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The ongoing march for LGB health care equality

Turning Supreme Court victories into real change

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health care equality, marriage equality, Supreme Court, gay news, Washington Blade

(Washington Blade photo by Michael Key)

By TIMOTHY M. WESTMORELAND

& JEFFREY S. CROWLEY

Two Supreme Court rulings this summer helped assure that the lesbian, gay, and bisexual (LGB) community reaches health care equality with their non-LGB peers.

The King v. Burwell case upheld the federal subsidies created by the Affordable Care Act (ACA) to help all income-eligible people access affordable private plan insurance in the ACA’s health care marketplaces. Consequently, nearly nine out of 10 LGB adults (88.9 percent) now have some form of health insurance up from just 78.2 percent before the ACA was implemented. These gains mirror those made across other segments of the population.

The ACA also includes provisions that prevent insurers and providers from discriminating against people based on sexual orientation or gender identity. This provision was not directly under question in the King v. Burwell case. If, however, the Court had ruled in favor of the law’s opponents, it is likely these protections would have reached far fewer people.

The second case, Obergefell v. Hodges—which established a Constitutional guarantee for marriage equality across the United States—also had an impact on health care in the LGB community. For the first time for many same-sex couples, a legally recognized marriage meant having access to a spouse’s health insurance. This is to say nothing of what the ruling clears up for same-sex couples when it comes to hospital visits, do-not-resuscitate orders, and the general effects on an individual’s mental and physical health of not having to worry about whether or not the government accepts the validity of a couple’s relationship.

But as was evident from the court battle over a Kentucky clerk’s responsibilities to issue marriage licenses to same-sex couples, compliance with the Supreme Court’s rulings does not always come immediately or easily. Further, despite the newfound marriage equality enshrined in law, the LGB community still faces barriers to accessing health care at equal rates as straight individuals. A new study of survey data, published in the October issue of Health Affairs and authored by researchers at the Urban Institute in Washington, D.C., illustrates that despite recent landmark cases moving the needle on LGB rights and quality, there is still work to be done.

The authors of the study find that even with the increase in the number of LGB adults with health insurance, nearly a quarter of all LGB adults (24.4 percent) reported having problems accessing care over the past year compared to just 16.1 percent of non-LGB adults reporting the same problems. This could be because many of the newly insured had yet to find a doctor or they had so many health issues that went untreated while they were uninsured that it has simply taken more than 12 months to access all the care that they require. Even more troubling is the finding that more than four in 10 LGB adults (42.6 percent) reported having an unmet care need as a direct result of costs over the last twelve months, compared to just 32.4 percent on non-LGB adults reporting the same problem.

While these gaps may lessen, this is no time for complacency. Now that the barrier of health coverage has been reduced, the LGB community and their providers must refocus efforts on eliminating other access barriers in order to eliminate disparities in knowledge of HIV status; adapting the health system to promote widespread, affordable access to pre-exposure prophylaxis to prevent HIV infection; working to ensure early and sustained access to antiretroviral therapy that leads to viral suppression; and routinely screening and treating for other sexually transmitted infections. It also means addressing a broader array of issues directly affecting LGB people including access to breast and cervical cancer screening and tobacco cessation services, among others. Before we turn our attention away from making the ACA work more effectively, however, ongoing advocacy and awareness-raising efforts are also needed in the LGB community about what health insurance options are available, and which plans best suit different individuals and families and their specific health needs.

Though the federal government and the court system have written some aspects of equality into law, the march is not over yet. It is now time to turn law into reality.

Timothy Westmoreland is professor from practice at the Georgetown University Law Center, as well as a senior scholar at the Law Center’s O’Neill Institute for National and Global Health Law. Jeffrey S. Crowley is a distinguished scholar and program director of the National HIV/AIDS Initiative at the O’Neill Institute.

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Commentary

Stand with displaced queer people living with HIV

Dec. 1 is World AIDS Day

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(Bigstock photo)

Today, on World AIDS Day, we honor the resilience, courage, and dignity of people living with HIV everywhere especially refugees, asylum seekers, and queer displaced communities across East Africa and the world.

