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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
Trans activists gather on National Mall for Transgender Day of Visibility
Around 200 members, supporters of the trans community, gathered on the Mall amid the increasingly hostile political environment.
The National Mall was covered in kites on Saturday as transgender activists from around the country gathered to support the second annual Transgender Day of Visibility. The event, put on by the Christopher Street Project — whose mission to protect and support trans Americans on the ballot and in streets — brought together around 200 supporters and organizations to honor trans homicide victims and rally for the future of human rights.
Created 17 years ago by psychotherapist and trans activist Rachel Crandall-Crocker, the day was born out of a need to celebrate one of the most marginalized groups in American politics, she told The 19th in 2021.
Since then, the nation has slowly caught up. This year marked the second time the observance has expanded into a multi-day movement, with events ranging from panels and congressional lobbying to organizing efforts, culminating in a rally on the “nation’s front door” — the National Mall.
A recent survey conducted by SRSS, a national research and marketing firm, and commissioned by the Human Rights Campaign Foundation, found that 41 percent of American adults say they personally know someone who is trans. That figure is up from previous estimates of around 30 percent. The study also shows that 27 percent say they have had a regular conversation with a transgender person in the last year. For HRC, this data is confirmation that visibility efforts are working.
“Transgender people are not strangers. They are our neighbors, coworkers, family members, and friends. And this new data shows that as people get to know them, they are more likely to stand by them as allies,” said Kelley Robinson, president of HRC said in a statement. “Defending trans rights is part of defending democracy itself. The more we show up for each other, the stronger our communities and our democracy become.”
Despite this progress and growing positive sentiment, more than 80 anti-trans bills are currently pending in state legislatures across the country, according to HRC, while similar issues are being debated at the national level. Many of the bills seek to restrict trans youth from participating in sports aligned with their gender identity and limit access to gender-affirming medical care.
Tyler Hack, founder and executive director of the Christopher Street Project, who is trans and nonbinary, spoke with the Washington Blade on March 28 about the growing importance of the day.
“We saw that there was a lack of political power for the trans community. We saw that there was a lack of political power for the trans community,” Hack said. “We decided to step up and implement the demand leadership and have galvanized people all across this country for Trans Day of Visibility and our gatherings these last few days we’ve had people come from as far as Hawaii to come celebrate with us, advocate for our rights on the hill, and learn about what it means to fight for all of us.”
Fighting for “all of us,” Hack noted, means showing up where political power is concentrated — in the nation’s capital. The National Mall, a hub for both protest and tourism, draws a wide range of visitors, from political activists brandishing MAGA hats or “You did it, Joe” t-shirts to everyday sightseers.
“I literally just saw a guy in a Trump shirt [at the rally], but we’re not going anywhere,” they said. “Visablity is really important, alongside needing to be an active parts of society, being having public life, and we need to demonstrate that we’re not going anywhere. I mean, we had people from the hill, Congress members come who weren’t even planning to come and did … We are now learning about what it means to fight for and stand up for our rights.”
Hack then looked toward the Capitol after being asked why they believe there are so many negative — and false — statements coming from congressional legislators about trans people. After a pause, they emphasized that the fight for trans rights is often deliberately mischaracterized by Republican opponents try to turn Americans against the community. That, they pointed out, is not what is happening outside the halls of the Hill.
“We are fighting for an America that works for all of us, and we know that,” Hack said. “We know that fighting for all of us is not unpopular. What’s unpopular is genital inspections in schools for girls as young as four years old — who some of our leaders want to transvestigate for not looking feminine enough. What’s unpopular are subpoenas of hospitals so the government can go through your records and decide what they like and don’t like. It is about power.”
That framing — that trans people simply want to live freely and equally under the law — has become central to the movement’s messaging, even as conservative media organizations and political leaders continue to shape public perception in opposing ways.
“We can’t cede any ground because we don’t need to. We are not fighting for a cause that’s inherently unpopular. People know that we shouldn’t throw anyone under the bus, and that’s what we’re here to say to our leaders: we’re paying attention.”
This year’s TDoV was noticeably larger in production than last year’s event, with a bigger stage, more high-profile speakers, increased security, and expanded programming across multiple days.
“We also planned three days of programming. We had dozen panels and workshops on Thursday, and we had over 75 Hill meetings on Friday,” they said. “Now we have this rally, and our capacity hasn’t grown that much — a lot of this was done by two people, but I think it just has come to fruition in a way. I’m happy with it, but I would love to see people with crazy budgets and includes expanded capacity, also we can continue to step out and do the work.”
One moment that stood out to Hack was seeing a parent advocate for her trans child — highlighting what they described as the deeply human nature of these stories.
