Opinions
Medicaid cuts will lead to an uptick in STIs
Move threatens progress to end HIV epidemic

We have come a long way from the days when HIV was an almost certain death sentence. But our work is far from over. The COVID-19 pandemic led to an uptick in rates of sexually transmitted infections (STIs), including HIV, and low-income communities, LGBTQ+ communities, and communities of color continue to be impacted at alarming and disproportionately high rates.
These communities are also more likely to be served by Medicaid. Medicaid is the largest source of insurance coverage for people living with HIV in the United States, covering an estimated 40 percent of nonelderly adults with HIV, and Medicaid accounted for 45 percent of all federal HIV spending in 2022. During September, Sexual Health Awareness Month, it is worth examining the crucial ways Medicaid works to keep people healthy — and what threatens our progress today.
In recent weeks, we have seen a troubling trend develop. Five million Americans have been removed from Medicaid rolls, and many millions more are on the verge of losing coverage as a result of the Medicaid enrollment cuts. This represents the single greatest threat to our progress toward ending the HIV epidemic in years.
During the pandemic, Medicaid enrollment grew by an estimated 20 million people, contributing to the uninsured rate dropping to the lowest level on record in early 2022. But, after a three-year period during which states provided continuous enrollment in exchange for enhanced federal funding, some states resumed dis-enrolling people from Medicaid on April 1. A recent KFF survey found that 17 million people could lose Medicaid coverage as a result of this process, referred to as the Medicaid “unwinding.”
Many states are not doing enough to ensure that Medicaid-eligible residents don’t lose their coverage. While some have been removed from the rolls because they are newly ineligible, procedural issues account for 74 percent of people losing coverage. An unacceptably high number of Florida, Texas, and Virginia residents who are still eligible for Medicaid are losing coverage because of procedural reasons, such as failing to confirm proof of income or household size.
Our goal should be to ensure that no one who qualifies for Medicaid loses their coverage. The U.S. Centers for Medicare and Medicaid Services (CMS) gave states the option to use a 12-month grace period, along with other flexibilities, to prepare for the unwinding and make sure residents had what they needed to recertify. So why are some states so eager to remove their residents from Medicaid rolls?
New York, on the other hand, has made equity a cornerstone of recertification work and provides a template for what states can do to help their residents remain covered. The state maximizes the flexibilities offered by CMS and works directly with providers, health plans, and recipients to minimize procedural disenrollments and ensure that people retain health care coverage, either through Medicaid, the state’s health exchange, or private insurance. New York is among the nation’s top-performing states in terms of call center wait times, call drop rates, and average time it takes to make an eligibility determination, according to the Center on Budget and Policy Priorities. New York’s call center is also able to produce materials in 26 languages. In June 2023 alone, New York State certified renewals for more than 400,000 residents.
At Amida Care in New York, we know firsthand that gaps in care for people living with or placed at elevated risk of contracting HIV can be especially devastating. When people lose access to PrEP medication to prevent HIV, they are left vulnerable to contracting HIV, and when people living with HIV lose access to antiretroviral therapy, they risk becoming seriously ill and transmitting HIV to others. We support and guide our members through the recertification process with dedicated outreach efforts that include phone calls, mailings, text messages, and home visits to limit loss of coverage and interruptions in life-saving treatments.
We cannot begin to address health inequity or end the HIV epidemic without strengthening Medicaid. The recent moves by some states to strip their residents of Medicaid coverage will undermine the progress we’ve made.
Doug Wirth is president and CEO of Amida Care, a Medicaid Special Needs Health Plan for people affected by HIV.
Opinions
Trans people must be allowed to live full, safe lives
MAGA, Project 2025 targeting most vulnerable in society

I have spent much of my life fighting for equality for all people. I grew up with parents who were refugees from Hitler, and am a first-generation gay, Jewish, American. I understand discrimination, though I have had what we now call ‘white privilege.’ That is something granted to me by society, not something I earned. I have fought for civil rights, women’s rights, the rights of people with disabilities, and finally my own rights, when I came out at the age of 34. I was working for Rep. Bella S. Abzug (D-N.Y.), and still not out when she introduced the first version of the Equality Act in 1974. It was five years after Stonewall.
It is now 56 years after Stonewall, and Donald Trump and his MAGA acolytes, still felt they could easily attack transgender people in his campaign for president. The campaign used ads attacking transgender persons to great effect, saying, “Democrats are more into helping they/them, than into helping you.” It was unfair, and disgusting, but effective. It was also a great way to distract people from the havoc they intended to create with Project 2025, both here at home, and around the world. It worked.
What helped make those ads so effective is the simple fact 99% of the population has likely never met a transgender person, or if they have, they don’t know it. Only about 1 percent of the population in the U.S. identify as transgender. There is some debate about the numbers, but currently the LGBTQ community as a whole makes up nearly 10% of the population.
