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GOP health plan’s ‘devastating’ impact on those with HIV

Concerns over PrEP coverage, treatment of trans patients



From left, President Donald Trump, White House Press Secretary Sean Spicer and Speaker of the House Paul Ryan (Washington Blade photos of Trump and Ryan by Michael Key; photo of Spicer courtesy C-Span)

The Republican plan to repeal and replace Obamacare with the American Health Care Act continues to worry advocates seeking to ensure access to health care for LGBT people and people with HIV — a concern that a recent report from the Congressional Budget Office has validated.

According to CBO, 14 million people would lose insurance coverage in 2018 if the American Health Care Act were to become law as a result of the elimination of the individual mandate under Obamacare. But that number would climb to 21 million in 2020, then to 24 million in 2026 following repeal of the Medicaid expansion under Obamacare. In 2026, CBO estimates 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law.

As President Trump pushes for the proposal and continues to call Obamacare a “disaster,” a major source of fear for advocates of LGBT people and people with HIV is the rollback of Medicaid, which as health coverage for low-income Americans provides care for more than 40 percent of people with HIV and many transgender people.

CBO estimates the American Health Care Act would decrease direct spending in Medicaid by $880 billion over the 2017-2026 period resulting in 14 million fewer Medicaid enrollees by the end of that period.

Carl Schmid, deputy director of the AIDS Institute, said he couldn’t overstate the calamity passage of the American Health Care Act would mean for people with HIV.

“I hate to use the word devastating, other people have used it,” Schmid said. “The CBO score is not surprising at all because it’s what we had said that the biggest impact, they’re really cutting back, scaling back coverage in Medicaid. They’re removing all these people from the Medicaid rolls.”

Schmid said the American Health Care Act would also remove the Medicaid requirements that the states provide 10 essential health benefits, including prescription drugs, which means “we don’t know what the states will provide” to people with HIV.

Also at risk under the plan, Schmid said, is access to preventative services, like HIV testing, or access to PrEP as a means of HIV prevention for low-income people on Medicaid.

“PrEP is covered by most plans right now,” Schmid said. “Medicaid plans and qualified health plans. If people don’t have coverage, they can’t access the medications, and the federal government’s not paying for PrEP by the CDC or the Ryan White program. Ryan White is just for people who are HIV positive.”

One aspect of Obamacare that LGBT supporters value is Section 1557, which prohibits discrimination on the basis of sex in health care. The Obama administration interpreted that provision to bar discrimination in health care against transgender people, including by denying them gender reassignment surgery. A court order has enjoined enforcement of that regulation, but advocates insist transgender people can sue under the underlying law if they face discrimination in health care.

Mara Keisling, executive director of the National Center for Transgender Equality, said the provision is safe for the time being because it couldn’t be eliminated through the budget reconciliation process planned for the American Health Care Act, but nonetheless transgender people would face other problems.

“That really doesn’t matter because the repeal bill would make it so much harder for trans people to get insurance though the continuous coverage requirement, the gutting of Medicaid and several other aspects, that protecting from discrimination would move to a lesser concern,” Keisling said. “Trans people would be among those most hurt.”

In the individual market, CBO estimates the Republican plan would reduce premiums by an average of 10 percent, but there’s a wide fluctuation in estimated payments for older people and younger people. For a person making $26,500 a year, the yearly net premium would be $1,450 if that person were 21 years old, $2,400 if that person were 40 years old and $14,600 if that person were 64 years old.

Under the legislation, premiums for older people could be five times larger than those for younger people in many states, but the size of the tax credits for older people would only be twice the size of the credits for younger people.

CBO estimates the American Health Care Act would result in greater cost savings than Obamacare for the federal government. Under the Republican proposal, the agency projected a reduction in the federal deficits by by $337 billion over the 2017-2026 period.

White House Press Secretary Sean Spicer defended the American Health Care Act on Tuesday by dismissing the CBO’s estimates that the number of uninsured people would increase, asserting its estimate during the Obama era that 24 million people would have coverage under Obamacare in 2016 was “way off.”

“They were off by 13 million people — over 50 percent,” Spicer said. “In fact, only 10.4 million people were actually covered. Reports now suggest that that number has dwindled down to 9 million. CBO coverage estimates are consistently wrong and, more importantly, did not take into consideration the comprehensive nature of the three-pronged plan to repeal and replace Obamacare with the American Health Care Act.”

The second prong to the administration’s approach to health care reform is regulatory relief aimed at reducing costs by 10 percent in the individual markets. The third is additional legislation to undo Obamacare that can’t be done through the regulatory process, which only requires a majority vote for passage in the U.S. Senate as opposed to 60 votes to overcome as a filibuster.

Phill Wilson, CEO of The Black AIDS Institute, said in a statement the White House attack on the CBO’s calculations is “spin” because the American Health Care Act will increase premiums, reduce benefits and replace subsidies with tax credits.

