars in state and federal funds. Like the Whitman-Walker Clinic in D.C., many of the clinics and advocacy groups provide a vast array of services for people with HIV and AIDS, most of whom can’t afford private health insurance.

But in March, Congress approved and President Obama signed into law a sweeping health care reform measure called the Patient Protection and Affordable Care Act. Obama administration officials say it will result in more than 94 percent of all Americans being covered by some form of private or public health insurance by 2014.

Although most AIDS activists and officials with local and national AIDS organizations have hailed the health care reform measure as an unprecedented benefit to people with HIV and AIDS, some believe the law could prompt large numbers of patients to leave the community-based clinics and seek medical care elsewhere.

With a possible loss of clients, community AIDS clinics would be in jeopardy of losing government funding, which is based on the number of clients served. It would be ironic, some have said, if the benefits of healthcare reform result in the closing of community institutions that have served people with AIDS during a time of need.

“The LGBT community and people living with HIV are going to have options that they may not have now,” said Don Blanchon, executive director of the Whitman-Walker Clinic, which has served people with HIV and AIDS since the epidemic began.

“And so for us, health care reform has been a real motivator around us improving the quality of what we do because we know we’re going to have to get better,” Blanchon said. “We know at some point in time almost every District resident is going to have some type of public or private insurance, which means they, in theory, are going to be able to go to a lot of different places for their care.”

Blanchon noted that a financial crisis that Whitman-Walker faced four years ago forced it to take steps that have placed it in an excellent position to flourish under the health care reform law. The Clinic’s board hired Blanchon, a managed care expert, to help the Clinic survive at a time when private donations and fundraising efforts were faltering.

With the board’s full approval and over the objections of some of the Clinic’s longtime supporters and volunteers, Blanchon transformed the Clinic from a volunteer model operation into a managed care type facility with the status known as a “federally qualified health center look alike.”

According to Blanchon and other Clinic officials, the new status enables the Clinic to accept a greater number of Medicaid patients as well as patients with a wide range of private health insurance. Patients covered by these programs allow the Clinic to obtain reimbursement for its services by doctors, its own pharmacy, and other service providers, eliminating the need to rely more on private donors.

Unlike other community-based AIDS clinics, Whitman-Walker will be in an excellent position to take on new patients or retain its existing ones as the new health care reform measure enables the majority of patients to obtain private insurance or Medicaid.

Under the Patient Protection and Affordable Care Act, all lower income individuals, including people with HIV, will be eligible for Medicaid coverage if they fall below 133 percent of the federal poverty level, where an individual has an income of about $15,000 a year or lower.

Under current federal law, low-income people with full-blown AIDS are already eligible for Medicaid coverage. For years, Congress has declined to pass legislation proposed by AIDS advocacy groups calling for Medicaid coverage for low-income people with HIV, with the intent of providing medical services to prevent them from advancing to AIDS.

The new law makes that legislation unnecessary after 2014, when the Medicaid provision takes effect.

Jeffrey Crowley, director of the White House Office of National AIDS Policy, calls the Patient Protection and Affordable Care Act one of the nation’s most significant advances for the care and treatment for people with HIV/AIDS.

“It will fundamentally expand access to insurance coverage for people living with HIV,” he said. “Much of that will be through the mandatory expansion of the Medicaid program.”

He said that similar to all Americans, people with HIV will also be eligible for private insurance coverage through a variety of options based on their income. Among the options will be the purchase of insurance coverage through competitive insurance exchanges. He noted that by 2014, no insurance company can deny coverage based on pre-existing conditions such as HIV or other illnesses.

Keith Maley, a spokesperson for the U.S. Department of Health and Human Services, which will administer most of the provisions of the new health care law, said people with HIV and other illnesses could be immediately eligible for private insurance coverage through high-risk pools.

Those eligible for the immediate coverage must show that they have had no health insurance coverage for six consecutive months, have a chronic health condition, and are not eligible for employer provided insurance or Medicaid.

Crowley noted that the new law has other immediate benefits for people with HIV and other chronic health conditions. As of July 1, private health insurers can no longer use a rescission, a practice that cancels a policy when someone gets sick and needs expensive treatment.

