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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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Democrats must stop the self-immolation

We can win the presidency and Congress if we stick together

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Sen. Bernie Sanders (I-Vt.) (Washington Blade file photo by Michael Key)

It is both fascinating and depressing, that groups like Our Revolution, which Sen. Bernie Sanders (I-Vt.) began in 2016 to screw Hillary Clinton, are still out there screwing other Democrats. 

They are currently trying to defeat President Biden in the Michigan primary. They couch what they are doing “as trying to influence what President Biden is doing about the Israel/Hamas war.” But, reality is, any headline attacking Joe Biden, is helping Donald Trump, no matter how you try to sugarcoat it. Joe Biden will not make foreign policy based on the far-left wing of the Democratic Party. They have every right to speak out, and Sanders was even willing to hurt our national security by voting against Biden’s bill for aid to Ukraine and Israel, and a number of other allies. The bill even includes humanitarian aid for the people of Gaza. Sanders is an embarrassment. But if he doesn’t speak out against ‘Our Revolution’ he is also a hypocrite, as he claims to support Biden. Thankfully, Michigan Gov. Gretchen Witmer did speak out, urging people to vote for Biden in the primary.  

Trying to influence a change in policy is fine, and speaking out for what you believe is great. But if you don’t look at the global perspective, and at all the possible repercussions of your actions and words, you are not very smart. Remember, on the issue of Gaza, if you want to support the Palestinian people, then having Trump in office is far worse than Biden. Trump claims to be best friends with Netanyahu, he moved the American embassy to Jerusalem, he will totally abandon Gaza and the Palestinian people. So, if that is what you want in the White House, then attacking Biden so he loses a primary, and then by either voting for a third party, or staying home, for the general election, that is what you will get.

The Democratic Party can learn a lot from Tom Suozzi’s win in a swing district in New York, in the special election to replace expelled former Rep. George Santos (R-N.Y.). Counter to what some are saying, how he ran the race is important. He managed to turn the immigration issue around against his Republican opponent by tying her to Trump, and the MAGA Republicans who today want to leave the border open. He used the issue of abortion by highlighting his position as a pro-choice candidate, against an opponent who was pro-life. He also told the district he was willing to work with Republicans when necessary to get things done. He told the voters he understood the founding fathers set up a government requiring compromise, not on your principles, but on ways to move forward what you believe in. Yes, he is a moderate, but then so are the vast majority of Americans.  

It is clear we live in difficult times. The issue of Biden’s age is being blown out of proportion, and the media are helping to do that. Every Democrat needs to read, talk about, and share, the recent column from the New York Times, “We’re Thinking About Biden’s Memory and Age in the Wrong Way.” It talks about, and explains, how we all begin to lose memory of certain things starting at the age of 30. How not remembering a name, or a date, doesn’t in any way indicate an inability to think about and work on important and complex issues. 

We also have to understand how far off polls can be, and often are, these days. What we as Democrats need to do to win this election is stick to what we know people respond to. That includes talking about Republicans wanting to restrict a woman’s right to health care, and control of her own body. It means we talk about how Trump wants us to abandon NATO, and has even encouraged Putin to invade our allies. He has no problem with Putin taking as much land as he wants. We need to remind people about how Trump staged a coup, which thankfully failed, and remind voters he will try again if we reelect him. We need to play the tape of him saying he wants to be a dictator, and will use the Department of Justice to get even with his enemies. How electing him will mean the end of our democracy. 

Democrats can win the presidency, and the Congress, if we stick together. Divided we will fail, and Trump will be in the White House. 

Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist. He writes regularly for the Blade.

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Pinto shepherds ‘Secure D.C.’ crime bill through Council

Republicans in Congress are closely watching measure

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D.C. Council member Brooke Pinto (D-Ward 2) (Washington Blade file photo by Michael Key)

Council member Brooke Pinto is shepherding the comprehensive crime bill, Secure D.C., through the Council. This is not easy considering some Council members are always looking to ensure we aren’t too tough on criminals, especially juveniles. In talking with Council member Pinto, she is cognizant, and reminding her fellow council members that the Republican Congress is watching this closely. 