“Particularly if you’re a person living with HIV/AIDS, a poor person, a person with other chronic illnesses, or an older American — regardless of what lie the administration or the Congress tries to sell to you — ask yourself this: Is my health insurance likely to be more robust, better and cheaper under the new plan than it was under the Affordable Care Act?” Wilson said. “Then mobilize accordingly.”

Under questioning from CNN’s Jim Acosta, Spicer conceded millions of people won’t have health coverage as a result of the American Health Care Act, but insisted “you have to look at the current situation.”

“If you could bring down cost and choices and allow people to find a plan that fit their budget, that was tailored to their needs, there is actually a higher likelihood that they will find something that they want at a price that they can afford — as to right now, which is I get a plan that I’m forced to buy that has a deductible that I can’t afford, but I’ve got a cute little plastic card that I can wave around,” Spicer said.

Schmid rejected the argument health care plans can’t be used now because premiums and deductibles are too high, noting for many people, such as those on Medicaid, it’s either this coverage or nothing at all.

“We agree that there are problems with high deductibles,” Schmid said. “That’s why we want to repair the Affordable Care Act, but taking away coverage from people is even worse. And he mixes up Medicaid. Medicaid doesn’t have premiums and deductibles and so that’s the biggest problem. They keep on saying it doesn’t work. You have deductibles. Well, that’s only the qualified health plans. Medicaid doesn’t have premiums, doesn’t have deductibles. They have minor co-pays and they’re limited by law, and they’re minimal.”

As part of an effort to derail repeal, Democrats, including Senate Minority Leader Chuck Schumer (D-N.Y.), have sought to vilify the proposal by calling it “Trumpcare” much like Republican opponents of Affordable Care Act dubbed the Democratic plan Obamacare — a nomenclature President Obama ultimately accepted as his own.

Spicer, however, sought to put some distance between Trump and the Republican proposal by rejecting the Trumpcare label for the American Health Care Act, saying the issue at hand isn’t labels, but health care reform.

“The Obama administration didn’t label it Obamacare, they called it the ACA,” Spicer said. “I mean, this is the American Health Care Act. The president is proud of it. The president is proud of the fact that we’re working with Congress. But this is a bill that is not his, it’s a joint effort that we’ve worked with the House and the Senate on. He’s proud of it. He’s proud of the impact that it’s going to have on American patients. So I don’t think this is about labels and names, this is about getting a job done.”

The office of U.S. House Speaker Paul Ryan (R-Wis.), who was the originator of the American Health Care Act before Trump endorsed it, didn’t respond to the Washington Blade’s request to comment on the impact the plan would have on LGBT people and people with HIV.

Gregory Angelo, president of the Log Cabin Republicans, said he’d withhold formal comment on the American Health Care Act, citing on ongoing review of the American Health Care Act on LGBT people and people with HIV.

“I will say that I continue to get messages from LCR members across the country whose premiums have skyrocketed or whose healthcare plans have been canceled as a result of Obamacare,” Angelo said. “Clearly there has to be a better way.”

Because of opposition on all sides, passage in the Republican-controlled Congress will be an uphill fight. Democrats, including the conservative Sen. Joe Manchin (D-W.Va.) seem locked in opposition to the American Health Care Act. On the other side of the aisle, the far-right House Freedom Caucus opposes the measure because it doesn’t go far enough, as do Sens. Tom Cotton (R-Ark.) and Rand Paul (R-Ky.), whose states have enacted some version of the Medicaid expansion.

Schmid said he doesn’t think the current version of the American Health Care Act would make it through Congress, saying Republicans are “running scared” over the prospects of the bill becoming law.

“I think what they’ll do is make some changes, but I don’t see how this is going to pass even in the House, let alone the Senate,” Schmid said. “It’s ripping coverage away from people with health care, and we can’t do that. What we say is people with HIV need consistent care, and you cannot risk taking away their medications or health care. Not even for a single day.”

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Bill to ban conversion therapy dies in Puerto Rico Senate committee

Advocacy group describes lawmakers as cowards



Puerto Rico Pulse nightclub victims, gay news, Washington Blade


A Puerto Rico Senate committee on Thursday killed a bill that would have banned so-called conversion therapy on the island.

Members of the Senate Community Initiatives, Mental Health and Addiction Committee voted against Senate Bill 184 by an 8-7 vote margin. Three senators abstained.

Amárilis Pagán Jiménez, a spokesperson for Comité Amplio para la Búsqueda de la Equidad, a coalition of Puerto Rican human rights groups, in a statement sharply criticized the senators who opposed the measure.