He said the law also immediately prohibits insurers from imposing a lifetime “cap” on insurance benefits. Annual limits on coverage or benefits will end in 2014, he said.

Crowley, a gay man who previously worked for the National Association of People with AIDS before joining the White House staff, said he expects most community-based AIDS clinics and local and national AIDS advocacy organizations to continue to exist after the health care law is fully implemented in 2014. However, he said most will have to change the way they do business.

“I think we know from our experience with HIV that we’ve built up a great HIV workforce,” he said. “We have a lot of expertise. I want to make sure as we build and expand an insurance system through the Affordable Care Act that these HIV medical providers are making sure that they’re part of this new system.”

“Some of them might only receive funding through the Ryan White programs, and I would say they need to look at their future and say that they need to be part of the new insurance system,” he said. “But there’s no question that we’re going to need their expertise and commitment at providing medical care going forward.”

Crowley’s reference to the Ryan White CARE Act, the largest existing federal program created to provide care for low-income people with HIV/AIDS, is expected to change significantly following the full implementation of the Patient Protection and Affordable Care Act, according to officials with a number of national AIDS groups.

Nearly everyone, including Crowley, agrees that the Ryan White program should remain, but most likely in a scaled back form. Congress passed the act in the 1990s as a means of helping cities and states that were grappling with the enormous burden of providing care for people with HIV/AIDS who lacked health insurance coverage and were overwhelming local and state hospitals and health care facilities.

Carl Schmid, director of federal affairs for the AIDS Institute, a national advocacy organization; Michael Weinstein, executive director of the AIDS Healthcare Foundation, the nation’s largest AIDS-related medical care provider; and Jose Zuniga, executive director of the International Association of Physicians in AIDS Care, each said they believe the Ryan White program will be needed for at least some services the new law does not provide.

“It will not solve all of our access issues,” said Schmid of the new health care measure.

Weinstein said that state programs to expand health insurance have been slow to enroll as many people as expected for a variety of reasons, some bureaucratic in nature.

“So I wouldn’t expect an overnight change in 2014,” he said, pointing to a need to keep the Ryan White program operating for some time after 2014.

Weinstein said that in some states, including California, Medicaid reimbursement for medical services is far lower than that provided by private insurance companies. He predicted that people with HIV or AIDS who obtain coverage under the new law through Medicaid might be turned away by private doctors who declined to take all Medicaid patients.

“The reimbursement that we receive from Medicaid or from private insurance is far below our cost and far below what we get from Ryan White,” he said of the AIDS Healthcare Foundation. “So we will suffer a hit in that regard as well as most providers.”

Weinstein said his organization has a wide variety of income streams and the lower reimbursements under the new law “won’t be a fatal blow to us.”

Blanchon of Whitman-Walker said the benefits of the new law greatly outweigh its possible shortfalls.

“Health care reform is going to be a real help to our patients and clearly to the Clinic because more of our patients are going to be insured under more comprehensive benefit programs,” he said.

“And what that means at the end of the day is the Clinic is not going to have to shell out as much free care. So we’re going to be in a position to be able to offer more services to more patients and keep them healthy, and ultimately that’s what we’re here for.”

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District of Columbia

D.C. police arrest man for burglary at gay bar Spark Social House  

Suspect ID’d from images captured by Spark Social House security cameras

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Spark Social House (Washington Blade photo by Michael Key)

D.C. police on Feb. 18 arrested a 63-year-old man “of no fixed address” for allegedly stealing cash from the registers at the gay bar Spark Social House after unlawfully entering the bar at 2009 14th St., N.W., around 12:04 a.m. after it had closed for business, according to a police incident report.

“Later that day officers canvassing for the suspect located him nearby,” a separate police statement says. “63-year-old Tony Jones of no fixed address was arrested and charged with Burglary II,” the statement says.

The police incident report states that the bar’s owner, Nick Tsusaki, told police investigators that the bar’s security cameras captured the image of a man who has frequently visited the bar and was believed to be homeless.

