News
Obama admin says insurers can’t discriminate against gay unions
Prohibits discrimination even in non-marriage equality states

The Centers for Medicare & Medicaid has issued guidance clarifying insurers can’t discriminate against same-sex couples. (Image public domain)
The Obama administration clarified on Friday that insurers are prohibited from discriminating against same-sex marriages for the purposes of non-grandfathered family coverage — even if applicants are applying in non-marriage equality states.
In guidance dated March 14, the Centers for Medicare & Medicaid says existing provisions in the health care reform law prohibiting discrimination by insurers on the basis of gender — which the Obama administration has interpreted to extend non-discrimination protections based on sexual orientation and gender identity — also requires insurers not to refuse family coverage for married same-sex couples.
The guidance is set up as Q&A. The question is “If a health insurance issuer in the group or individual market offers coverage of an opposite-sex spouse, may the issuer refuse to offer coverage of a same-sex spouse?” The response starts off simply, “No.”
“This section prohibits an issuer from choosing to decline to offer to a plan sponsor (or individual in the individual market) the option to cover same-sex spouses under the coverage on the same terms and conditions as opposite sex-spouses,” the guidance states.
Alicia Hartinger, a CMS spokesperson, said the guidance spells out that non-discrimination is the rule for insurers — both on and off the health insurance exchanges — when selling policies.
“CMS recognizes the importance of all Americans and their families having access to quality, affordable coverage,” Hartinger said. “Today’s guidance clarifies that issuers may not choose to treat same-sex spouses differently from opposite-sex spouses. If an issuer offers opposite-sex spouse coverage, it may not choose to deny the same coverage to a same-sex spouse. We will continue to work with states and issuers to help ensure all Americans have an equal opportunity to purchase the new coverage options available to them.”
The guidance says insurers cannot refuse family coverage to married same-sex couples even if they live in — or the insurance is sold in — a non-marriage equality state that doesn’t recognize those unions.
Additionally, the guidance acknowledges insurers may not have realized this prohibition when designing their policies for the 2014 coverage year. Accordingly, while encouraging immediate compliance, CMS says insurers need not begin adhering to this policy until Jan. 1, 2015. The guidance also directs states to begin enforcing the regulations no later than Jan. 1, 2015.
The guidance doesn’t address whether it requires CMS to provide coverage to same-sex couples in domestic partnerships or civil unions. A CMS official said the guidance applies only to marriages, not these other unions.
LGBT advocates praised the new guidance as a step toward ensuring that married same-sex couples have the same access to health insurance as their opposite-sex counterparts.
Rea Carey, executive director of the National Gay & Lesbian Task Force, earlier said her group wanted the Obama administration to make the clarification and upon news of the guidance said it would help same-sex couples “hurting right now” because they were denied health insurance.
“Today’s important HHS announcement will help remove this type of discrimination by requiring the health insurance industry to treat us the same as straight married couples — even if the states where we live do not recognize marriage equality,” Carey said. “While insurers are not required to be in compliance with the new rules until January 2015, we urge the industry to act now — as affordable health care delayed is affordable health care denied.”
There have been reported incidents of married gay couples being unable to receive family coverage in the aftermath of the implementation of the Affordable Care Act. In February, a gay couple — Alfred Cowger and Anthony Wesley of Gates Mills, Ohio — filed a federal lawsuit charging that they were unable to obtain family coverage because their state doesn’t recognize their marriage.
In January, Blue Cross and Blue Shield canceled family insurance policies it sold to same-sex couples under the Affordable Care Act in North Carolina. Following news reports about the cancellations, the insurer changed course and agreed to offer family coverage on the health insurance exchange to same-sex couples.
Kellan Baker, director of the LGBT State Exchanges Project for the Center for American Progress, said the new guidance is important because research shows LGBT families have trouble accessing health insurance.
“Research has shown that same-sex couples, as well as transgender people and other members of the lesbian, gay, bisexual, and transgender, or LGBT, communities, frequently face obstacles to affordable, comprehensive insurance coverage,” Baker said. “My colleagues and I look forward to working with HHS to ensure that this guidance is fully implemented in a timely manner and that similar action is taken to remove other barriers to coverage, such as discriminatory insurance exclusions that target transgender people.”
The Comings & Goings column is about sharing the professional successes of our community. We want to recognize those landing new jobs, new clients for their business, joining boards of organizations and other achievements. Please share your successes with us at [email protected].
The Comings & Goings column also invites LGBTQ college students to share their successes with us. If you have been elected to a student government position, gotten an exciting internship, or are graduating and beginning your career with a great job, let us know so we can share your success.