“If they publicly recognize that conversion therapies are abuse, if they even voted for a similar bill in the past, if the hearings clearly established that the bill was well-written and was supported by more than 78 professional and civil entities and that it did not interfere with freedom of religion or with the right of fathers and mothers to raise their children, voting against it is therefore one of two things: You are either a hopeless coward or you have the same homophobic and abusive mentality of the hate groups that oppose the bill,” said Pagán in a statement.

Thursday’s vote comes against the backdrop of continued anti-LGBTQ discrimination and violence in Puerto Rico.

Six of the 44 transgender and gender non-conforming people who were reported murdered in the U.S. in 2020 were from Puerto Rico.

A state of emergency over gender-based violence that Gov. Pedro Pierluisi declared earlier this year is LGBTQ-inclusive. Then-Gov. Ricardo Rosselló in 2019 signed an executive order that banned conversion therapy for minors in Puerto Rico.

“These therapies lack scientific basis,” he said. “They cause pain and unnecessary suffering.”

Rosselló issued the order less than two weeks after members of the New Progressive Party, a pro-statehood party  he chaired at the time, blocked a vote in the Puerto Rico House of Representatives on a bill that would have banned conversion therapy for minors in the U.S. commonwealth. Seven out of the 11 New Progressive Party members who are on the Senate Community Initiatives, Mental Health and Addiction Committee voted against SB 184.

“It’s appalling. It’s shameful that the senators didn’t have the strength and the courage that our LGBTQ youth have, and it’s to be brave and to defend our dignity and our humanity as people who live on this island,” said Pedro Julio Serrano, founder of Puerto Rico Para [email protected], a Puerto Rican LGBTQ rights group, in a video. “It’s disgraceful that the senators decided to vote down this measure that would prevent child abuse.”

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Undocumented LGBTQ immigrants turn to Fla. group for support

Survivors Pathway is based in Miami



Survivors Pathway works with undocumented LGBTQ immigrants and other vulnerable groups in South Florida. (Photo courtesy of Francesco Duberli)


MIAMI – The CEO of an organization that provides support to undocumented LGBTQ immigrants says the Biden administration has given many of his clients a renewed sense of hope.

“People definitely feel much more relaxed,” Survivors Pathway CEO Francesco Duberli told the Washington Blade on March 5 during an interview at his Miami office. “There’s much hope. You can tell … the conversation’s shifted.”

Duberli — a gay man from Colombia who received asylum in the U.S. because of anti-gay persecution he suffered in his homeland — founded Survivors Pathway in 2011. The Miami-based organization currently has 23 employees.

Survivors Pathway CEO Francesco Duberli at his office in Miami on March 5, 2021. (Washington Blade photo by Yariel Valdés González)

Duberli said upwards of 50 percent of Survivors Pathway’s clients are undocumented. Duberli told the Blade that many of them are survivors of domestic violence, sexual assault and human trafficking and victims of hate crimes based on their sexual orientation and gender identity.

“Part of the work that we have done for years is for us to become the bridge between the communities and law enforcement or the justice system in the United States,” said Duberli. “We have focused on creating a language that helps us to create this communication between the undocumented immigrant community and law enforcement, the state attorney’s office and the court.”

“The fear is not only about immigration,” he added. “There are many other factors that immigrants bring with them that became barriers in terms of wanting to or trying to access the justice system in the United States.”

Duberli spoke with the Blade roughly a week after the Biden administration began to allow into the U.S. asylum seekers who had been forced to pursue their cases in Mexico under the previous White House’s “Remain in Mexico” policy.

The administration this week began to reunite migrant children who the Trump administration separated from their parents. Title 42, a Centers for Disease Control and Prevention rule that closed the Southern border to most asylum seekers and migrants because of the coronavirus pandemic, remains in place.

Duberli told the Blade that Survivors Pathway advised some of their clients not to apply for asylum or seek visa renewals until after the election. Duberli conceded “the truth of the matter is that the laws haven’t changed that much” since Biden became president.

Survivors Pathway has worked with LGBTQ people in U.S. Immigration and Customs Enforcement custody in South Florida. American Civil Liberties Union National Political Director Ronald Newman in an April 28 letter it sent to Homeland Security Secretary Alejandro Mayorkas called for the closure of the Krome North Service Processing Center in Miami, the Glades County Detention Center near Lake Okeechobee and 37 other ICE detention centers across the country.

The road leading to the Krome North Service Processing Center in Miami on June 7, 2020. (Washington Blade photo by Michael K. Lavers)

Survivors Pathway responded to trans woman’s murder in 2020

Survivors Pathway has created a project specifically for trans Latina women who Duberli told the Blade don’t know they can access the judicial system.

Duberli said Survivors Pathway works with local judges and police departments to ensure crime victims don’t feel “discriminated, or outed or mistreated or revictimized” because of their gender identity. Survivors Pathway also works with Marytrini, a drag queen from Cuba who is the artistic producer at Azúcar, a gay nightclub near Miami’s Little Havana neighborhood.