“Once inside, the defendant was observed via the establishment’s security cameras opening the cash register, removing U.S. currency, and placing the currency into the left front pocket of his jacket,” the report says.

Tsusaki told the Washington Blade that he and Spark’s employees have allowed Jones to enter the bar many times since it opened last year to use the bathroom in a gesture of compassion knowing he was homeless. Tsusaki said he is not aware of Jones ever having purchased anything during his visits.

According to Tsusaki, Spark closed for business at around 10:30 p.m. on the night of the incident at which time an employee did not properly lock the front entrance door. He said no employees or customers were present when the security cameras show Jones entering Spark through the front door around 12:04 a.m. 

Tsusaki said the security camera images show Jones had been inside Spark for about three hours on the night of the burglary and show him taking cash out of two cash registers. He took a total of $300, Tsusaki said.

When Tsusaki and Spark employees arrived at the bar later in the day and discovered the cash was missing from the registers they immediately called police, Tsusaki told the Blade. Knowing that Jones often hung out along the 2000 block of 14th Street where Spark is located, Tsusaki said he went outside to look for him and saw him across the street and pointed Jones out to police, who then placed him under arrest.

A police arrest affidavit filed in court states that at the time they arrested him police found the stolen cash inside the pocket of the jacket Jones was wearing. It says after taking him into police custody officers found a powdered substance in a Ziploc bag also in Jones’s possession that tested positive for cocaine, resulting in him being charged with cocaine possession in addition to the burglary charge.

D.C. Superior Court records show a judge ordered Jones held in preventive detention at a Feb. 19 presentment hearing. The judge then scheduled a preliminary hearing for the case on Feb. 20, the outcome of which couldn’t immediately be obtained. 

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District of Columbia

Judge rescinds order against activist in Capital Pride lawsuit

Darren Pasha accused of stalking organization staff, board members, volunteers

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Darren Pasha (Washington Blade photo by Michael Key)

A D.C. Superior Court judge on Feb.18 agreed to rescind his earlier ruling declaring local gay activist Darren Pasha in default for failing to attend a virtual court hearing regarding an anti-stalking lawsuit brought against him by the Capital Pride Alliance, the group that organizes D.C.’s annual Pride events.

The Capital Pride lawsuit, initially filed on Oct. 27, 2025, accuses Pasha of engaging in a year-long “course of conduct” of “harassment, intimidation, threats, manipulation, and coercive behavior” targeting Capital Pride staff, board members, and volunteers.

In his own court filings without retaining an attorney, Pasha has strongly denied the stalking related allegations against him, saying “no credible or admissible evidence has been provided” to show he engaged in any wrongdoing. 

Judge Robert D. Okum nevertheless on Feb. 6 approved a temporary stay-away order requiring Pasha to stay at least 100 feet away from Capital Pride’s staff, volunteers, and board members until the time of a follow-up court hearing scheduled for April 17. He reduced the stay-away distance from 200 yards as requested by Capital Pride.

In his two-page order issued on Feb. 18, Okun stated that Pasha explained that he was involved in a scooter accident in which he was injured and his phone was damaged, preventing him from joining the Feb. 6 court hearing.

“Therefore, the court finds there is a good cause for vacating the default,” Okun states in his order.

At the time he initially approved the default order at the Feb. 6 hearing that Pasha didn’t attend, Okun scheduled an April 17 ex parte proof hearing in which Capital Pride could have requested a ruling in its favor seeking a permanent anti-stalking order against Pasha.

In his Feb. 18 ruling rescinding the default order Okun changed the April 17 ex parte proof hearing to an initial scheduling conference hearing in which a decision on the outcome of the case is not likely to happen.

In addition, he agreed to consider Pasha’s call for a jury trial and gave Capital Pride 14 days to contest that request. The Capital Pride lawsuit initially called for a non-jury trial by judge.

One request by Pasha that Okum denied was a call for him to order Capital Pride to stop its staff or volunteers from posting information about the lawsuit on social media. Pasha has said the D.C.-based online blog called DC Homos, which Pasha claims is operated by someone associated with Capital Pride, has been posting articles portraying him in a negative light and subjecting him to highly negative publicity.

