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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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  1. Mark Cichewicz

    October 23, 2015 at 7:06 pm

    33 states lack protection for LGBT citizens. Michigan is one of them. I could have lost my job, been thrown out of my house, or been denied a place to stay, just because I’m a gay man living in this state. In Michigan my husband and I could have been told we can’t spend our honeymoon in the place of our choice, just because we are gay. In Michigan the republican legislators in the house and senate seek to inact laws to protect religious freedom. RFRA laws disallowing LGBT adoption rights. Many other rights. are at stake as well. This kind of governing is discrimination for all involved. My husband and I stand with FREEDOM FOR ALL AMERICANS. The stupidity must end, help us end it NOW.

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Opinions

‘Don’t Ask, Don’t Tell’ repeal serves as a guide for enacting equality legislation

Equality Act supporters should take cues from Senate moderates

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Equality legislation is close to passing in Congress, but close isn’t good enough. “Close” won’t change anything for the LGBTQ Americans who face discrimination every day. Senate Democrats and Republicans must make a push to negotiate. With a reach on both sides to find common ground, we can move equality legislation from “close” to “done deal.”

Some Democrats are waiting for the filibuster to end—despite clear evidence that they lack the votes to end it. Some Republicans are practicing a tried-and-true brand of obstructionism. To break this deadlock, we should look to the successful, bipartisan repeal of “Don’t Ask, Don’t Tell” (DADT) as a guide.

The DADT repeal is the single reference point for LGBTQ advocates for overcoming the Senate filibuster. Other victories have been in the courts; notably, the Supreme Court’s 2015 Obergefell decision that made gay marriage legal nationwide.

Before Obergefell, advocates had success in the state legislatures. I worked on campaigns for the freedom to marry in Minnesota, New Hampshire, New York and elsewhere, finding common ground between Democrats and Republicans who thought it was impossible to negotiate on marriage. Eventually, enough people from both parties came together to pass marriage laws in a majority of states.

Working together at the state level is one thing. Congress is another.

Despite Democrats’ control of the White House, Senate and House, negotiations are failing at the federal level. So, we lets look to ancient history—the 2010 repeal of DADT—for guidance on reaching 60 votes in the Senate.

The most important lesson from the DADT repeal is that Senate moderates must champion the cause and lead negotiations. The more partisan figures on both sides need to step back. Overcoming the filibuster is a job for moderates, not ideologues.

As it happens, the hero of the DADT repeal is still a senator and can help. Republican Sen. Susan Collins of Maine led the negotiations on DADT repeal.

Senator Collins supports the Equality Act in principle and even sponsored a version of the bill in past. However, the current version is too extreme for Sen. Collins, as a result, she has withdrawn as a co-sponsor. The current bill has also foundered with Sen. Lisa Murkowski, another important figure in the repeal of DADT.

The fact that moderate, pro-LGBTQ senators are unable to back the current version of the Equality Act should send a clear message to Democrats that we need to make reasonable changes to the bill. So far, the message is being ignored.

On the Democratic side, independent Sen. Joe Lieberman was essential to the repeal of DADT. There certainly were passionate, liberal Democrats who could have asserted themselves during the debate. But then, the bill would have taken longer to pass, or even might have failed.

The lesson is clear. Listen to the moderates. Let them lead this charge.

Another important lesson from the repeal of DADT is to be flexible in the legislative strategy. DADT repeal was originally an amendment to a large defense authorization bill. Rather than give up, Collins and Lieberman fought and saved DADT repeal from defeat by pulling out key provisions they knew could pass on their own and making them a standalone measure. Repeal passed with bipartisan support.

The current version of the Equality Act tries to do too much. That’s why it can’t win support from moderate Republicans who have legitimate concerns the bill might suppress free speech or shut down religious charities.  

Over 60 senators can agree on the basic premise of the Equality Act. They would gladly vote to prohibit discrimination against LGBTQ Americans in employment, housing, and public accommodations, so long as the law didn’t intrude on the First Amendment.

If the far left believes that our country has too much religious liberty, they can deal with that in future legislation. But so long as we have a filibuster—and, there’s no indication it will end any time soon—the Equality Act needs to reflect our society’s current views on religious liberty.  

The DADT repeal passed with 65 votes in the Senate, overcoming the filibuster. Let’s replicate that victory by using the same playbook. Moderates: Take the lead.

