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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

Catching up with the asexuals and aromantics of D.C.

Exploring identity and finding community

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Local asexuals and aromantics met recently on the National Mall.

There was enough commotion in the sky at the Blossom Kite Festival that bees might have been pollinating the Washington Monument. I despaired of quickly finding the Asexuals and Aromantics of the Mid-Atlantic—I couldn’t make out a single asexual flag among the kites up above. I thought to myself that if it had been the Homosexuals of the Mid-Atlantic I would’ve had my gaydar to rely on. Was there even such a thing as ace-dar?

As it turned out, the asexual kite the group had meant to fly was a little too pesky to pilot. “Have you ever used a stunt kite?” Bonnie, the event organizer asked me. “I bought one. It looked really cool. But I can’t make it work.” She sighed. “I can’t get the thing six feet off the ground.” The group hardly seemed to care. There was caramel popcorn and cookies, board games and head massages, a game of charades with more than its fair share of Pokémon. The kites up above might as well have been a coincidental sideshow. Nearly two dozen folks filtered in and out of the picnic throughout the course of the day.

But I counted myself lucky that Bonnie picked me out of the crowd. If there’s such a thing as ace-dar, it eludes asexuals too. The online forum for all matters asexual, AVEN, or the Asexual Visibility and Education Network, is filled with laments: “I don’t think it’s possible.” “Dude, I wish I had an ace-dar.” “If it exists, I don’t have it.” “I think this is just like a broken clock is right twice a day type thing.” What seems to be a more common experience is meeting someone you just click with—only to find out later that they’re asexual. A few of the folks I met described how close childhood friends of theirs likewise came out in adulthood, a phenomenon that will be familiar to many queer people. But it is all the more astounding for asexuals to find each other this way, given that asexual people constitute 1.7% of sexual minorities in America, and so merely .1% of the population at large. 

To help other asexuals identify you out in the world, some folks wear a black ring on their middle finger, much as an earring on the right ear used to signify homosexuality in a less welcoming era. The only problem? The swinger community—with its definite non-asexuality—has also adopted the signal. “It’s still a thing,” said Emily Karp. “So some people wear their ace rings just to the ace meet-ups.” Karp has been the primary coordinator for the Asexuals and Aromantics of the Mid-Atlantic (AAMA) since 2021, and a member of the meet-up for a decade. She clicked with the group immediately. After showing up for a Fourth of July potluck in the mid-afternoon, she ended up staying past midnight. “We played Cards against Humanity, which was a very, very fun thing to do. It’s funny in a way that’s different than if we were playing with people that weren’t ace. Some of the cards are implying, like, the person would be motivated by sex in a way that’s absurd, because we know they aren’t.” 

Where so many social organizations withered during the pandemic, the AAMA flourished. Today, it boasts almost 2,000 members on meetup.com. Karp hypothesized that all the social isolation gave people copious time to reflect on themselves, and that the ease of meeting up online made it convenient as a way for people to explore their sexual identity and find community. Online events continue to make up about a third of the group’s meet-ups. The format allows people to participate who live farther out from D.C. And it allows people to participate at their preferred level of comfort: while many people participate much as they would at an in-person event, some prefer to watch anonymously, video feed off. Others prefer to participate in the chat box, though not in spoken conversation.

A recent online event was organized for a discussion of Rhaina Cohen’s book, “The Other Significant Others,” published in February. Cohen’s book discusses friendship as an alternative model for “significant others,” apart from the romantic model that is presupposed to be both the center and goal of people’s lives. The AAMA group received the book with enthusiasm. “It literally re-wired my brain,” as one person put it. People discussed the importance of friendship to their lives, and their difficulties in a world that de-prioritized friendship. “I can break up with a friend over text, and we don’t owe each other a conversation,” one said. But there was some disagreement when it came to the book’s discussion of romantic relationships. “It relegates ace relationships to the ‘friend’ or ‘platonic’ category, to the normie-reader,” one person wrote in the chat. “Our whole ace point is that we can have equivalent life relationships to allo people, simply without sex.” (“Allo” is shorthand for allosexual or alloromantic, people who do experience sexual or romantic attraction.)

The folks of the AAMA do not share a consensus on the importance of romantic relationships to their lives. Some asexuals identify as aromantic, some don’t. And some aromantics don’t identify as asexual, either. The “Aromantic” in the title of the group is a relatively recent addition. In 2017, the group underwent a number of big changes. The group was marching for the first time in D.C. Pride, participating in the LGBTQ Creating Change conference, and developing a separate advocacy and activism arm. Moreover, the group had become large enough that discussions were opened up into forming separate chapters for D.C., Central Virginia, and Baltimore. During those discussions, the group leadership realized that aromantic people who also identified as allosexual didn’t really have a space to call their own. “We were thinking it would be good to probably change the name of the Meetup group,” Emily said. “But we were not 100% sure. Because [there were] like 1,000 people in the group, and they’re all aces, and it’s like, ‘Do you really want to add a non-ace person?’” The group leadership decided to err on the side of inclusion. “You know, being less gatekeep-y was better. It gave them a place to go — because there was nowhere else to go.”

