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Will health reform make AIDS groups obsolete?
HIV clinics face new competition as clients obtain insurance by 2014
‘Health care reform has been a real motivator around us improving the quality of what we do because we know we’re going to have to get better,’ said Don Blanchon, executive director of Whitman-Walker Clinic. (Washington Blade photo by Michael Key)
When the AIDS epidemic burst on the scene in the 1980s, a cadre of volunteers –many from the LGBT community — emerged to provide compassionate and dedicated care for the sick and dying, services that government agencies and existing charitable groups were not providing.
Since that time, the mostly volunteer-driven, community-based AIDS clinics and advocacy groups created back then have evolved into professionally run facilities receiving millions of dollars in state and federal funds. Like the Whitman-Walker Clinic in D.C., many of the clinics and advocacy groups provide a vast array of services for people with HIV and AIDS, most of whom can’t afford private health insurance.
But in March, Congress approved and President Obama signed into law a sweeping health care reform measure called the Patient Protection and Affordable Care Act. Obama administration officials say it will result in more than 94 percent of all Americans being covered by some form of private or public health insurance by 2014.
Although most AIDS activists and officials with local and national AIDS organizations have hailed the health care reform measure as an unprecedented benefit to people with HIV and AIDS, some believe the law could prompt large numbers of patients to leave the community-based clinics and seek medical care elsewhere.
With a possible loss of clients, community AIDS clinics would be in jeopardy of losing government funding, which is based on the number of clients served. It would be ironic, some have said, if the benefits of healthcare reform result in the closing of community institutions that have served people with AIDS during a time of need.
“The LGBT community and people living with HIV are going to have options that they may not have now,” said Don Blanchon, executive director of the Whitman-Walker Clinic, which has served people with HIV and AIDS since the epidemic began.
“And so for us, health care reform has been a real motivator around us improving the quality of what we do because we know we’re going to have to get better,” Blanchon said. “We know at some point in time almost every District resident is going to have some type of public or private insurance, which means they, in theory, are going to be able to go to a lot of different places for their care.”
Blanchon noted that a financial crisis that Whitman-Walker faced four years ago forced it to take steps that have placed it in an excellent position to flourish under the health care reform law. The Clinic’s board hired Blanchon, a managed care expert, to help the Clinic survive at a time when private donations and fundraising efforts were faltering.
With the board’s full approval and over the objections of some of the Clinic’s longtime supporters and volunteers, Blanchon transformed the Clinic from a volunteer model operation into a managed care type facility with the status known as a “federally qualified health center look alike.”
According to Blanchon and other Clinic officials, the new status enables the Clinic to accept a greater number of Medicaid patients as well as patients with a wide range of private health insurance. Patients covered by these programs allow the Clinic to obtain reimbursement for its services by doctors, its own pharmacy, and other service providers, eliminating the need to rely more on private donors.
Unlike other community-based AIDS clinics, Whitman-Walker will be in an excellent position to take on new patients or retain its existing ones as the new health care reform measure enables the majority of patients to obtain private insurance or Medicaid.
Under the Patient Protection and Affordable Care Act, all lower income individuals, including people with HIV, will be eligible for Medicaid coverage if they fall below 133 percent of the federal poverty level, where an individual has an income of about $15,000 a year or lower.
Under current federal law, low-income people with full-blown AIDS are already eligible for Medicaid coverage. For years, Congress has declined to pass legislation proposed by AIDS advocacy groups calling for Medicaid coverage for low-income people with HIV, with the intent of providing medical services to prevent them from advancing to AIDS.
The new law makes that legislation unnecessary after 2014, when the Medicaid provision takes effect.
Jeffrey Crowley, director of the White House Office of National AIDS Policy, calls the Patient Protection and Affordable Care Act one of the nation’s most significant advances for the care and treatment for people with HIV/AIDS.
“It will fundamentally expand access to insurance coverage for people living with HIV,” he said. “Much of that will be through the mandatory expansion of the Medicaid program.”
