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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.

TheĀ King v. BurwellĀ 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 ACAā€™s health care marketplaces.Ā 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 theĀ King v. BurwellĀ case. If, however, the Court had ruled in favor of the lawā€™s opponents, it is likely these protections would have reached far fewer people.

The second case,Ā Obergefell v. Hodgesā€”which established a Constitutional guarantee for marriage equality across the United Statesā€”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 spouseā€™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 individualā€™s mental and physical health of not having to worry about whether or not the government accepts the validity of a coupleā€™s relationship.

But as was evident from the court battle over a Kentucky clerkā€™s responsibilities to issue marriage licenses to same-sex couples, compliance with the Supreme Courtā€™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 ofĀ Health AffairsĀ 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 barriersĀ 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 Centerā€™s Oā€™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 Oā€™Neill Institute.

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Opinions

The impact of womenā€™s bills of rights on trans employees

A mechanism to spread discriminatory policies

(Photo by 1STunningArt/Bigstock)

Around the country, Womenā€™s Bills of Rights (ā€œWomenā€™s BoRsā€) have emerged as a mechanism to spread anti-transgender policy under the guise of womenā€™s rights. These laws redefine terms like gender, sex, woman, and man to binary definitions that exclude protections and recognition of transgender, nonbinary, and in some contexts, intersex individuals. The focus of these laws is on public institutions and facilities, such as restrooms and changing rooms.  

What do these laws mean for students and employees of public institutions, such as public schools and government agencies? How may private employers react to these laws? We will dive into the rise of Womenā€™s BoR laws, their impact on workplace protections, and what we can expect with the rise of anti-transgender policies.  

In early 2022, Independent Womenā€™s Voice and the Womenā€™s Liberation Front introduced the Womenā€™s BoR as model legislation seeking to limit legal recognition of sex to oneā€™s sex assigned at birth. While both groups identify as womenā€™s advocacy organizations, Independent Womenā€™s Voice and the Womenā€™s Liberation Front have long sought to limit the rights of transgender Americans as a primary area of focus. The Womenā€™s BoR entered mainstream politics when Republicans in the House of Representatives and Senate attempted to endorse the legislation in a resolution in 2022. While federal attempts to pass a national Womenā€™s BoR have not been successful, states have begun to adopt similar bills. Throughout 2023 and 2024, state legislators in Kansas, Louisiana, Montana, Mississippi, Oklahoma, Tennessee, and Utah enacted statutes based on the federal bill. 

Advocates frame Womenā€™s BoR as supporting women, but they do not positively affect or protect cisgender or transgender women; in actuality, their only impact is to exclude transgender Americans from legal recognition and erase the experience of nonbinary and intersex individuals. In light of this worrisome impact, transgender, nonbinary, and intersex people may wonder what protections they have in workplaces if their state has passed a Womenā€™s BoR.  

Each stateā€™s Womenā€™s BoR is unique depending on what laws it sought to amend and how far-reaching its impact will be, but clear throughlines exist nationwide. Transgender, nonbinary, and intersex employees are affected by the redefinition of terms including sex, gender, men, and women, as legislators use outdated and transphobic lenses to categorize individuals and essentially erase any protection of those who do not identify as cisgender women or men. Furthermore, some of these bills place legal consequences on transgender, nonbinary, and intersex employees who use public facilities that align with their gender identity. For example, under the Louisiana Womenā€™s Safety and Protection Act, an individual who alleges they have suffered ā€œany direct or indirect harm as a result of a violation ofā€ this law may file a lawsuit against the party in violation for relief that may include injunctive relief (a court order to do something or to stop doing something) and attorney fees, damages, and costs associated with the lawsuit. The state seems to be incentivizing these cases by waiving a procedural hurdle that is usually required to get an injunction.  

What do these bills mean for transgender, nonbinary, or intersex employees that are employed in states that have enacted a Womenā€™s BoR? If the individual is employed by a state government, public school, or another form of public institution, that institution may take the position that only cisgender employees are protected by the stateā€™s anti-discrimination laws, which they may now interpret as only applying to cisgender women and men.  

Oklahomaā€™s Womenā€™s BoR states that ā€œany policy, program, or statute that prohibits sex discrimination shall be construed to forbid unfair treatment of females or males in relation to similarly situated members of the opposite sex.ā€ By stating that laws only forbid ā€œunfair treatment of females or males,ā€ the bill may result in transgender, nonbinary, and intersex employees no longer being covered by the Oklahoma Anti-Discrimination Act. Montana similarly appears to have passed legislation that limits ā€œsex discriminationā€ to only males and females, which could be interpreted as removing transgender, nonbinary, or intersex individuals from the protections of the Montana Human Rights Act.