The DC LGBT Center now sponsors a support group for both asexuals and aromantics, but it was formed just a short while ago, in 2022. The founder of the group originally sought out the center’s bisexual support group, since they didn’t have any resources for ace folks. “The organizer said, you know what, why don’t we just start an ace/aro group? Like, why don’t we just do it?” He laughed. “I was impressed with the turnout, the first call. It’s almost like we tapped into, like, a dam. You poke a hole in the dam, and the water just rushes out.” The group has a great deal of overlap with the AAMA, but it is often a person’s first point of contact with the asexual and aromantic community in D.C., especially since the group focuses on exploring what it means to be asexual. Someone new shows up at almost every meeting. “And I’m so grateful that I did,” one member said. “I kind of showed up and just trauma dumped, and everyone was really supportive.”

Since the ace and aro community is so small, even within the broader queer community, ace and aro folks often go unrecognized. To the chagrin of many, the White House will write up fact sheets about the LGBTQI+ community, which is odd, given that when the “I” is added to the acronym, the “A” is usually added too. OKCupid has 22 genders and 12 orientations on its dating website, but “aromantic” is not one of them — presumably because aromantic people don’t want anything out of dating. And since asexuality and aromanticism are defined by the absence of things, it can seem to others like ace and aro people are ‘missing something.’ One member of the LGBT center support group had an interesting response. “The space is filled by… whatever else!” they said.  “We’re not doing a relationship ‘without that thing.’ We’re doing a full scale relationship — as it makes sense to us.”

CJ Higgins is a postdoctoral fellow with the Alexander Grass Humanities Institute at Johns Hopkins University.

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District of Columbia

Bowser budget proposal calls for $5.25 million for 2025 World Pride

AIDS office among agencies facing cuts due to revenue shortfall

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D.C. Mayor Muriel Bowser’s proposed 2025 budget includes a request for $5.25 million in funding to support the 2025 World Pride celebration. (Washington Blade file photo by Michael Key)

D.C. Mayor Muriel Bowser’s proposed fiscal year 2025 budget includes a request for $5.25 million in funding to support the June 2025 World Pride celebration, which D.C. will host, and which is expected to bring three million or more visitors to the city.

The mayor’s proposed budget, which she presented to the D.C. Council for approval earlier this month, also calls for a 7.6 percent increase in funding for the Mayor’s Office of LGBTQ Affairs, which amounts to an increase of $132,000 and would bring the office’s total funding to $1.7 million. The office, among other things, provides grants to local organizations that provide  services to the LGBTQ community.

Among the other LGBTQ-related funding requests in the mayor’s proposed budget is a call to continue the annual funding of $600,000 to provide workforce development services for transgender and gender non-conforming city residents “experiencing homelessness and housing instability.” The budget proposal also calls for a separate allocation of $600,000 in new funding to support a new Advanced Technical Center at the Whitman-Walker Health’s Max Robinson Center in Ward 8.

Among the city agencies facing funding cuts under the mayor’s proposed budget is the HIV/AIDS, Hepatitis, Sexually Transmitted Disease, and Tuberculosis Administration, known as HAHSTA, which is an arm of the D.C. Department of Health. LGBTQ and AIDS activists have said HAHSTA plays an important role in the city’s HIV prevention and support services. Observers familiar with the agency have said it recently lost federal funding, which the city would have to decide whether to replace.

“We weren’t able to cover the loss of federal funds for HAHSTA with local funds,” Japer  Bowles, director of the Mayor’s Office of LGBTQ Affairs, told the Washington Blade. “But we are working with partners to identify resources to fill those funding  gaps,” Bowles said.

The total proposed budget of $21 billion that Bowser submitted to the D.C. Council includes about $500 million in proposed cuts in various city programs that the mayor said was needed to offset a projected $700 million loss in revenue due, among other things, to an end in pandemic era federal funding and commercial office vacancies also brought about by the post pandemic commercial property and office changes.

Bowser’s budget proposal also includes some tax increases limited to sales and business-related taxes, including an additional fee on hotel bookings to offset the expected revenue losses. The mayor said she chose not to propose an increase in income tax or property taxes.

Earlier this year, the D.C. LGBTQ+ Budget Coalition, which consists of several local LGBTQ advocacy organizations, submitted its own fiscal year 2025 budget proposal to both Bowser and the D.C. Council. In a 14-page letter the coalition outlined in detail a wide range of funding proposals, including housing support for LGBTQ youth and LGBTQ seniors; support for LGBTQ youth homeless services; workforce and employment services for transgender and gender non-conforming residents; and harm reduction centers to address the rise in drug overdose deaths.