He said that similar to all Americans, people with HIV will also be eligible for private insurance coverage through a variety of options based on their income. Among the options will be the purchase of insurance coverage through competitive insurance exchanges. He noted that by 2014, no insurance company can deny coverage based on pre-existing conditions such as HIV or other illnesses.
Keith Maley, a spokesperson for the U.S. Department of Health and Human Services, which will administer most of the provisions of the new health care law, said people with HIV and other illnesses could be immediately eligible for private insurance coverage through high-risk pools.
Those eligible for the immediate coverage must show that they have had no health insurance coverage for six consecutive months, have a chronic health condition, and are not eligible for employer provided insurance or Medicaid.
Crowley noted that the new law has other immediate benefits for people with HIV and other chronic health conditions. As of July 1, private health insurers can no longer use a rescission, a practice that cancels a policy when someone gets sick and needs expensive treatment.
He said the law also immediately prohibits insurers from imposing a lifetime “cap” on insurance benefits. Annual limits on coverage or benefits will end in 2014, he said.
Crowley, a gay man who previously worked for the National Association of People with AIDS before joining the White House staff, said he expects most community-based AIDS clinics and local and national AIDS advocacy organizations to continue to exist after the health care law is fully implemented in 2014. However, he said most will have to change the way they do business.
“I think we know from our experience with HIV that we’ve built up a great HIV workforce,” he said. “We have a lot of expertise. I want to make sure as we build and expand an insurance system through the Affordable Care Act that these HIV medical providers are making sure that they’re part of this new system.”
“Some of them might only receive funding through the Ryan White programs, and I would say they need to look at their future and say that they need to be part of the new insurance system,” he said. “But there’s no question that we’re going to need their expertise and commitment at providing medical care going forward.”
Crowley’s reference to the Ryan White CARE Act, the largest existing federal program created to provide care for low-income people with HIV/AIDS, is expected to change significantly following the full implementation of the Patient Protection and Affordable Care Act, according to officials with a number of national AIDS groups.
Nearly everyone, including Crowley, agrees that the Ryan White program should remain, but most likely in a scaled back form. Congress passed the act in the 1990s as a means of helping cities and states that were grappling with the enormous burden of providing care for people with HIV/AIDS who lacked health insurance coverage and were overwhelming local and state hospitals and health care facilities.
Carl Schmid, director of federal affairs for the AIDS Institute, a national advocacy organization; Michael Weinstein, executive director of the AIDS Healthcare Foundation, the nation’s largest AIDS-related medical care provider; and Jose Zuniga, executive director of the International Association of Physicians in AIDS Care, each said they believe the Ryan White program will be needed for at least some services the new law does not provide.
“It will not solve all of our access issues,” said Schmid of the new health care measure.
Weinstein said that state programs to expand health insurance have been slow to enroll as many people as expected for a variety of reasons, some bureaucratic in nature.
“So I wouldn’t expect an overnight change in 2014,” he said, pointing to a need to keep the Ryan White program operating for some time after 2014.
Weinstein said that in some states, including California, Medicaid reimbursement for medical services is far lower than that provided by private insurance companies. He predicted that people with HIV or AIDS who obtain coverage under the new law through Medicaid might be turned away by private doctors who declined to take all Medicaid patients.
“The reimbursement that we receive from Medicaid or from private insurance is far below our cost and far below what we get from Ryan White,” he said of the AIDS Healthcare Foundation. “So we will suffer a hit in that regard as well as most providers.”
Weinstein said his organization has a wide variety of income streams and the lower reimbursements under the new law “won’t be a fatal blow to us.”
Blanchon of Whitman-Walker said the benefits of the new law greatly outweigh its possible shortfalls.
“Health care reform is going to be a real help to our patients and clearly to the Clinic because more of our patients are going to be insured under more comprehensive benefit programs,” he said.