“The defendant has not set forth a sufficient basis for the court to restrict the plaintiff’s social media postings, and the court therefore will deny the defendant’s request in his social media praecipe,” Okun states in his order. 

A praecipe is a formal written document requesting action by a court.

Pasha called the order a positive development in his favor. He said he plans to file another motion with more information about what he calls the unfair and defamatory reports about him related to the lawsuit by DC Homos, with a call for the judge to reverse his decision not to order Capital Pride to stop social media postings about the lawsuit.    

Pasha points to a video interview on the LGBTQ Team Rayceen broadcast, a link to which he sent to the Washington Blade, in which DC Homos operator Jose Romero acknowledged his association with Capital Pride Alliance.

Capital Pride Executive Director Ryan Bos didn’t immediately respond to a message from the Blade asking whether Romero was a volunteer or employee with Capital Pride. 

Pasha also said he believes the latest order has the effect of rescinding the temporary stay away order against him approved by Okun in his earlier ruling, even though Okun makes no mention of the stay away order in his latest ruling. Capital Pride attorney Nick Harrison told the Blade the stay away order “remains in full force and effect.”

Harrison said Capital Pride has no further comment on the lawsuit.

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District of Columbia

Trans activists arrested outside HHS headquarters in D.C.

Protesters demonstrated directive against gender-affirming care

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(Photo by Alexa B. Wilkinson)

Authorities on Tuesday arrested 24 activists outside the U.S. Department of Health and Human Services headquarters in D.C.

The Gender Liberation Movement, a national organization that uses direct action, media engagement, and policy advocacy to defend bodily autonomy and self-determination, organized the protest in which more than 50 activists participated. Organizers said the action was a response to changes in federal policy mandated by Executive Order 14187, titled “Protecting Children from Chemical and Surgical Mutilation.”

The order directs federal agencies and programs to work toward “significantly limiting youth access to gender-affirming care nationwide,” according to KFF, a nonpartisan, nonprofit organization that provides independent, fact-based information on national health issues. The executive order also includes claims about gender-affirming care and transgender youth that critics have described as misinformation.

Members of ACT UP NY and ACT UP Pittsburgh also participated in the demonstration, which took place on the final day of the public comment period for proposed federal rules that would restrict access to gender-affirming care.

Demonstrators blocked the building’s main entrance, holding a banner reading “HANDS OFF OUR ‘MONES,” while chanting, “HHS—RFK—TRANS YOUTH ARE NO DEBATE” and “NO HATE—NO FEAR—TRANS YOUTH ARE WELCOME HERE.”

“We want trans youth and their loving families to know that we see them, we cherish them, and we won’t let these attacks go on without a fight,” said GLM co-founder Raquel Willis. “We also want all Americans to understand that Trump, RFK, and their HHS won’t stop at trying to block care for trans youth — they’re coming for trans adults, for those who need treatment from insulin to SSRIs, and all those already failed by a broken health insurance system.”

“It is shameful and intentional that this administration is pitting communities against one another by weaponizing Medicaid funding to strip care from trans youth. This has nothing to do with protecting health and everything to do with political distraction,” added GLM co-founder Eliel Cruz. “They are targeting young people to deflect from their failure to deliver for working families across the country. Instead of restricting care, we should be expanding it. Healthcare is a human right, and it must be accessible to every person — without cost or exception.”

(Photo by Cole Witter)

Despite HHS’s efforts to restrict gender-affirming care for trans youth, major medical associations — including the American Medical Association, the American Academy of Pediatrics, and the Endocrine Society — continue to regard such care as evidence-based treatment. Gender-affirming care can include psychotherapy, social support, and, when clinically appropriate, puberty blockers and hormone therapy.

The protest comes amid broader shifts in access to care nationwide. 

NYU Langone Health recently announced it will stop providing transition-related medical care to minors and will no longer accept new patients into its Transgender Youth Health Program following President Donald Trump’s January 2025 executive order targeting trans healthcare. 

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