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.”
Uganda
Ugandan activist named Charles F. Kettering Foundation fellow
Clare Byarugaba founded PFLAG-Uganda
The Charles F. Kettering Foundation has named a prominent Ugandan LGBTQ activist as one of its 2026 fellows.
Clare Byarugaba, founder of PFLAG-Uganda, is one of the foundation’s five 2026 Global Fellows.
Byarugaba, among other things, has been a vocal critic of Uganda’s Anti-Homosexuality Act. Byarugaba in 2024 met with Pope Francis — who criticized criminalization laws during his papacy — at the Vatican.
The foundation on its website says it “is dedicated to bringing research and people together to make the promise of democracy real for everyone, everywhere.”
“Clare is the kind of hero who rushes toward the emergency to help,” said PFLAG CEO Brian K. Bond in a Feb. 27 statement to the Washington Blade. “She founded PFLAG-Uganda as the country pushed to criminalize homosexuality and those who support LGBTQ+ people. Yet, she never hesitated in her courage, telling us that families wanted to organize to keep their LGBTQ+ loved ones safe, and PFLAG was the way to do it. Clare Byarugaba not only deserves this honor, but she will use her compassion and experience to teach the world about LGBTQ+ advocacy as a Kettering Global Fellow.”
U.S. Capitol Police on Thursday arrested 13 HIV/AIDS activists in the Cannon House Office Building Rotunda.
The activists — members of Housing Works, Health GAP, and the Treatment Action Group — joined former PEPFAR staffers in demanding full funding of the program that President George W. Bush created in 2003. They chanted “AIDS cuts kill, PEPFAR now!” and unfurled banners from the Rotunda’s second floor that read “Trump and (Office of Management and Budget Director Russell) Vought kill people with AIDS worldwide,” “Over 200,000 deaths since January 2025,” and “Hands off PEPFAR” before their arrest.
(Washington Blade video by Michael K. Lavers)
This protest is the latest against the Trump-Vance administration’s HIV/AIDS policies since it took office.
Secretary of State Marco Rubio on Jan. 28, 2025, issued a waiver that allowed PEPFAR and other “life-saving humanitarian assistance” programs to continue to operate during a freeze on nearly all U.S. foreign aid spending. HIV/AIDS service providers around the world with whom the Washington Blade has spoken say PEPFAR cuts and the loss of funding from the U.S. Agency for International Development, which officially closed on July 1, 2025, has severely impacted their work.
The State Department last September announced PEPFAR will distribute lenacapavir in countries with high prevalence rates. Zambia is among the nations in which the breakthrough HIV prevention drug has arrived.
The New York Times last summer reported Vought “apportioned” only $2.9 billion of $6 billion that Congress set aside for PEPFAR for fiscal year 2025. (PEPFAR in the coming fiscal year will use funds allocated in fiscal year 2024.)
Bipartisan opposition in the U.S. Senate prompted the Trump-Vance administration last July withdraw a proposal to cut $400 million from PEPFAR’s budget. Vought on Aug. 29, 2025, said he would use a “pocket rescission” to cancel $4.9 billion for HIV/AIDS prevention and global health programs and other foreign aid assistance initiatives that Congress had already approved.
The White House in January announced an expansion of the global gag rule to ban U.S. foreign aid for groups that promote “gender ideology.” President Ronald Reagan in 1985 implemented the original regulation, also known as the “Mexico City” policy, which bans U.S. foreign aid for groups that support abortion and/or offer abortion-related services. The Council for Global Equality and other groups say the expanded rule will adversely impact HIV prevention efforts around the world.
A press release that Housing Works and Health GAP issued on Thursday notes more than $977 million “in appropriated PEPFAR funding for HIV prevention and treatment was unspent by the end of fiscal year (FY) 2025 — triple amount unspent at the end of FY 2024.”
“Activists predict this backlog will worsen rapidly in FY 2026 unless Congress immediately reasserts its Constitutionally-mandated oversight authority,” notes the press release.
The press release also indicates funding for the Centers for Disease Control and Prevention’s PEPFAR programs “will run out” by April 1 because “only 45 percent of their FY26 funding has been transferred from the State Department.