“The first person to come up to me today was a mom of a trans kid and a nonbinary kid who said she came to our whole convening, going to the Hill to advocate yesterday — for the first time, because we inspired her to act, and that she was too scared to be a part of something,” they said. “She knew that her kids’ lives had been criminalized and that she needed to act and –that really hit me. I also know most of the people who educated our lawmakers, were people who have never been to the Hill before. These people who were also telling their stories, were also fighting for reproductive freedom for all. I mean, we had people from Hawaii, Washington State, California, people who some of them hadn’t been to D.C. Those are the people that we are here to mobilize because they haven’t been galvanized by any project before. I’m just grateful we gave them something that they’re willing to get behind.”
Speakers throughout the rally echoed similar themes of urgency, visibility, and collective action.
Rayceen Pendarvis, a local D.C. trans activist, spoke at the event, emphasizing the history behind the current fight — especially the exclusion of trans people from broader LGBTQ movements — and the need to push back against current political attacks on the most marginalized.
“Trans people in D.C. had to fight for their seat at the table. Trans people were either an afterthought — or left out completely. Now, trans people have become the scapegoat. Ignorance about trans people has been weaponized.”
The lifelong Washingtonian, who had a popular show that ran for 10 seasons with a range of programming covering local and national LGBTQ topics from 2012–2021, continued on the need to stay aware and vocal during the increasingly difficult Trump-Vance administration.
“We have to push back — be as relentless as they are. If your vote was not important, they wouldn’t spend so much time trying to stop you from using it. Voting is not enough — we all must get involved. Let us make our ancestors proud by unifying, organizing, and fighting back.”
She ended her speech with advice to not only strategically spend time advocating, but also build relationships within and around the transgender community.
“Support each other, encourage each other, and help each other. Spend time with your trans elders while you can and learn from them. Give them their flowers, but also give the old dolls some money to pay their bills,” she said to cheers from the crowd. “Allies need to put their money where their mouth is!”
“RuPaul’s Drag Race” contestant, singer-songwriter, and trans activist Peppermint spoke about the mixed feelings the day brings, allowing her to recognize both pride and frustration with the slow-moving progress for the transgender community.
“I love being trans, and it’s inspiring to see more people feel comfortable expressing who they are,” Peppermint said to the crowd. “But I’m disappointed that we have to march for our rights. I’m disappointed that we have to convince people who we are, while we’ve been here supporting them all along. I’m disappointed that not enough people show up when the trans community is under attack.”
Last year, a record number of anti-trans policies passed through state and federal legislatures — many originating from Republican lawmakers who argue such measures are necessary for safety. Idaho voted to make it a criminal offense to use the bathroom aligned with one’s gender identity if it does not match sex assigned at birth, setting up a bounty-style enforcement system. Twenty-seven states have banned sports participation for transgender children, primarily targeting transgender girls, citing fairness and safety — claims that research has shown are not supported by evidence. Last month, Kansas’s state Senate voted to invalidate driver’s licenses and birth certificates of trans residents who had updated their gender markers, while also defining sex strictly as assigned at birth.
Peppermint highlighted the specific cruelty of these policies and echoed the rally’s broader message.
“People are being asked to make an agreement to throw us under the bus. You’re watching our civil rights be stripped away like it’s entertainment. When you empower a government to take rights from some, you empower it to take rights from everyone,” the Broadway performer added. “That’s the reality we’re facing.”
She finished by affirming those present and pointing toward the future of the fight for equal treatment under the law.
“Trans people are women, men, nonbinary, immigrants, disabled — every kind of person. We are here, and we are inevitable. I’m disappointed — but I’m hopeful. I’m grateful — and you should be too,” Peppermint said. “I love you, I’m in awe of you, and I am grateful for you. I’m proud to stand with this diverse trans community. We have always shown up for others, year after year. And we’re still here.”
Rabbi Abby Stein framed the moment through a spiritual and historical lens, offering an alternative to narratives often pushed by conservative lawmakers and commentators.
“They’ve moved past trying to erase us — they’re using us. We have become the rock they’re using to hit the people they want to oppress,” Stein said. “We are visible, but we’ve been forced into a narrow place. That’s the reality of this moment.”
She continued, explaining that, despite what some have said, her trans identity reaffirms her religion and strengthens her Jewish faith.
“For generations, we’ve told stories about leaving narrow places. Those narrow places exist today — in closets, in systems, in the ways people try to restrict us. But we have always found a way out. That is our history and our power.”
“Coming out and being who you are isn’t just okay — it’s a spiritual obligation. It is powerful, and it is necessary. If you try to take away our visibility, our rights, and our joy, you will fail. We are going to win because we will keep fighting together.”