“And what that means at the end of the day is the Clinic is not going to have to shell out as much free care. So we’re going to be in a position to be able to offer more services to more patients and keep them healthy, and ultimately that’s what we’re here for.”
District of Columbia
GLAA releases ratings for 18 candidates running for D.C. mayor, Council, AG
Mayoral contender Janeese Lewis Geroge among those receiving highest score
D.C. mayoral candidate Janeese Lewis George, a Democrat, is among just four candidates to receive the highest rating score of +10 from GLAA D.C. who are competing in the city’s June 16 primary election.
GLAA, formally known as the Gay and Lesbian Activists Alliance of Washington, has rated candidates for public office in D.C. since the 1970s. It rated 18 of the 36 candidates on this year’s primary ballot for mayor, D.C. Council, and D.C. attorney general based on its policy of only rating candidates who return a GLAA questionnaire asking for their positions on a wide range of issues, most of which are not LGBTQ-specific.
Among the candidates who did not return the questionnaire and thus did not receive a rating, according to GLAA, was Democratic mayoral contender Kenyan McDuffie, who along with Lewis George, is considered by political observers to be one of the two leading mayoral candidates running in the Democratic primary.
Lewis George and McDuffie, who each have long records of support for the LGBTQ community, are among a total of eight candidates running for mayor on the June 16 primary ballot: seven Democrats and one Statehood Green Party candidate. In addition to Lewis George, GLAA rated just two other mayoral candidates. Rini Sampath, a Democrat who self identifies as queer, received a +6.5 rating, and Ernest E. Johnson, also a Democrat, received a +4.5 rating
Under the GLAA rating system, candidate ratings range from a +10, the highest score, to a -10, the lowest possible score. In its ratings for the June 16 primary, the lowest score issued was +4.5. GLAA said in a statement that each of the 18 candidates it rated expressed strong support for LGBTQ-related issues in their questionnaire responses, indicating that the overall rating scores reflect the candidates’ positions on mostly non-LGBTQ-specific issues.
The three other candidates who received a +10 GLAA rating are each running as Democrats for the Ward 1 D.C. Council seat. They include gay candidate Miguel Trindade Deramo; Aparna Raj, who identifies as bisexual; and LGBTQ ally Rashida Brown. The only other Ward 1 candidate rated by GLAA is LGBTQ ally Terry Lynch, who received a +5.5 rating.
Ward 5 D.C. Councilmember Zachary Parker, the Council’s only gay member who is facing two opponents in the Democratic primary, received a +7 GLAA rating. The two challengers did not return the questionnaire and were not rated.
“In seven out of 10 of our priorities, every candidate indicated agreement,” GLAA said in its statement to the Washington Blade in referring to the candidates it rated. “Total consensus on core issues signals that whomever is elected to Council and mayor, we should expect to hold our elected officials accountable to our goals of protecting home rule, resisting federal overreach, advancing transgender healthcare rights, and eliminating chronic homelessness in the District,” the statement says.
“While candidates agree on the basics, they distinguish themselves in the depth and creativity in their responses, and their record on the issues,” according to the statement, which adds that candidates’ full questionnaire responses and ratings can be accessed on the GLAA website, glaa.org.
Like past election years, GLAA does not rate candidates running for the D.C. Congressional Delegate seat or the so-called “shadow” U.S. House of Representatives and U.S. Senate seats.
With the exception of one question asking about transgender rights, none of the other nine of the 10 questionnaire questions are LGBTQ-specific. But most of the questions mention that LGBTQ people are impacted by the issues being raised, such as affordable housing, federal government intrusion into D.C. home rule, and access to healthcare and public benefits for low-income residents.
One of the questions asks candidates if they support decriminalization of sex work in D.C. among consenting adults, which GLAA supports. Lewis George is among the candidates who said they do not support sex work decriminalization at this time. The other two mayoral candidates that GLAA rated, Sampath and Johnson, said they support sex work decriminalization.