Tyler Deaton is the senior advisor to the American Unity Fund, a conservative nonprofit organization working to advance LGBTQ freedom and religious freedom

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LGBTQ people are being hunted down in Afghanistan

Homosexuality punishable by death under Taliban Sharia law interpretation

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Two men in Kabul, Afghanistan, in July 2021 (Photo courtesy of Dr. Ahmad Qais Munzahim)

Kabul was known as one of the few “liberal” cities in Afghanistan. The word liberal is in quotation marks, and inflected, because it is liberal compared to the rest of the country. Now that the Taliban has taken over, most people who expressed themselves differently and openly are forced to adhere to Sharia law, completely change their ways, hide their identity, or be killed.

The U.S. State Department reported in 2020 that even before the Taliban took power in August, LGBTQ people in Afghanistan faced “discrimination, assault and rape” and “homosexuality was widely seen as taboo and indecent.” Laws against lesbian, gay and transgender people made their existence illegal and punishable by up to two years in jail. Those laws were not always enforced, but they did leave LGBTQ people at risk of extortion and abuse by authorities, as reported by the U.K. government.

Even with the discrimination and abuse, LGBTQ people still had a sliver of space in society. Nemat Sadat, an LGBTQ Afghan author living in the United States said that gay, lesbian and transgender people helped the country’s cultural life develop since the Taliban’s last rule 20 years ago. But, most of these people built their lives quietly.

Now with the Taliban regime, their sliver of space in society is gone, there is no room to live quietly as an openly LGBTQ person. Under the Taliban’s interpretation of Sharia law, homosexuality is punished by death.

In an interview with Reuters, Waheedullah Hashimi, a top decision maker for the Taliban said, “there will be no democratic system at all because it does not have a base in our country,” and continued to say, “what type of political system should we apply in Afghanistan is clear. It is sharia law and that is it.”

One source spoke to a 20-year-old university student who is lesbian in Afghanistan. Her family accepted her as a lesbian, but now the new Taliban leadership has put the lives of all of her family at risk. There is a new surge of violence against any lesbian, gay and transgender people. This includes anyone speculated of being lesbian, gay, or trans, and those who support them.

This young lesbian woman has gone into hiding. She is part of hundreds of LGBTQ people in Afghanistan who are pleading with advocates and organizations outside Afghanistan for help to escape the Taliban tyranny.

Nemat Sadat shares stories of lesbian, gay and trans people in hiding. He shared a story of a gay man who watched from his hiding place in the ceiling as Taliban fighters beat the friend who refused to disclose his location.  

LGBTQ people in Afghanistan fear the risk of being arrested, beaten and killed. The Taliban made it clear that it is enforcing its strict religious laws against Afghanistan’s LGBTQ citizens. In an interview with Germany’s Bild newspaper, one Taliban judge said there were only two punishments for homosexuality: “stoning or being crushed under a wall.”

LGBTQ people in Afghanistan are reporting that their friends, partners and members of their community are being attacked and raped. They also stated that Islamic fundamentalists and riotous groups are encouraged by the new tyranny and are on the hunt for LGBTQ people.

Another source shared that a gay man was targeted for his sexuality and then raped by his male attackers. That is a terrible paradox. He was raped by his male attackers, who criminalizing him for having same sex relations.

LGBTQ people are in hiding, desperately trying to get out of the country, and trying to erase any proof of their queer identity.

They feel abandoned by the international LGBTQ community. The Taliban is proving that the Western nations have normalized relations to their government. The Taliban and their supporters see this a proof of their victory. This leaves LGBTQ people defeated and fearing torture and death.

The U.S. government and other Western countries evacuated many people out of Afghanistan, including journalists, women’s rights activists and those who worked with foreigners. But, LGBTQ activists said that nothing has been done for them. A source says about her situation, “we will definitely be killed. We are asking to be evacuated immediately from Afghanistan.” To date, no safe route has been found.

Even underground measures to help LGBTQ people are challenging and near impossible. The Rainbow Railroad is a non-governmental organization helping LGBTQ people around the world escape persecution. Executive Director Kimahli Powell said evacuating LGBTQ people from Afghanistan is especially hard as they are often alone, in hiding, and unable to contact each other. If routes to get them out is nearly impossible, that still means those routes are somewhat possible. As difficult as it may be, we must find pathways to save these people and get them out.