Another one of the coalition’s proposals is $1.5 million in city funding for the completion of the D.C. Center for the LGBTQ Community’s new building, a former warehouse building in the city’s Shaw neighborhood that is undergoing a build out and renovation to accommodate the LGBTQ Center’s plans to move in later this year. The coalition’s budget proposal also calls for an additional $300,000 in “recurring” city funding for the LGBTQ Center in subsequent years “to support ongoing operational costs and programmatic initiatives.”

Bowles noted that Bowser authorized and approved a $1 million grant for the LGBTQ Center’s new building last year but was unable to provide additional funding requested by the budget coalition for the LGBTQ Center for fiscal year 2025.

“We’re still in this with them,” Bowles said. “We’re still looking and working with them to identify funding.”

The total amount of funding that the LGBTQ+ Budget Coalition listed in its letter to the mayor and Council associated with its requests for specific LGBTQ programs comes to $43.1 million.

Heidi Ellis, who serves as coordinator of the coalition, said the coalition succeeded in getting some of its proposals included in the mayor’s budget but couldn’t immediately provide specific amounts.  

“There are a couple of areas I would argue we had wins,” Ellis told the Blade. “We were able to maintain funding across different housing services, specifically around youth services that affect folks like SMYAL and Wanda Alston.” She was referring to the LGBTQ youth services group SMYAL and the LGBTQ organization Wanda Alston Foundation, which provides housing for homeless LGBTQ youth.

“We were also able to secure funding for the transgender, gender non-conforming workforce program,” she said. “We also had funding for migrant services that we’ve been advocating for and some wins on language access,” said Ellis, referring to programs assisting LGBTQ people and others who are immigrants and aren’t fluent in speaking English.

Ellis said that although the coalition’s letter sent to the mayor and Council had funding proposals that totaled $43.1 million, she said the coalition used those numbers as examples for programs and policies that it believes would be highly beneficial to those in the LGBTQ community in need.

 “I would say to distill it down to just we ask for $43 million or whatever, that’s not an accurate picture of what we’re asking for,” she said. “We’re asking for major investments around a few areas – housing, healthcare, language access. And for capital investments to make sure the D.C. Center can open,” she said. “It’s not like a narrative about the dollar amounts. It’s more like where we’re trying to go.”

The Blade couldn’t’ immediately determine how much of the coalition’s funding proposals are included in the Bowser budget. The mayor’s press secretary, Daniel Gleick, told the Blade in an email that those funding levels may not have been determined by city agencies.

“As for specific funding levels for programs that may impact the LGBTQ community, such as individual health programs through the Department of Health, it is too soon in the budget process to determine potential adjustments on individual programs run though city agencies,” Gleick said.

But Bowles said several of the programs funded in the mayor’s budget proposal that are not LGBTQ specific will be supportive of LGBTQ programs. Among them, he said, is the budget’s proposal for an increase of $350,000 in funding for senior villages operated by local nonprofit organizations that help support seniors. Asked if that type of program could help LGBTQ seniors, Bowles said, “Absolutely – that’s definitely a vehicle for LGBTQ senior services.”

He said among the programs the increased funding for the mayor’s LGBTQ Affairs office will support is its ongoing cultural competency training for D.C. government employees. He said he and other office staff members conduct the trainings about LGBTQ-related issues at city departments and agencies.

Bowser herself suggested during an April 19 press conference that local businesses, including LGBTQ businesses and organizations, could benefit from a newly launched city “Pop-Up Permit Program” that greatly shortens the time it takes to open a business in vacant storefront buildings in the downtown area.

Bowser and Nina Albert, D.C. Deputy Mayor for Planning and Economic Development, suggested the new expedited city program for approving permits to open shops and small businesses in vacant storefront spaces could come into play next year when D.C. hosts World Pride, one of the word’s largest LGBTQ events.

“While we know that all special events are important, there is an especially big one coming to Washington, D.C. next year,” Bowser said at the press conference. “And to that point, we proposed a $5.25 million investment to support World Pride 2025,” she said, adding, “It’s going to be pretty great. And so, we’re already thinking about how we can include D.C. entrepreneurs, how we’re going to include artists, how we’re going to celebrate across all eight wards of our city as well,” she said.

Among those attending the press conference were officials of D.C.’s Capital Pride Alliance, which will play a lead role in organizing World Pride 2025 events.

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Maryland

Health care for Marylanders with HIV is facing huge cuts this summer

Providers poised to lose three-quarters of funding

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(Photo courtesy of NIH)

BY MEREDITH COHN | By the end of June, health care providers in Maryland will lose nearly three-quarters of the funding they use to find and treat thousands of people with HIV.

Advocates and providers say they had been warned there would be less money by the Maryland Department of Health, but were stunned at the size of the drop — from about $17.9 million this fiscal year to $5.3 million the next. The deep cuts are less than three months away.

The rest of this article can be read on the Baltimore Banner’s website.

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