Other activists that spoke included military members who had been forced out of their jobs and benefits following the Trump-Vance administration’s return to banning transgender military members, including SPARTA Pride Executive Director and US Army Major Kara Corcoran and Air Force Master Sgt. Logan Ireland, both focusing their time on stage on sharing how they gave their country their lives, yet the president couldn’t accept their gender identity.
Others who spoke/performed included the queer cheerleading group Cheer DC, local trans DJ and organizer Samson, and Chastity Bowick, Executive Director of Marsha P. Johnson Institute also spoke.
Hack closed with a message centered on their belief in collective action to create a better world for everyone and the resilience of the community.
“We’ve been fighting in the halls of power, and I’m proud of how far we’ve come. This week is about educating, advocating, and rallying. There isn’t one strategy to take back our country. It takes all of us … This is not just about trans people — this is about whether the government gets to decide who is acceptable. When one group is targeted, it never stops there. That’s what history shows us. That’s why this moment matters.”
“We’re being scapegoated and forced out of public life. There are efforts to legislate us out of existence. Our freedoms are intertwined — we can’t leave anyone out. They think we’re small, but they’re wrong.”
“The days of respectability politics are over,” Hack said, with rainbow kites lying overhead, signaling a welcome and powerful reflection of the day’s movement — one that echoed the sentiments of those gathered. “Our movement has never needed permission to exist — and we’re not asking for it now. There is something inevitable about a people who refuse to disappear. It is inevitable that we win.”
Maryland’s legislative caucuses outlined their legislative priorities heading into the final weeks of the 2026 General Assembly during a joint press conference on March 24.
The press conference was titled “We are Maryland,” where a representative for each of the legislative caucuses outlined priorities.
State Del. Kris Fair (D-Frederick County) of the LGBTQ+ Caucus opened the press conference with a statement on the unity of Maryland’s caucus.
“Together we can show our state and our community a different world, one where we mutually support one another and through that support uplift every Marylander,” he said.
In a press conference on March 5, the LGBTQ+ Caucus outlined its top legislative priorities. Fair highlighted two of those bills again during the “We are Maryland” press conference.
The first of the two highlighted pieces of legislation was Senate Bill 626 and House Bill 1589.
The bills would simplify the process of updating an individual’s birth certificate and align the Department of Health and DMV systems to reflect those changes. The bill is being led by state Sen. Clarence Lam (D-Anne Arundel and Howard Counties) and state Del. Ashanti Martinez (D-Prince George’s County).
The second piece of legislation is Senate Bill 950 and House Bill 1209, which would update and modernize laws and regulations around so-called conversion therapy. The bills have failed to pass either chamber thus far. They are being led by state Sen. Cheryl Kagan (D-Montgomery County) and state Del. Bonnie Cullison (D-Montgomery County).
(The U.S. Supreme Court on Tuesday ruled against a Colorado law that bans so-called conversion therapy for minors. Maryland is among the U.S. jurisdictions that prohibit the widely discredited practice for anyone under 18.)
Martinez and Lam have introduced bills in their respective chambers that would expand PrEP access in Maryland. Martinez did not attend the press conference, and Fair did not mention it when he spoke.
State Del. N. Scott Phillips (D-Baltimore County) represented the Black Caucus during the press conference. State Del. Dana Jones (D-Anne Arundel County) spoke on behalf of the Women’s Caucus, State Del. Teresa Woorman (D-Montgomery County) represented the Latino Caucus, and State Del. Lily Qi (D-Montgomery County) represented the Asian-American and Pacific Islander Caucus. State Del. Jared Solomon (D-Montgomery County) represented the Jewish Caucus, and state Del. Sean Stinnett (D-Baltimore County) represented the Muslim Caucus during the press conference.
Solomon ended the press conference by explaining the importance of all the caucuses coming out together.
“We are stronger when we’re together, and many of these issues that we have talked about, again, impact all of us,” said Solomon.
District of Columbia
Blade contributor, husband exchange vows in D.C.
Yariel Valdés and Kevin Vega held ceremony at Jefferson Memorial on March 23
Washington Blade contributor Yariel Valdés and his husband, Kevin Vega, exchanged vows at the Jefferson Memorial on March 23.
The couple married in Fort Lauderdale, Fla., on Nov. 24, 2025. The Jefferson Memorial ceremony — which Blade International News Editor Michael K. Lavers and Samy Nemir Olivares officiated — coincided with the third anniversary of Yariel and Kevin’s first date.
Yariel in 2019 asked for asylum in the U.S. because of the persecution he suffered as a journalist in his native Cuba. He spent nearly a year in U.S. Immigration and Customs Enforcement custody before his release on March 4, 2020.
Yariel wrote a series of articles about his time in ICE custody that the Blade published. The series was nominated for a GLAAD Media Award in 2022.
Yariel and Kevin live in South Florida.
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