The Taliban regime has established itself, knowing with certainty that the world will stand aside, albeit condemning and protesting, but not intervening. This is empowering jihadists across the world, especially in the Middle East. The Taliban has many allies and admirers, including the Palestinian Islamic Jihad (PIJ) and Hamas. 

The leader of Hamas, Ismail Haniyeh, travelled from Palestinian territories to meet with Taliban leaders in Qatar. The Palestinian Islamic Jihad has a history of ties to the Taliban, even with radicals joining each other’s organizations. Very public statements of congratulations were made between leaders of the Taliban, Hamas, and Palestinian Islamic Jihad, and all with full Iranian support.

The increase in brazen forcefulness of these groups reaches beyond Afghanistan, and spreads to the lands dominated by other similar groups. This causes an escalation of the threats to anyone who opposes Sharia law or who lives differently than what Sharia law allows. LGBTQ people in these lands are in peril. 

If we do not help LGBTQ people in Afghanistan, the lives of LGBTQ people under other similar tyrannies face increased uncertainty and danger.

Since posting this video, I have been receiving direct messages from LGBTQ people in hiding in Afghanistan, and those who are seeking to be evacuated. They all share harrowing experiences of being attacked, raped, and threatened by Taliban, Islamic State and bullying groups.

Yuval David is an innovative actor, host and filmmaker with a creative mantra to entertain, uplift and inspire. He is a captivating performer and compelling storyteller who uses his platform for sharing narratives that affect social change, specifically on behalf of highly respected U.S. and international organizations that raise awareness for the marginalized and under-represented, inspired by his LGBTQ+ and Jewish identity, and his Israeli-American roots.

He can be reached through social media

YouTube.com/YuvalDavid

Instagram.com/Yuval_David_

Facebook.com/YuvalDavid

Twitter.com/YuvalDavid

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Proposed zoning code changes will harm Rehoboth

Public hearing to take place on Oct. 15

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Double L, Diego's Hideaway, Fourth, Rehoboth Beach, Delaware, gay news, Washington Blade
(Washington Blade file photo by Michael Key)

As a former city commissioner for nine of the past 15 years, I have seen a lot of changes in the laws and decisions governing the city of Rehoboth Beach. Like most things in life, some have been good and some have been not so good. The ones that have been good for the city plan for the future. The ones that have been bad for the city try to hold on to the past. The city of Rehoboth Beach has been a magnet for tourists for a long time and that has not changed, nor can it be changed. Trying to stifle our business community will not decrease the numbers that come to our city but will only frustrate our residents and visitors by putting into place ordinances that will promote the construction of buildings that lack functional architectural creativity. Worse, discouraging business innovation will drive businesses to Route 1, resulting in vacant storefronts along our commercial streets that will ultimately increase costs to residents in terms of higher taxes, provision of basic services, and increased utility fees. 

On Oct. 15, a public hearing will be held regarding patchwork changes to the zoning code. The proposed changes have been put forth as “clarifications”. They are NOT clarifications but changes that will change the downtown commercial districts for generations to come. And not in a good way. 

This may seem like an over-reaction but truly it is not. Not to over-simplify, but the basic zoning code that applies to commercial buildings allows for construction of a building from lot line to lot line with a maximum height of 42 feet. The proposed changes/clarifications would count interior courtyards and elevator shafts. These changes do not change the bulk of a building but could very well disincentivize desired architectural enhancements, such as balconies and courtyards. In this day and age of COVID, open space should be promoted not penalized. Why would we stifle architects with ideas for buildings that embrace creative use of a parcel of land? The effect of the proposed changes on the new hotel projects that are currently being designed warrants involvement by everyone who wants to make sure that Rehoboth Avenue does not end up showcasing buildings with zero architectural interest. 

It is important to remember that the one square mile of the city of Rehoboth Beach is not a suburban community, nor is it a retirement community. It is a city that hosts tens of thousands of visitors eight to nine months a year with a vibrant restaurant scene, beach and boardwalk, farmers market, recreational dock, and hopefully one day a performing arts center. What can you do? Send an email by Oct. 15 to [email protected], asking the mayor and city commissioners to pause making these patchwork changes to the city code, changes that will have negative unintended consequences for years to come. Ask them to do what was programmed in the budget over a year ago—to hire a zoning expert to look holistically at the city ordinances and make practical, coordinated changes that incentivize development that sustains the aesthetics and prosperity of our town. 

Pat Coluzzi is a former city commissioner for the city of Rehoboth Beach.

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