For many, living with HIV is not just a health journey it is a journey of navigating stigma, borders, laws, discrimination, and survival.

Yet even in the face of displacement, uncertainty, and exclusion, queer people living with HIV continue to rise, thrive, advocate, and build community against all odds.

To every displaced person living with HIV:

• Your strength inspires us.

• Your story matters.

• You are worthy of safety, compassion, and the full right to health.

• You deserve a world where borders do not determine access to treatment, where identity does not determine dignity, and where your existence is celebrated not criminalized.

Let today be a reminder that:

• HIV is not a crime.

• Queer identity is not a crime.

• Seeking safety is not a crime.

• Stigma has no place in our communities.

• Access to treatment, care, and protection is a human right.

As we reflect, we must recommit ourselves to building systems that protect not punish displaced queer people living with HIV. We must amplify their voices, invest in inclusive healthcare, and fight the inequalities that fuel vulnerability.

Hope is stronger when we build it together.

Let’s continue to uplift, empower, and walk alongside those whose journeys are too often unheard.

Today we remember.

Today we stand together.

Today we renew hope.

Abraham Junior lives in the Gorom Refugee Settlement in South Sudan.

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Perfection is a lie and vulnerability is the new strength

Rebuilding life and business after profound struggles

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(Photo by Orhan/Bigstock)

I grew up an overweight, gay Black boy in West Baltimore, so I know what it feels like not to fit into a world that was not really made for you. When I was 18, my mother passed from congestive heart failure, and fitness became a sanctuary for my mental health rather than just a place to build my body. That is the line I open most speeches with when people ask who I am and why I started SWEAT DC.

The truth is that little boy never really left me.

Even now, at 42 years old, standing 6 feet 3 inches and 225 pounds as a fitness business owner, I still carry the fears, judgments, and insecurities of that broken kid. Many of us do. We grow into new seasons of life, but the messages we absorbed when we were young linger and shape the stories we tell ourselves. My lack of confidence growing up pushed me to chase perfection as I aged. So, of course, I ended up in Washington, D.C., which I lovingly call the most perfection obsessed city in the world.

Chances are that if you are reading this, you feel some of that too.

D.C. is a place where your resume walks through the door before you do, where degrees, salaries, and the perfect body feel like unspoken expectations. In the age of social media, the pressure is even louder. We are all scrolling through each other’s highlight reels, comparing our behind the scenes to someone else’s curated moment. And I am not above it. I have posted the perfect photo with the inspirational “God did it again” caption when I am feeling great and then gone completely quiet when life feels heavy. I am guilty of loving being the strong friend while hating to admit that sometimes I am the friend who needs support.

We are all caught in a system that teaches us perfection or nothing at all. But what I know for sure now is this: Perfection is a lie and vulnerability is the new strength.

When I first stepped into leadership, trying to be the perfect CEO, I found Brené Brown’s book, “Daring Greatly” and immediately grabbed onto the idea that vulnerability is strength. I wanted to create a community at SWEAT where people felt safe enough to be real. Staff, members, partners, everyone. “Welcome Home” became our motto for a reason. Our mission is to create a world where everyone feels confident in their skin.

But in my effort to build that world for others, I forgot to build it for myself.

Since launching SWEAT as a pop up fundraiser in 2015, opening our first brick and mortar in 2017, surviving COVID, reemerging and scaling, and now preparing to open our fifth location in Shaw in February 2026, life has been full. Along the way, I went from having a tight trainer six pack to gaining nearly 50 pounds as a stressed out entrepreneur. I lost my father. I underwent hip replacement surgery. I left a relationship that looked fine on paper but was not right. I took on extra jobs to keep the business alive. I battled alcoholism. I faced depression and loneliness. There are more stories than I can fit in one piece.

But the hardest battle was the one in my head. I judged myself for not having the body I once had. I asked myself how I could lead a fitness company if I was not in perfect shape. I asked myself how I could be a gay man in this city and not look the way I used to.

Then came the healing.

A fraternity brother said to me on the phone, “G, you have to forgive yourself.” It stopped me in my tracks. I had never considered forgiving myself. I only knew how to push harder, chase more, and hide the cracks. When we hung up, I cried. That moment opened something in me. I realized I had not neglected my body. I had held my life and my business together the best way I knew how through unimaginable seasons.