I know Mayor Bowser is concerned about this as well. She submitted a bill, most of which is now included in the comprehensive bill, and wants to see it passed without additional amendments. On Feb. 6, the bill was passed on a first vote by the Council 12-0, with Ward 8 Council member, Trayon White, Sr., not voting. It is in his Ward most of the crime is being committed. Those living there deserve to be protected as much as those who live in Ward 3. 

As the Council now moves toward a second vote, which is needed before the mayor can sign the legislation, the plan is to do that in March. The mayor has asked that it be done sooner and that there are no more amendments weakening the bill. Once it is passed and signed, it will go to Congress for the review period and everyone is aware of what they did to the rewrite of the criminal code. Not only the Congress, but the people of the District, want a strong, tough on crime bill. People are afraid. 

Last year was a tough year for D.C. with crime running rampant in parts of the District. There were 274 homicides, a 20-year high. Carjackings were epidemic. There were 906, more than double the previous year. People are scared. A good friend recently told me it is the first time in years he looks behind himself when walking in Dupont in the evening. There was the recent shooting near the Dupont Metro on Connecticut and Q Street. The police have still not released detailed information on that. It was rumored to be a road rage incident, but the facts aren’t out. Again, people are scared, and that is not how anyone wants to live.

I am not naïve. There are many reasons one can point to for the spike in crime, including juvenile crime. The pandemic had a lot to do with that. There are young people who weren’t in school for two years, many without any supervision. Their parents were the ones out working, making a living, having to leave home to go to work. They didn’t have the option to stay home and work remotely so they could monitor what their kids were doing. Many juveniles committing crimes come from homes where there is food insecurity, and other issues impacting their lives. Clearly, we must deal with those issues if we are to change things in the long term. But the reality is we cannot wait to do that, the Council must act now. We must make those who are thinking of committing a crime understand there will be serious repercussions for what they do. 

The bill the Council is considering makes carjacking a more serious offense, as well as any crime committed with a gun. We also need to deal with the parents, or guardians, of children, like the recent 9- and 13-year-olds, who threatened a woman with a knife. Someone must be held responsible for those kids. Do they need to be removed from the situation they are now in? What is that situation? We need to involve the faith community, as well as all city resources, in this effort. However we do it, we must pass a serious crime bill that will pass muster with both the people of the District, and Congress.  

There are issues about the bill that are still being debated. One relates to drug free zones in which loiterers would be subject to arrest. Then they have removed the section that would have allowed all people arrested to be swabbed for their DNA. One issue being debated is how long one can hold both adults and youth in detention while awaiting trials. The bill would make it a felony to discharge a firearm in public, making permanent something that was put into emergency legislation last summer. 

Again, the bottom line is, for both the mayor and the Council, they must do something about crime. The debate is simply how tough to be on criminals, and what programs need to be funded that will make a difference, and make people safer. 

Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist. He writes regularly for the Blade.

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Letter-to-the-Editor

Real Agency for Community Development helps LGBTQ Ugandans who have fled country

Yoweri Museveni signed Anti-Homosexuality Act in May 2023

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Real Agency for Community Development was established by a proactive group of people who have fled persecution due to their sexual orientation in their respective districts of origin (Isingiro, Mbarara and Ntungamo) and now live in the Nakivale refugee camp where they hoped to find greater safety and freedom.

Homosexuality, however, is illegal in Uganda and they face new challenges: Arbitrary arrests, discrimination, corrective rape, kidnapping, robbery, stigma, homophobia, harassment and bullying. RACD has identified more than 123 LGBTQ Ugandans and other refugees living in the Nakivale and Oruchinga refugee camps. The organization provides them with services depending on their unique situations.

The legal and social marginalization experienced by these people results in many violations of LGBTQ persons’ liberty and threats to their safety. 

Since the beginning of this year, we have already seen three people arbitrarily arrested for being LGBTQ. Another two LGBTQ community members were brutally attacked by a gang of 10 homophobic neighbors in Kampala. One of them had his jaw shattered and had to get a surgery to insert a metal to his jaw. HIV prevention drugs and equipment are always a necessary part of the work with LGBTQ people and female sex workers. The general economic situation in Uganda is decreasing rapidly, and LGBTQ persons suffer the most. Many members reported that they pass many days without being able to obtain any food.

Please email [email protected] for more information about RACD. Donations can also be made to RACD through this GoFundMe link.

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