One of the issues people are making a big deal about is whether transgender women should be able to participate in women’s sports, despite the fact their numbers in sport are nearly non-existent. But the argument, even among members of the LGBTQ community, allows questioning their participation be a touch point for discrimination. Those, like lesbian tennis great Martina Navratilova, and others in the LGBTQ community, think those who have transitioned to being women, should not be allowed to participate in women’s sports. Recently California Gov. Gavin Newsom agreed with that. There is some scientific debate about whether a man who goes through puberty as a man, and then transitions, will have an advantage over a cisgender woman. Again, this debate within the LGBTQ community, and the Democratic Party, which generally supports transgender rights, has helped MAGA Republicans use this as a divisive cultural issue.
The debate within the LGBTQ community over transgender people is not new. Over the years there has been debate about how Rep. Barney Frank (D-Mass.), a hero in the LGBTQ community, managed to get ENDA passed in the House in 2007 without including trans protections. His bill was not opposed by the Human Rights Campaign at the time. Barney and HRC came under vicious attack for doing this.
Today, Trump has signed an executive order barring trans people from serving in our military, despite their having fought bravely, and effectively, for years. At the moment a judge has blocked him from carrying out this order but we still don’t know the final decision as Trump’s Justice Department is appealing the ruling. This is just another way Trump and his acolytes, using Project 2025, are going after the most vulnerable in our society. So far, they have threatened Republicans with primaries, and kept any Republican in Congress from speaking out. As we move forward, we will find out if any will put their oath to the Constitution, ahead of their next election.
I have been fortunate to meet many transgender people, some of whom I have fought alongside for the rights of the LGBTQ community. There are groups like Advocates for Trans Equality, and their CEO, Rodrigo Heng-Lehtinen, whose mom happened to be a congresswoman, and Diego Miguel Sanchez, who has fought valiantly for the rights of the LGBTQ community, and is now at PFLAG. Now we have our first transgender congresswoman, Sarah McBride (D-Del.). Then there is Virginia State Sen. Danica Roem, a recognized national leader in the fight for transgender rights. These are men and women who will allow more and more people to see transgender persons are the same as them. They just want to live free, full, and safe lives, like the rest of us.
Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.
Opinions
Finding the courage to flee U.S. to save my trans daughter
‘My child has begged for her safety so I must go’

Well, we did it. Two weeks ago, I climbed into our SUV with my 23-year-old trans daughter and I drove to Toronto. A foot firmly in the highly logical/practical and a foot in the conceptual/creative means I am not risk averse because I can sense a problem and comfortably decide whether I can absorb the outcome.
As a result, I don’t scare easily. Every now and then though, my more intuitive self will sound an alarm letting me know that I need to pay attention, and so I do – especially when it comes to my children. Like many of you my internal sirens have been clanging at air raid levels for some time. It’s been clear to me that trans people are going to be both a political tool and a targeted group for the new administration. As ugly forces converged to deliver the results that Tuesday in November I have been fighting the urge to grab my family and simply leave. To get up, get out of the way of what I feel is coming. That’s crazy talk, right? This is the United States. I mean we can’t be there? You know what I mean. THERE.
The place that created the phrase: “Pessimists went to New York, optimists went to Auschwitz.” Rounding up people and simply sending them somewhere. I think we are, and I can’t wait to be wrong.
As I listen to stunning silence from Democrats and threat-immobilized or power-driven Republicans alike, and watch companies pay fealty and capitulate in advance, I am appalled by so few rising to meet the moment. I am disgusted by the demonstrated cowardice just about everywhere we look. What luxury it is to think that as a politician you’re secure enough to wait it out, as though there will be anything left. To think that you will never be in the crosshairs or to think that it’s too hard to do more than you already do. I decided I didn’t have that privilege; for my family optimism could be ruinous.
On occasion I ask my daughter how she feels about things as they evolve, the clank of each hammer on the chisel chipping away her rights, or each time the president of our country has spent five rambling minutes regularly declaring my child a villain or abomination or the result of some woke virus. Being aware, far too sharp and equally sensitive, the question would overwhelm her, “Mom, I know. I know. I just can’t.” For months that would be the end of the conversation. Sometimes she would come to me in tears to talk about how it felt to be unsafe in your own country, or to know that the administration wants to eliminate you. It’s gut wrenching.
Her circle of friends, many of whom struggle, are her lifeline. We all know how important our 20-something tribes are. But when she’d raise the topic with her loves in hopes of creating a plan they too would shut down. This is not unique. For so many of us it is overwhelming. For my daughter, any desire to leave felt like a betrayal, or like she would be abandoning her circle. Any desire to stay felt perilous. I’ve shed torrents of tears at their predicament. That this is their future. And I waited, hitting the snooze button on my internal alarm.