In the race for D.C. attorney general, GLAA issued a rating for just one of the three candidates running: Republican challenger Manuel Rivera, who received a +4.5 rating. Incumbent Democrat Brian Schwalb and Democratic challenger J.P. Szymkowicz were not rated because they didn’t return the questionnaire.
D.C. Council Chair Phil Mendelson (D), who is running unopposed in the primary, received a +6.5 rating. Ward 6 Councilmember Charles Allen, who is facing three Democratic challengers in the primary and who is a longtime LGBTQ ally, received a +6.5 rating.
In the special election to fill the at-large D.C. Council seat vacated by the resignation of then-Independent Councilmember McDuffie to enable him to run for mayor as a Democrat, GLAA has rated two of the three Independent candidates competing for the seat. Elissa Silverman received a +5.75 rating, and Doni Crawford received a +5.6 rating.
Finally, in the At-Large D.C. Council race GLAA issued ratings for five of the 11 candidates running in the primary, each of whom are Democrats. Oye Owolewa received a +9; Lisa Raymond, +7.5; Dwight Davis, +6.5; Dyana N.M. Forester, +6; and Fred Hill, +6.6.
The full list of GLAA-rated candidates and their detailed questionnaire responses can be accessed at glaa.org.
Rehoboth Beach
From the Capitol to the coast: Rep. Sarah McBride shares Rehoboth favorites
As summer kicks off, Congresswoman Sarah McBride shares her favorite Rehoboth spots.
Each year for the past 19 years, the Washington Blade has kicked off the summer season with a quintessential tradition — a party in Rehoboth Beach. The annual celebration is well known among Blade readers as the unofficial start of summer and beach season. (This year’s event is May 15, 5-7 p.m. at Diego’s featuring remarks from Ashley Biden.)
Two weeks ago, the Blade sat down with Sarah McBride (D-Del.), the first openly transgender person elected to Congress, to discuss her first year in office. While reflecting on key milestones and challenges ahead, she also shared some of her favorite Rehoboth spots and what the beach town means to her.
“I love Rehoboth,” the state’s sole House member told the Blade, beaming from her office in the Longworth House Office Building. “I love Baltimore Avenue, and love going to Aqua and the Pines.”
Both Aqua and the Pines have long served as staples of Rehoboth’s LGBTQ community. From the Saturday night lines stretching down the street off the main drag to the Sunday tea dances, the venues have helped cement Rehoboth as one of the top LGBTQ beach destinations in the United States dating back to at least the 1940s, when LGBTQ federal workers would escape the pressures — and often prying eyes — of Washington for a queer haven along the Delaware coast.
While attitudes and the community itself have evolved over the decades, Rehoboth today can still feel like an extension of D.C. — only with more Speedos and sandy flip-flops. Conversations that begin in Washington about politics and nightlife often continue beachside, shifting from “What’s Bunker’s theme tonight?” to “Who’s DJing at Aqua?”
When asked where she likes to dine in town, McBride highlighted one longtime favorite while also teasing a new addition she’s eager to try.
“Drift Seafood and Raw Bar is one of my favorite restaurants,” she said. “I actually ran into a Rehoboth restaurateur the other day while I was at Longwood Gardens for the tulips — which were beautiful. The restaurateur just opened a new restaurant on the south end of Baltimore Avenue that I’m excited to try. It sounds like an Indian fusion restaurant.”
When asked whether she frequents Poodle Beach — the longtime LGBTQ section of the shoreline — McBride shared that she prefers a quieter stretch of sand a bit farther north of Rehoboth’s gay beach scene.
“I usually go to Deauville, which is just north. It’s right there in between the boardwalk and Gordon’s Pond and North Shores.”
Regardless of where she chooses to unwind from the pressures of Washington and Dover, McBride was clear about how much both Rehoboth and Delaware mean to her.
“I love Rehoboth. I love the restaurants there. This is the professional privilege of my lifetime, getting to represent Delaware.”