“Unless funding is transferred immediately, CDC’s global HIV programs across sub-Saharan Africa, Asia and the Caribbean will grind to a halt,” notes the press release.
The activists demanded Trump, Vought, Rubio, and Congress do the following:
- Activists are calling for full obligation of appropriated PEPFAR funds and rejection of growing political interference in global and domestic HIV programs
- Immediately release already-appropriated, unobligated PEPFAR funds
- Break the blackout on PEPFAR data, so Congress and people with HIV know how funding is being spent and can program based on data
- Activists are calling for full obligation of appropriated PEPFAR funds and rejection of growing political interference in global and domestic HIV programs.
“PEPFAR has saved more than 26 million lives and changed the trajectory of an epidemic,” said Housing Works CEO Charles King. “However, the Trump administration’s decision, over the objection of Republicans in Congress, to freeze PEPFAR funding has caused decades of progress to come undone and has been a death sentence for people with HIV relying on life-saving treatment. The U.S. must immediately restore PEPFAR funding and regain our standing in the global fight against HIV.”
King is among the activists who were arrested.
(Washington Blade video by Michael K. Lavers)
Texas state Rep. James Talarico won a hard-fought primary Tuesday to become the state’s Democratic nominee for U.S. Senate, defeating U.S. Rep. Jasmine Crockett in one of the year’s most closely watched and competitive Democratic contests.
Talarico, a Presbyterian seminarian and three-term lawmaker from Round Rock, was declared the winner by the Associated Press early Wednesday morning after a closely tracked vote count that drew national attention.
“Tonight, the people of our state gave this country a little bit of hope,” Talarico told the AP. “And a little bit of hope is a dangerous thing.”
With 52.8% of the vote to Crockett’s 45.9%, Talarico secured the nomination outright, avoiding a runoff and capping months of sharp contrasts between the two candidates over strategy, messaging, and how best to compete statewide in Texas. Democrats hope the competitive primary — and the relatively narrow margin — signals growing momentum in a state that has not elected a Democrat to the U.S. Senate since 1988.
Talarico has long expressed support for the LGBTQ community, a position he highlights prominently on his campaign website. Under the “Issues” section, he directly addresses assumptions that might arise from his faith and background as a seminarian in a deeply conservative state.
“My faith in Jesus leads me to reject Christian Nationalism and commit myself to the project of democracy,” his website reads. “Because that’s the promise of America: a democracy where every person and every family — regardless of religion, race, gender, sexual orientation, or any other difference between us — can truly be free and live up to their full potential.”
Crockett struck a conciliatory tone following her defeat, emphasizing party unity ahead of November.
“This morning I called James and congratulated him on becoming the Senate nominee,” Crockett told Politico. “Texas is primed to turn blue and we must remain united because this is bigger than any one person. This is about the future of all 30 million Texans and getting America back on track.”
Talarico also drew national attention earlier in the race when “Late Show” host Stephen Colbert said he was initially unable to air an interview with the state legislator due to potential FCC concerns involving CBS. The episode sparked a broader political debate.
Brendan Carr, chair of the Federal Communications Commission, appointed by President Donald Trump, told reporters the controversy was a “hoax,” though he also acknowledged Talarico’s ability to harness the moment to build support as an underdog candidate. The interview was later released online and garnered millions of views, boosting Talarico’s national profile.
In November, Talarico will face the winner of the Republican primary between incumbent Sen. John Cornyn and Texas Attorney General Ken Paxton, who have been locked in a bruising GOP contest. Rep. Wesley Hunt was also in the Republican primary field. The GOP race is expected to head to a May runoff.
In a joint statement, Senate Minority Leader Chuck Schumer and Democratic Senatorial Campaign Committee Chair Kirsten Gillibrand praised Talarico’s victory and framed him as a candidate capable of broad appeal.
“As an eighth-generation Texan, former middle school teacher, and Presbyterian seminarian, James will be a fighter for Texans from all walks of life and of all political stripes,” they said. “In November, Texans will elect a champion for working people: James Talarico.”
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