Marytrini and Duberli are among those who responded to the case of Yunieski “Yuni” Carey Herrera, a trans woman and well-known activist and performer from Cuba who was murdered inside her downtown Miami apartment last November. Carey’s boyfriend, who had previously been charged with domestic violence, has been charged with murder.

“That was an ongoing situation,” noted Duberli. “It’s not the only case. There are lots of cases like that.”

Duberli noted a gay man in Miami Beach was killed by his partner the same week.

“There are lots of crimes that happen to our community that never gets to the news,” he said. “We got those cases here because of what we do.”

Yunieski “Yuni” Carey Herrera was murdered in her downtown Miami apartment in November 2020. (Photo courtesy of social media)

















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Patrick O’Connell, acclaimed AIDS activist, dies at 67

Played key role in creating red ribbon for awareness



Activist Patrick O’Connell was instrumental in creating the red ribbon to promote AIDS awareness. (Photo courtesy of Allen Frame; courtesy Visual AIDS)

Patrick O’Connell, a founding director of the New York City-based AIDS advocacy group Visual AIDS who played a lead role in developing the internationally recognized display of an inverted, V-shaped red ribbon as a symbol of AIDS advocacy, died on March 23 at a Manhattan hospital from AIDS-related causes, according to the New York Times. He was 67.

Visual AIDS said in a statement that O’Connell held the title of founding director of the organization from 1980 to 1995.

During those years, according to the statement and others who knew him, O’Connell was involved in the group’s widely recognized and supported efforts to use art and artist’s works to advocate in support of people with HIV/AIDS and efforts to curtail the epidemic that had a devastating impact on the art world.

Thanks to a grant from the Art Matters foundation, Visual AIDS was able to retain O’Connell as its first paid staff member in 1990, the group said in its statement.

“Armed with a fax machine and an early Macintosh computer, Patrick helped Visual AIDS grow from a volunteer group to a sustainable non-profit organization,” the statement says. “A passionate spokesperson for the organization, he helped projects like Day Without Art, Night Without Light, and the Red Ribbon reach thousands of people and organizations across the world,” the group says in its statement.

“We were living in a war zone,” the statement quoted O’Connell as saying in a 2011 interview with the Long Island newspaper Newsday. “But it was like a war that was some kind of deep secret only we knew about,” O’Connell said in the interview. “Thousands were dying of AIDS. We felt we had to respond with a visible expression,” he told the newspaper.

With O’Connell’s help, Visual AIDS in 1989 organized the first annual Day Without Art in which dozens of galleries and museums in New York and other cities covered art works with black cloths to symbolize the mourning of those who died of AIDS. Among those participating were the Brooklyn Museum, the J. Paul Getty Museum in Los Angeles, and the Metropolitan Museum of Art in New York, which replaced a Picasso painting with a “somber informational placard,” according to the New York Times.

In 1990 O’Connell helped Visual AIDS organize the first Night Without Light, which was held at the time of World AIDS Day. New York City’s skyscraper buildings, bridges, monuments, and Broadway theaters turned off their lights for 15 minutes to commemorate people who lost their lives to AIDS, the New York Times reported.

In the kickoff of its Red Ribbon Project in 1991, McConnell helped organize volunteers to join “ribbon bees” in which thousands of the ribbons were cut and folded for distribution around the city, the Times reports. Those who knew McConnell said he also arranged for his team of volunteers to call Broadway theaters and producers of the upcoming Tony Awards television broadcast to have participants and theater goers display the red ribbons on their clothes.

Among those displaying a red ribbon on his label at the Tony Awards broadcast was actor Jeremy Irons, who was one of the hosts. In later years, large numbers of celebrities followed the practice of wearing the red ribbon, and in 1993 the U.S. Postal Service issued a red ribbon stamp.

The Times reports that O’Connell was born and raised in Manhattan, where he attended Fordham Preparatory School and later graduated from Trinity College in Hartford, Conn., in 1973 with a bachelor’s degree in history. According to Visual AIDS, O’Connell served as director of the Hallwalls arts center in Buffalo, N.Y. from 1977 to 1978 before returning to New York City to work for a gallery called Artists Space.

The Times reports that O’Connell learned in the middle 1980s that he had contracted AIDS and began a regimen of early AIDS treatment with a cocktail of over 30 pills a day. His involvement with Visual AIDS, which began in 1989, ended on an active basis in 1995 when his health worsened, the Times reports.

As one of the last remaining survivors of his New York contemporaries who had HIV beginning in the 1980s, O’Connell continued in his strong support for AIDS-related causes through 2000s and beyond, people who knew him said.
Visual AIDS says it is gathering remembrances and photos for a tribute post for O’Connell on its website. It has invited people to share their memories of him by sending written contributions and images via email to: [email protected].

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