“One of the things that I love is seeing how much goodness there is in this state,” she shared. “I represent more people in the House of Representatives than any other representative. Unlike most members who represent exclusively urban, suburban, or rural districts, I represent all three. Delaware demographically looks like America.”
She went on to say that representing a state whose demographics closely mirror the country as a whole gives her hope for the future — something that can at times feel elusive within the often-divisive halls of Congress.
“That means every day that I’m here, and every time Delawareans come to visit me, I get to see the full diversity of this country and this state on display. I get to see the goodness across that diversity, whether it’s diversity of identity or diversity of thought. It makes me even prouder to represent a state that time and time again judges candidates not based on their identities, but based on their ideals.”
She ended with a simple but hopeful message about her state and its people.
“Our politics are too often defined by hate. I’m glad Delaware and Delawareans are showing that a different kind of politics is possible.”
District of Columbia
Anti-LGBTQ violence prevention efforts highlighted at D.C. community fair
Mayor’s Office of LGBTQ Affairs organized May 8 event
Detailed advice on how LGBTQ people can avoid, defend themselves against, and prevent themselves and loved ones from becoming victims of violence, with a focus on domestic and intimate partner violence, was presented at a May 8 LGBTQIA+ Safety in Numbers Community Fair.
The event, organized by the D.C. Mayor’s Office of LGBTQ Affairs, included five workshop sessions and information tables set up by 14 LGBTQ-supportive organizations and D.C. government agencies or agency divisions, including the D.C. Metropolitan Police Department’s LGBT Liaison Unit and the D.C. LGBTQ+ Community Center.
Also playing a lead role in organizing the event was the D.C. LGBTQIA+ Violence Prevention and Response Team, or VPART, a coalition of D.C. officials and leaders of community-based organizations that work with the Office of LGBTQ Affairs.
The event was held in meeting space in the building where the Office of LGBTQ Affairs is located at 899 N. Capitol St., N.E.
The workshop topics included de-escalation training on healthy relationships, bystander intervention, self-defense training, violence prevention grants, and suicide prevention.
“This will be a public safety and violence prevention event where community partners will educate attendees on various methods of violence intervention and trauma-informed practices,” according to a statement released by the Mayor’s Office of LGBTQ Affairs prior to the start of the event.
The statement adds, “We will have live demos, interactive games, and workshops focused on strategies for self-defense, protecting vulnerable communities, increasing access to mental health resources, providing tools for recognizing domestic violence/intimate partner violence signs in intimate relationships, and assistance for substance abuse.”
Sonya Joseph, associate director of engagement for the Office of LGBTQ Affairs, told the Washington Blade that studies have shown rates of domestic or intimate partner violence are higher in the LGBTQ community than in the community at large.
“Domestic violence and intimate partner violence are two very big prevalent issues in the LGBTQ community,” she said, adding that some of the workshops at the event would be providing “training on healthy relationships and how to recognize and prevent intimate partner violence and the signs of it.”
About 35 to 40 people attended the workshop sessions.
Experts specializing in violence impacting the LGBTQ community have said domestic violence refers to violence among people in domestic relationships that can include spouses but also siblings, parents, cousins, and other relatives. Intimate partner violence, according to the experts, refers to violence perpetuated by a partner in a romantic or dating relationship.
These D.C. based organizations or agencies that participated in the LGBTQIA+ Safety in Numbers event, and which can be contacted for assistance, include:
• Defend Yourself
• DC LGBTQ+ Community Center
• American Foundation for Suicide Prevention
• Joseph’s House
• Us Helping Us, People into Living, Inc.
• MCSR (formerly known as Men Can Stop Rape)
• MPD LGBT Liaison Unit
• Volunteer Legal Advocates
• DC SAFE
• Destination Tomorrow
• D.C. Office of Victims Services and Justice Grants
• Life Enhancement Services
• ONYX Therapy Group
• U.S. Attorney’s Office for D.C.
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