These employees may still be protected by federal anti-discrimination laws, though, including Title VII of the Civil Rights Act, which prohibits employment discrimination based on gender identity. For instance, if a transgender employee is barred by their employer from using the office locker room that aligns with their gender identity, they may be able to establish a Title VII violation. Similarly, a Title VII or Affordable Care Act violation may be established where a transgender employee is denied coverage for gender-affirming care but cisgender employees are covered for the same procedure or treatment. 

Though not all have been labeled Womenā€™s BoR, more than 40 ā€œre-definitionā€ bills were introduced in state legislatures this year, according to the ACLU, marking a significant increase in this type of legislation. This indicates a concerted effort by certain political groups to roll back protections and recognition for transgender and nonbinary individuals. This legislative push not only threatens to erode hard-won rights but also fosters a climate of discrimination and exclusion. As these bills have gained traction in the past few years, it becomes increasingly important for employers and allies to stay informed and engaged to protect and advance the rights of transgender and nonbinary individuals at both the state and national levels. 

It is essential for public and private employers to understand the implications of these laws and how they might affect their workforce. When possible, employers should be proactive in counteracting harmful policies by incorporating specific protective language into their company policies and providing robust support systems for their transgender, nonbinary, and intersex employees. This could involve conducting informational sessions to ensure that employees know their rights and the potential impacts of these laws.  

While public employers in states that have passed Womenā€™s BoRs may be more limited in how they can support their transgender, nonbinary, and intersex employees, private employers can support their employees by implementing inclusive policies and practices such as anti-discrimination policies that explicitly protect gender identity and expression; providing comprehensive healthcare benefits that cover gender-affirming treatments and ensuring that facilities, such as restrooms, are accessible to all employees. Additionally, providing support networks, such as employee resource groups, and ensuring that all employees are aware of and have access to these resources can significantly enhance the sense of belonging and safety for transgender, nonbinary, and intersex employees. By doing so, employers can create a more inclusive and supportive work environment, helping to mitigate the negative effects of these legislative changes on their employees. 

Dacey Romberg, Madison Zucco, Luke Lamberti, and Xan Wolstenholme-Britt are with Sanford Heisler Sharp.

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Opinions

Electing Harris is an imperative for LGBTQ community

We will not go back into the closet

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Vice President Kamala Harris (Washington Blade file photo by Michael Key)

Since before 1969 and Stonewall in New York, activists have fought, many literally risking their lives, for the rights of the LGBTQ community. Fifty years ago, in 1974, Congresswoman Bella S. Abzug (D-N.Y.) introduced the original Equality Act in Congress. While we have made huge progress since that time, including gaining marriage equality, the rights of the LGBTQ community are still far from guaranteed. 

Too many today donā€™t realize after 50 years, Congress still has not passed the Equality Act. Just as after 101 years since it was introduced in Congress, the ERA has still not been added to our Constitution. The LGBTQ community must understand in 37 states you can get married on Sunday, and fired from your job, and thrown out of your home, on Monday. Donald Trump and J.D. Vance are OK with that. That is what they mean when they keep saying they want states to have the right to make decisions on equality. They are OK with states taking womenā€™s rights away, and not guaranteeing the rights of the African-American community. They are not only OK with that, they are fighting for it. 

So, it is imperative for the LGBTQ community to come out in huge numbers to vote for Kamala Harris and Tim Walz. If we care about our future, and future generations, it is crucial Harris and Walz win. We need to believe politicians when they talk about what they believe, when it comes to peopleā€™s rights. We can debate foreign policy, and the Affordable Care Act. We can debate issues impacting the border. But what should never be a debate in this great nation of ours, is the notion that we are ā€œall equal with certain inalienable rightsā€ and that we have a right to life, liberty, and the pursuit of happiness. That we will always work toward a more ā€˜perfect union.ā€™ Those are all the things Donald Trump, and J.D. Vance, oppose. 

They are happy to take us back to the time women couldnā€™t control their own healthcare; to when African Americans had to fight for their right to vote. To when members of the LGBTQ community had to hide who they were born to be, to protect their health and safety. Trump was presented with a pledge by the Christian nonprofit, Concerned Women for America, and asked to sign it. It stated ā€œa personā€™s ā€˜gender identityā€™ doesnā€™t overrule their sex,ā€ and that if he becomes president again, ā€œall federal agencies will be directed to uphold this fact in every policy and program at home and abroad.ā€ Such a promise would have wide-ranging implications, the form emphasized, ā€œaffecting schools, prisons, shelters, health-care providers, the military and more.ā€ He signed it.Ā 

