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Higher AIDS drug costs under Obamacare?

Sebelius urged to allow drug company subsidies in exchanges

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Kathleen Sebelius, AIDS, HHS, gay news, Washington Blade

AIDS groups sent a letter to HHS Secretary Kathleen Sebelius urging her to allow drug company discount programs to operate under Obamacare. (Washington Blade file photo by Michael Key).

AIDS advocacy organizations say people with HIV could be forced to pay hundreds of dollars more each month for life-saving prescription drugs through health insurance plans required under the soon-to-be implemented Affordable Care Act known as Obamacare.

Leaders of more than 160 national and local organizations advocating for people with AIDS and other diseases sent a joint letter on Monday to Kathleen Sebelius, the U.S. Secretary of Health and Human Services, urging her to allow drug company discount programs to operate under Obamacare.

“We, the undersigned organizations and individuals, are writing to urge that the HHS issue clear guidance on the allowance of drug industry-provided co-payments, co-insurance, or other out-of-pocket discount cards and coupons in the Affordable Care Act’s Health Insurance Marketplaces,” the letter to Sebelius says.

“As people living with, and organizations serving people with HIV, HCV [Hepatitis C Virus], and other life-threatening and chronic health conditions, we are alarmed by the possibility of the prohibition of these critical financial lifelines,” the letter says.

The signers of the letter were referring to a controversy that erupted last month when Sebelius released a letter she sent to U.S. Rep. Jim McDermott (D-Wash.) saying HHS determined that the Obamacare health insurance exchanges were not “federal health care programs” as defined by a separate federal law aimed at curtailing health care fraud.

By declaring that the exchanges are not federal health care programs HHS, among other things, made the exchanges and the insurance plans sold under them exempt from a provision of the Social Security Act that bans pharmaceutical companies from providing insurance co-payment discounts or subsidies to patients for the purchase of prescription drugs.

Although this initial action by HHS drew strong support from AIDS organizations it surprised and angered many private health insurance companies and federal and state consumer protection regulators, who argued that the exemption would take away an important tool for preventing and prosecuting health care fraud.

Critics, including U.S. Charles Grassley (R-Iowa), noted that the Social Security Act prohibits pharmaceutical companies from providing co-payment assistance to patients under Medicare and Medicaid and that the Affordable Care Act should be considered as a similar federal health program.

Possibly due to the criticism of Sebelius’s initial determination on the issue, a short time later the HHS Center for Consumer Information and Insurance Oversight, which oversees insurance-related matters, issued a memo that appeared to contradict Sebelius’s interpretation of the Social Security Act.

The latter development prompted the AIDS organizations and allied groups to send their Dec. 2 letter to Sebelius urging her to hold firm on her initial determination that the insurance exchanges are exempt from the Social Security Act’s ban on drug company subsidies for prescription drug coverage.

The D.C.-based national group Health HIV participated in efforts to recruit groups to sign the letter.

According to the Wall Street Journal, drug companies spent about $4 billion on co-payment assistance programs for patients with HIV and other illnesses in 2011. The paper cited experts in the pharmaceutical industry that said the assistance programs often lowered a patient’s co-payment from $250 or more per month to just $5 per month for a prescription drug.

Critics of the program say the subsidies often are given for brand-name drugs and encourage patients not to request cheaper generic drugs. This forces insurance companies to pay more for the name-brand drugs, resulting in higher premiums for everyone in the long run, critics have said.

But in their letter to Sebelius, the AIDS organization officials said most AIDS-related drugs needed by people with HIV are not available in generic forms.

“[W]e urge you to consider the unintended consequences of suddenly removing industry-provided out-of-pocket assistance for brand-name drugs without generic equivalents from the patchwork of programs that so many people with serious and chronic conditions rely on,” the joint letter says.

“It could potentially threaten access to lifesaving medications for thousands of people living with HIV; bar millions of people with hepatitis C from benefiting from the new short-course curative treatment combinations; and keep countless people with cancer and other debilitating and life-threatening illnesses from the treatment they need to stay alive,” the letter says.

“We fear this will be a major setback to the goals of the Affordable Care Act,” it says.

HHS spokesperson Mike Robinson said he would make inquiries in response to a request by the Blade for Sebelius’s response to the joint letter by the AIDS organizations, but he did not immediately respond.