Congratulations to Yadiel Meléndez, on their new role as Community Associate, with the Wanda Alston Foundation. Meléndez is piloting a new role as a Community Associate at the Wanda Alston Foundation, where they support queer and trans young people in finding their footing, building independence, and experiencing a housing community where they are seen, valued, and affirmed. They are coming into this role with more than a decade of experience as a community organizer and operations specialist, supporting diverse communities through service, advocacy, and program coordination.
Previously they worked for Right Proper Brewing Shaw as a server and bartender and at Sephora, Washington, DC, and at FreshFarm, DC, in bilingual food access. They also worked freelance to build foundational structures for local queer BIPOC performance art coalitions, producing variety shows to curate space for marginalized performance artists in the community. They were a production manager for Haus of Hart Productions, a BIPOC centric performance art production. They also worked as field staff with the American Foundation for Suicide Prevention in Stafford, Va.
Meléndez is bilingual, Spanish and English. Their work is guided by a commitment to dignity, safety, and trauma-informed engagement, particularly within LGBTQ and BIPOC communities.
Congratulations also to Ben Rosen LICSW, on his new role as program director, with the Wanda Alston Foundation. Rosen previously worked with Fountain House’s OnRamps program, helping to build a new, innovative outreach program for individuals considered chronically homeless, and living with serious mental illness, in the Times Square area of New York. Rosen is a Psychotherapist, having worked with SG Psychotherapy, and as the psychotherapist with the Nest Community Health Center (URAM).
Rosen has a B.F.A. in Theatre Arts: Musical Theatre, Minor in Psychology (Cum Laude) from Malloy University Conservatory; and his M.S.W. in Clinical Practice with Individuals, Families, and Groups, from The Silberman School of Social Work, Hunter College, N.Y. He is independently licensed in New York and Washington, D.C.
News
An effort to increase the number of psychiatrists of color
After 35 years in law and advocacy, Rawle Andrews Jr. returns to his roots
Rawle Andrews Jr. took an indirect path to become executive director of the American Psychiatric Association Foundation (APAF).
From a psychology major in college to becoming a lawyer, the passion for equity and inclusion that fueled him during his years at AARP and as a professor at Howard and Georgetown universities serves as the foundation for his career in mental health.
Andrews has made it his mission at APAF to prioritize youth mental health — including in schools in D.C. and across the country — and to reduce stigma around mental illness and increase the number of psychiatrists of color practicing in the U.S.
Andrews, who began his educational career studying psychology, said he felt out of place in college when his classmates were pursuing medical careers and he was more interested in law.
“I was the only person in my cohort who was going to law school,” he said. “Everybody else wanted to be a doctor and go to medical school.”
Everything changed for Andrews during the COVID-19 pandemic and after George Floyd was killed by police in Missouri: Those pivotal moments reshaped national conversations about health, race, and inequality, and pushed Andrews to rethink his career.
“I saw people deathly afraid of some disease, but also mortified by the fact that they witnessed somebody die on TV,” he said.
After nearly 16 years working as a lawyer in private practice and 15 years at AARP, Andrews found himself pulled back to mental and “whole body” health.
“My goal in law school was to be a courtroom lawyer all the time. If you had told me in 1990 that I would be a practicing lawyer going to court every day, I would have laughed you out of this room. If you had told me in 2010 that I wouldn’t be an in-house lawyer every day … I would have laughed you out of this room,” he said. “Everybody thinks you’re going to go straight from A to B. Life doesn’t work A to B.”
Now, Andrews says, he has the “ability to serve the whole house.” He can help “the eight-year-old who’s struggling in middle school … the parent who’s trying to get that child through, but also caring for an older loved one … who might have some cognitive decline or mobility challenges.”
Building a pipeline of Black mental health professionals
In his role at APAF, Andrews has his sights set on increasing the number of psychiatrists nationwide by reducing barriers to study and success, particularly for practitioners of color, who are vastly underrepresented.
Only about 5% of physicians are Black, and the number for Black psychiatrists is even lower at just 2%, according to the American Psychiatric Association. Widespread stigma around mental illness in communities of color, combined with “systemic barriers that keep persons of color from getting into medical school and matching for residency with teaching hospitals after graduating,” have contributed to the low numbers, Andrews says.
Financial pressures, limited residency slots, and a lack of exposure to psychiatry as a viable career all play important roles in limiting Black representation in the field. At the same time, stigma surrounding mental health — especially in Black communities — can discourage both patients and future physicians, according to Andrews.