J.D. Vance, Trumpā€™s MAGA running mate, ā€œexpressed his support for so-called ā€˜Donā€™t Say Gayā€™ laws prohibiting discussions of sexual orientation and gender identities in schools, writing, ā€˜Iā€™ll stop calling people ā€˜groomersā€™ when they stop freaking out about bills that prevent the sexualization of my children.ā€™ā€ Vanceā€™s use of the ā€œgroomerā€ slur, often used by right-wingers to claim that LGBTQ people and allies want to sexually abuse children, and his claim that merely educating kids on queer issues ā€œsexualizesā€ them both echo the anti-LGBTQ rhetoric of ā€œparentsā€™ rightsā€ groups like Moms for Liberty. He opposed the militaryā€™s LGBTQ-inclusion efforts as well as its efforts to root out white supremacists from its ranks. His campaign websiteĀ claimsĀ that American political leaders are ā€œusing Americaā€™s military as a social justice side project. Our troops donā€™t need to focus on diversity or equity or any other progressive buzzword.ā€ These are the people who want to sit in the White House, who want to control our lives.

Instead, we can vote for Harris and Walz, who have shown us who they are. Vice President Harris is part of the administration that has done more for the LGBTQ community than any in history. Tim Walz, in 1999, became the first faculty adviser to his high schoolā€™s gay-straight alliance group in Mankato, Minn. Harris is talking directly to the LGBTQ community when she says, ā€œWe will not go back.ā€ We will not go back into the closet. We will not go back to being afraid to acknowledge who we are, who we were born to be.

Instead, we will go out and vote proudly to defend our future, and the future of LGBTQ generations who come after us. We will join hands with women, African Americans, young people, and all those who want a better, safer, life; a ā€˜more perfect Union.ā€™ When we do, we will not be denied; and Trump and Vance, and their MAGA cult, will be relegated to the dustbin of history where they belong. 

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

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Commentary

Everything is local: How LGBTQ+ media amplified the movement

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I was 21 years old when I walked into the offices of Chicagoā€™s GayLife newspaper in the spring of 1984. Fresh out of journalism school, I had just learned about gay media and was excited that there might be a career ahead for an aspiring lesbian journalist. I had been afraid that being out would limit my choices ā€” and it did. Fortunately, the only choice was the right fit for me.

When I started 40 years ago, I had no idea that 60 years prior, a postal worker named Henry Gerber joined forces with a few brave men to launch the countryā€™s first gay-rights group, theĀ Society for Human Rights, and the nationā€™s first known gay newsletter, Friendship & Freedom. The men were soon arrested, and their organization shut down.

But we can trace the descendants of gay media to those roots 100 years ago. There were some short-lived and long-running ā€œhomosexualā€ publications ā€” from Lisa Benā€™s Vice Versa to the Mattachine Review, The Ladder, Gay Community News, BLK, Lesbian Connection and hundreds more. These media especially thrived after the 1969 Stonewall Rebellion in New York City, in part because of the growing movement, and in part because the tools to produce media became more affordable and accessible.

Now, as many community media outlets are looking at ways to counter the narrative of a collapsing ecosystem, News is Out, a collaboration of six LGBTQ+ media representing more than 250 collective years of experience covering the community, is launching the first Local LGBTQ+ Media Giving Day Tuesday, Oct. 8, 2024, during LGBTQ History Month. The timing for this first annual event is to celebrate the 100-year anniversary work of Henry Gerber and his peers. 

Tax-deductible donations are being accepted now atĀ https://givebutter.com/LGBTQequityfund. With one click, you can support six of the top LGBTQ+ outlets: Bay Area Reporter, Dallas Voice, Philadelphia Gay News, Tagg Magazine, Washington Blade and Windy City Times. News Is Out plans to expand the campaign in year two.Ā 

LGBTQ+ media has always had a vital and symbiotic relationship with the LGBTQ+ movement. Since most mainstream media either ignored or vilified our community for most of the past century, media by and for us helped document, amplify and change the trajectory of our movement. Whether it was covering the joy and celebrations or making sure we had ways to advocate for our rights and safety, or when we covered the start of HIV/AIDS in a way that was empathetic and educational, the LGBTQ+ press has been there, on the front lines, writing the first draft of our history.

Forty years later, I still feel so lucky to have found my niche in LGBTQ+ media. When I walked into GayLife, tucked between a menā€™s bathhouse and a menā€™s leather bar, I had no idea that my own life, and the whole movement, would have made it this far in a relatively short period of time.

But if the next 40 years are to continue to bend the arc of the moral universe forward, we need to make sure LGBTQ+ media are here to document and amplify the fight.

Donate here:Ā https://givebutter.com/LGBTQequityfund.


Tracy Baim is co-founder and owner of Windy City Times.

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