“We’re still waiting for a clear determination from HHS,” said Carl Schmid, deputy director of the AIDS Institute, one of the groups that signed on to the letter to Sebelius. “There have been some mixed signals from the department.”

Schmid said the drug company assistance programs seek to help people with HIV who are not eligible for the federal-state AIDS Drug Assistance Program known as ADAP, which provides AIDS drugs to low-income people who don’t have insurance.

Although people being helped by the pharmaceutical company assistance programs often are employed and have moderate incomes, the high cost of prescription drug co-payments could be devastating to them, Schmid and others familiar with the programs said. Some people with HIV need more than one drug for their treatment regimen, and co-payments under their insurance plans often result in co-payments of more than $200 per drug per month.

Dan Mendelson, president of the heath care consulting firm Avalere Health LLC told the Wall Street Journal that the average “silver” health insurance plan under the Obamacare exchanges has a required annual deductible of $2,500. He told the WSJ that the average deductible for the “bronze” plans under the exchanges, which are said to be the cheapest plans, is $5,000.

Schmid said these costs are often prohibitive for patients with modest incomes. The elimination of the drug company assistance programs under the Affordable Care Act’s exchanges would create a serious burden on HIV patients and others who now rely on the assistance programs.

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Puerto Rico

Bad Bunny shares Super Bowl stage with Ricky Martin, Lady Gaga

Puerto Rican activist celebrates half time show

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Bad Bunny performs at the Super Bowl halftime show on Feb. 8, 2026. (Screen capture via NFL/YouTube)

Bad Bunny on Sunday shared the stage with Ricky Martin and Lady Gaga at the Super Bowl halftime show in Santa Clara, Calif.

Martin came out as gay in 2010. Gaga, who headlined the 2017 Super Bowl halftime show, is bisexual. Bad Bunny has championed LGBTQ rights in his native Puerto Rico and elsewhere.

“Not only was a sophisticated political statement, but it was a celebration of who we are as Puerto Ricans,” Pedro Julio Serrano, president of the LGBTQ+ Federation of Puerto Rico, told the Washington Blade on Monday. “That includes us as LGBTQ+ people by including a ground-breaking superstar and legend, Ricky Martin singing an anti-colonial anthem and showcasing Young Miko, an up-and-coming star at La Casita. And, of course, having queer icon Lady Gaga sing salsa was the cherry on the top.”

La Casita is a house that Bad Bunny included in his residency in San Juan, the Puerto Rican capital, last year. He recreated it during the halftime show.

“His performance brought us together as Puerto Ricans, as Latin Americans, as Americans (from the Americas) and as human beings,” said Serrano. “He embraced his own words by showcasing, through his performance, that the ‘only thing more powerful than hate is love.’”

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Human Rights Watch sharply criticizes US in annual report

Trump-Vance administration ‘working to undermine … very idea of human rights’

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(Washington Blade photo by Yariel Valdés González)

Human Rights Watch Executive Director Philippe Bolopion on Wednesday sharply criticized the Trump-Vance administration over its foreign policy that includes opposition to LGBTQ rights.

“The U.S. used to actually be a government that was advancing the rights of LGBT people around the world and making sure that it was finding its way into resolutions, into U.N. documents,” he said in response to a question the Washington Blade asked during a press conference at Human Rights Watch’s D.C. offices. “Now we see the opposite movement.”

Human Rights Watch on Wednesday released its annual human rights report that is highly critical of the U.S., among other countries.

“Under relentless pressure from U.S. President Donald Trump, and persistently undermined by China and Russia, the rules-based international order is being crushed, threatening to take with it the architecture human rights defenders have come to rely on to advance norms and protect freedoms,” said Bolopion in its introductory paragraph. “To defy this trend, governments that still value human rights, alongside social movements, civil society, and international institutions, need to form a strategic alliance to push back.”

From left: Human Rights Watch Executive Director Philippe Bolopion and Human Rights Watch Washington Director Sarah Yager at a press conference at Human Rights Watch’s D.C. offices on Feb. 4, 2026. (Photo courtesy of Human Rights Watch)

The report, among other things, specifically notes the U.S. Supreme Court’s Skrmetti decision that uphold a Tennessee law banning gender-affirming medical interventions for minors.