Then politicians started talking about camps and withholding medications. I got a text. “Let’s go. It’s time. [My girlfriend] said she’d move to Canada.” Three weeks later we left.
My family members are fighters and protesters. Ask any one of them and they’ll roll up their sleeves and argue. My parents marched on Washington in the 1960s. They demonstrated at nuclear plants in the ‘70s. My daughter has always fantasized about how the only good Nazi is a dead Nazi, and embracing her free-floating desire to stay and fight. It’s only a fantasy, but I get it. I have that blood in my veins and that idealism thumping in my heart. A political science student and obsessive political hobbyist, I have gone with my peers to rage against the machine, and been an activist from time to time. I never imagined that I would be willing to walk off the field.
The optimist in me says it will all work out, that it is always worth the fight. The middle-aged woman, burdened with the tasks of modern living complains that it’s too hard, too expensive. But my child, my child. My child has begged for her safety. So, I must go. It’s really just logistics, like everything else when you have to move mountains — or countries — for your child. Rent our house. Sell our things. Pack. Drive. Get gas. Check and check. Just like we’d do for any other life change. Look for jobs. Split up the family and delegate responsibilities. Done. As I go through this I think, is it any less than Taylor Swift’s mom did when she left Pennsylvania for Tennessee? Or any family that moves and wakes way before dawn for gymnastics or hockey? I’m not going to lie, I picked the easiest place to go, and the one she was most willing to take on. We joke that if the administration is serious about invading Canada that she may choose to fight for the side where the government fights behind her. On her side and at her back.
“I want to live somewhere my own government doesn’t want me dead.”
Staying to fight the good fight is important. But leaving to protect the vulnerable and the precarious is (while no small feat) doable. I hope. If you feel you should, do. If you feel you can’t, look again. If you have to you will.
Anonymous is the mother of a trans daughter who recently moved from the U.S. to Canada.

It’s time for transgender Americans to be more scared. Donald Trump is leading a fascist administration. In his first month in office, Trump signed a flurry of executive orders that clamp down on trans people. One ordered that trans women can’t compete in women’s sports in federally funded institutions. Another banned transgender service members from the military. And yet another executive order, signed on his very first day in office, told the federal government that only two genders exist — those that people were given at birth.
Furthermore, Trump took over the Kennedy Center, electing himself as the chair of the board, and immediately a Pride event was cancelled. Taking over arts and letters is a surefire sign of fascism. Fascism, as defined by Merriam Webster, is a “populist political philosophy or regime that exalts nation and often race above the individual, that is associated with a centralized autocratic government headed by a dictatorial leader, and that is characterized by severe economic and social regimentation and by forcible suppression of opposition.”
America, in essence, is becoming more and more of a fascist state, and Trump is already a fascist leader. Trump’s strand of fascism is interesting, because he is an utter capitalist, with a fetish for colonizing foreign spaces. Trump has been trying to colonize Greenland for many years now, and he also shared an AI generated video of him colonizing the Gaza strip with a Trump hotel and pictures of Elon Musk spooning hummus next to the beach. Both of these are concerning, but the Trump Gaza video is especially horrifying because it shows he is in some sort of quasi break from reality where posting an AI generated future of a war-torn land seems OK. When I floated the Trump Gaza video among friends and family, they reacted with words like “crazy,” “insane,” and “delusional.”
When mentioning his transphobia, one relative who is politically aware theorized that Trump would unleash all of his anti-trans fury in just a few months but that he would run out of transphobic things to do. Unfortunately, the opposite seems to be true. Every passing day seems to bring a new anti-trans piece of legislation, whether it’s Texas’s proposed ban on being transgender in and of itself, or whether it’s Utah’s anti-trans bathroom ban.
Yet even more unfortunately, I am not seeing trans people get scared enough. I am not seeing enough action on our part. I am unsure whether our collective inaction is due to the fact that both houses of Congress are red, or whether some of us simply don’t have the privilege of fighting.
Regardless, I can propose one policy solution that trans people in the D.C. area can implement: Make Arlington a sanctuary city. In order to make Arlington a sanctuary city, Arlingtonians (and other Virginians for that matter) should lobby the county board to do so. However, Virginia faces stiff pushback from Gov. Youngkin when it comes to the formation of sanctuary cities. On Dec. 12, 2024, Youngkin proposed a budget that would include a “sanctuary city ban” across the state. We have to make sure that we lobby the legislature to reject this proposed version of the budget.
Until then, transgender Americans need to start devising plans to move to sanctuary cities across the country and to fund underprivileged trans people who need the money to do so. Some of us also need to start thinking about moving to Canada if our futures become less bright.
Isaac Amend is a writer based in the D.C. area. He is a transgender man and was featured in National Geographic’s ‘Gender Revolution’ documentary. He serves on the board of the LGBT Democrats of Virginia. Contact him at [email protected] or on Instagram at @literatipapi.
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