I stopped shaming myself for not looking like my past. I started honoring the new ways I had proven I was strong.

So here is what I want to offer anyone who is in that dark space now. Give yourself the same grace you give everyone else. Love yourself through every phase, not just the shiny ones. Recognize growth even when growth simply means you are still here.

When I created SWEAT, I hoped to build a home where people felt worthy just as they are, mostly because I needed that home too. My mission now is to carry that message beyond our walls and into the city I love. To build a STRONGER DC.

Because strength is not perfection. Strength is learning to love an imperfect you.

With love and gratitude, Coach G.


Gerard Burley, also known as Coach G, is a D.C.-based fitness entrepreneur.

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Happy Thanksgiving to all

Dreaming of a brighter future for America

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(Photo by lilkar/Bigstock)

I hope you have a great Thanksgiving and can enjoy it with family and friends and that you have things you can be thankful for this past year. That you have your health. Now here is the column I would have liked to share with you this Thanksgiving: 

To all my friends and family. This year I am thankful the felon has left the White House. It feels we can all finally breath again. I am so happy his idea of a ballroom at the White House was a joke, and we can once again walk in Jackie Kennedy’s rose garden, and visit the beautiful East Wing. I am thankful the felon’s personal Goebbels, Stephen Miller, lost his job when the reality that he was a fascist was too much to take. It was wonderful to see the Supreme Court wake up and do their job once again. They stopped drinking the MAGA Kool-Aid and voided all the executive orders calling on museums to hide the history of Black Americans, women, and the LGBTQ community. They told the president he didn’t have the right to place tariffs, and that he couldn’t fire legally appointed members of commissions under the rubric of Congress’s control.

Then I am thankful the Congress began to do its job. That so many Republicans grew a set of balls and decided to challenge Speaker Mike ‘sycophant’ Johnson, reminding him they were an independent part of government, and didn’t need to rubber stamp everything the felon wanted. I was thankful to see them extend the SNAP program indefinitely, and the same with the tax credits for the ACA, agreeing to include these important programs in next year’s budget. Then they went further, and paid for the programs, by rescinding all the tax benefits they had given to the wealthy, and corporations, in the felon’s big ugly bill. Finally realizing it is the poor and middle class who they had to help if the country was to move forward. Then I can’t thank them enough for finally passing the Equality Act, and doing it with a veto proof majority, so the felon had to sign it, before he left office. They did the same for the Choice Act, and the Voting Rights Act. It was a glorious year with so much to be thankful for. 

Then I am so thankful Congress finally stood up to the felon and said he couldn’t start wars without their approval, and the Supreme Court ruled they were right. That attacking Venezuela was not something he had the right to do. Then the final thing the court did this year I am thankful for, is they actually modified their ruling on presidential immunity, and said the felon’s grifting was not covered, as under their decision that was private, and not done in his role as president. Again, can’t thank them enough for waking up and doing that. 

Then there is even more I am thankful for this year. It was so nice to see Tesla collapse, and Musk lose his trillion-dollar salary. The people finally woke up to him and insisted Congress mandate the satellite system he built, basically with money from the government, was actually owned by the government, and he could no longer control who can use it. It was determined he alone would not be able to tell Ukraine whether or not they can use it in their war defending against the Russian invasion. Then I am so thankful Congress went even further, and approved the funds needed by the Ukrainians for long-range missiles, and a missile defense system, accepting Ukraine was actually fighting a proxy war for the West, and Ukraine winning that war would help keep our own men and women off the battlefield. 

And speaking of our military, I thank Congress for lifting the ban on transgender persons in the military, and honoring their service, along with the service of women, Black service members, all members of the LGBTQ community, and all minorities. It was fun to see Pete Hegseth being led out of the Pentagon, and being reminded he wasn’t the Secretary of War. There is no Department of War, it is still the Department of Defense, with congressional oversight. Again, so many things to be thankful for this past year. It seemed like my heart runneth over. 

Then my alarm went off and I woke up from my big beautiful dream, only to realize I was still living in the Trumpian nightmare. 


Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.

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