He explains that this stigma is rooted in underlying fear, shame, and historic discrimination, and the only way to deal with those issues is directly. If you break those down, Andrews said, you can actually address them.
There are signs of change, though. “In the digital world, more and more people are seeing and talking about mental health all the time,” Andrews said. “And I believe more and more young doctors of all colors are deciding, ‘we need more psychiatrists, and I want to be a part of that solution.’”
Not having enough psychiatrists of color has far-reaching consequences. If you are a “non-diverse” physician or a physician practicing without humility or cultural competency, you may over-diagnose or misdiagnose a patient, said Andrews. You might assume a patient has symptoms due to your own cognitive biases.
A 2024 study in the Journal of General Internal Medicine revealed that mistrust and suspicion were high among dozens of Black patients with serious mental illness, who said they felt doctors did not take their concerns seriously or took a condescending tone with them during appointments.
This type of treatment does not promote trust or disclosure, Andrews said. “What is my advantage to be vulnerable with people who don’t think much of me, because you already thought I was broken?”
To combat medical racism and bias, APAF runs one of the largest psychiatry pipeline programs in the world. It provides more than 1,000 medical students from underrepresented and marginalized communities with training and professional development. Programs like the Diversity Leadership Fellowship emphasize cultural competency and evidence-based practices to better serve diverse groups and at-risk populations.
These programs have had tangible success in producing leadership in the field of psychiatry: APA’s CEO Dr. Marketa Wills, the first CEO of color and first female CEO in the APA organization’s 180-year history, was a trainee with the APAF nearly three decades ago.
Despite efforts to make healthcare more equitable for patients of color and members of the LGBTQ+ community, many experts believe that racism and biases are more deeply ingrained in the system than many realize. For example, a 2019 study found that Black patients suffering from depression are often misdiagnosed with schizophrenia, and a 2016 study revealed that many doctors wrongly believe that Black patients have higher thresholds for pain tolerance.
“If you don’t have cultural humility or cultural competency, you could over-diagnose somebody because you’re looking for them to be ADHD, you’re looking for them to be bipolar, you’re looking for them to be schizophrenic,” said Andrews. “And then, because of the fears, the stigmas, the shame, people don’t want to go and get tested either.”
Youth mental health focus
Andrews says many fear that telling someone else about their struggles will cause that person to look down on them. That unwillingness to share about mental health challenges can start at a young age.
That’s why the APAF has partnered with local organizations in the Washington, D.C., area to help young people address mental health concerns. One of the programs, Our Minds Matter, operates in D.C.-area schools and other states to educate students on signs of emotional distress and how to address it. APAF also runs the Notice.Talk.Act. at School program, which helps train school staff to recognize and address student mental health issues and connect them to resources. The program was recently adopted at Jefferson Middle School Academy.
The program is “the ‘stop, drop and roll’ of mental health,” Andrews said. “How do I notice signs and symptoms of distress in a student? How do I create an open space to talk and be a better active listener with a student who wants to share their mental health concerns and then act?”
APAF’s program, funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and free to schools, trained about 890 school staff members across the country in 2024, and boasts a 70% reduction in truancy and 89% reduction in disciplinary referrals, according to the foundation.
Notice.Talk.Act. is not just in schools — there are versions for home, for college, for the workplace.
Andrews hopes that this work with the APAF will reduce the stigma surrounding mental health struggles and improve access to culturally competent care. But he acknowledges there’s still a long way to go.
“We are planting and sowing seeds now and fertilizing the soil and tilling the soil,” he said. “We know that the next generation of doctors is going to look closer to the way the population looks. But ultimately, we still haven’t done enough.”
(This work is part of a partnership between the Washington Blade Foundation and Youthcast Media Group, funded through the FY26 Community Development Grant from the Office of D.C. Mayor Muriel Bowser. Jebeh Pajibo is a senior at Bard High School Early College DC, one of Youthcast Media Group’s journalism class partners. Sarah Gandluri, a UNC-Chapel Hill sophomore, is an intern and former high school participant with YMG. YMG founder, former USA Today health policy reporter Jayne O’Donnell, contributed to this report.)
Rehoboth Beach
BLUF leather social set for April 10 in Rehoboth
Attendees encouraged to wear appropriate gear
Diego’s in Rehoboth Beach hosts a monthly leather happy hour. April’s edition is scheduled for Friday, April 10, 5-7 p.m. Attendees are encouraged to wear appropriate gear. The event is billed as an official event of BLUF, the free community group for men interested in leather. After happy hour, the attendees are encouraged to reconvene at Local Bootlegging Company for dinner, which allows cigar smoking. There’s no cover charge for either event.