The Trump-Vance administration has withdrawn the U.S. from the U.N. LGBTI Core Group, a group of U.N. member states that have pledged to support LGBTQ and intersex rights, and the U.N. Human Rights Council. Bolopion in response to the Blade’s question during Wednesday’s press conference noted the U.S. has also voted against LGBTQ-inclusive U.N. resolutions.

Maria Sjödin, executive director of Outright International, a global LGBTQ and intersex advocacy group, in an op-ed the Blade published on Jan. 28 wrote the movement around the world since the Trump-Vance administration took office has lost more than $125 million in funding.

The U.S. Agency for International Development, which funded myriad LGBTQ and intersex organizations around the world, officially shut down on July 1, 2025. The Trump-Vance administration last month announced it will expand the global gag rule, which bans U.S. foreign aid for groups that support abortion and/or offer abortion-related services, to include organizations that promote “gender ideology.”

“LGBTQ rights are not just a casualty of the Trump foreign policy,” said Human Rights Watch Washington Director Sarah Yager during the press conference. “It is the intent of the Trump foreign policy.”

The report specifically notes Ugandan authorities since the enactment of the country’s Anti-Homosexuality Act in 2023, which punishes “‘carnal knowledge’ between people of the same gender” with up to life in prison, “have perpetrated widespread discrimination and violence against lesbian, gay, bisexual, and transgender (LGBT) people, their families, and their supporters.” It also highlights Russian authorities “continued to widely use the ‘gay propaganda’ ban” and prosecuted at least two people in 2025 for their alleged role in “‘involving’ people in the ‘international LGBT movement’” that the country’s Supreme Court has deemed an extremist organization.

The report indicates the Hungarian government “continued its attacks on and scapegoating of lesbian, gay, bisexual, and transgender (LGBT) people” in 2025, specifically noting its efforts to ban Budapest Pride that more than 100,000 people defied. The report also notes new provisions of Indonesia’s penal code that took effect on Jan. 2 “violate the rights of women, religious minorities, and lesbian, gay, bisexual, and transgender (LGBT) people, and undermine the rights to freedom of speech and association.”

“This includes the criminalization of all sex outside of marriage, effectively rendering adult consensual same-sex conduct a crime in Indonesia for the first time in the country’s history,” it states.

Bolopion at Wednesday’s press conference said women, people with disabilities, religious minorities, and other marginalized groups lose rights “when democracy is retreating.”

“It’s actually a really good example of how the global retreat from the U.S. as an actor that used to be very imperfectly — you know, with a lot of double standards — but used to be part of this global effort to advance rights and norms for everyone,” he said. “Now, not only has it retreated, which many people expected, but in fact, is now working against it, is working to undermine the system, is working to undermine, at times, the very idea of human rights.”

“That’s definitely something we are acutely aware of, and that we are pushing back,” he added.

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Maryland

4th Circuit dismisses lawsuit against Montgomery County schools’ pronoun policy

Substitute teacher Kimberly Polk challenged regulation in 2024

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(Photo by Sergei Gnatuk via Bigstock)

A federal appeals court has ruled Montgomery County Public Schools did not violate a substitute teacher’s constitutional rights when it required her to use students’ preferred pronouns in the classroom.

The 4th U.S. Circuit Court of Appeals in a 2-1 decision it released on Jan. 28 ruled against Kimberly Polk.

The policy states that “all students have the right to be referred to by their identified name and/or pronoun.”

“School staff members should address students by the name and pronoun corresponding to the gender identity that is consistently asserted at school,” it reads. “Students are not required to change their permanent student records as described in the next section (e.g., obtain a court-ordered name and/or new birth certificate) as a prerequisite to being addressed by the name and pronoun that corresponds to their identified name. To the extent possible, and consistent with these guidelines, school personnel will make efforts to maintain the confidentiality of the student’s transgender status.”

The Washington Post reported Polk, who became a substitute teacher in Montgomery County in 2021, in November 2022 requested a “religious accommodation, claiming that the policy went against her ‘sincerely held religious beliefs,’ which are ‘based on her understanding of her Christian religion and the Holy Bible.’”

U.S. District Judge Deborah Boardman in January 2025 dismissed Polk’s lawsuit that she filed in federal court in Beltsville. Polk appealed the decision to the 4th Circuit.

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