Local
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.”
Virginia
Miyares joins efforts to fight Title IX changes
Republican Va. AG part of multi-state effort
BY NATHANIEL CLINE | Virginia Attorney General Jason Miyares has joined a multi-state effort to stop new Title IX rules from going into effect.
The list of new rules designed to protect victims of campus sexual assaults and the rights of LGBTQ students has come under attack by Republican attorneys general in several states.
Miyares called the changes a “dangerous overhaul” of Title IX, and said the new rules would negatively impact students, families and schools in the commonwealth. The ruling also comes after Gov. Glenn Youngkin’s administration overhauled the commonwealth’s transgender student policies.
“The Biden administration’s unlawful rule would jeopardize half a century of landmark protections for women, forcing the administration’s social agenda onto the states by holding federal funding hostage,” Miyares said in a statement. “They are avoiding Congress and the constitutional process because they know it will not pass. We cannot roll back Title IX in the name of false equity.”
Attorney generals from Tennessee, Indiana, Kentucky, Ohio, and West Virginia have also signed onto the suit, which was filed in Tennessee. Separate lawsuits have been filed in other states, including Louisiana and Texas.
Title IX, which has undergone several transformations based on the political party in office, was created to address women’s rights and prohibits any federally funded school or education program from discriminating against any student based on sex since it was established in 1972.
The Department of Education said some differences compared to the previous version developed under the Trump administration, include protections against all sex-based harassment and discrimination, prohibits schools from sharing personal information, and supports students and families.
Narissa Rahaman, executive director for Equality Virginia, said in a statement that the rule prevents opponents from weakening “crucial” civil rights protections including for LGBTQ students by ensuring that pregnant and parenting students have a right to equal education opportunities, protecting student survivors and guaranteeing the rights of LGBTQ students to come to school as themselves without fear of harassment or discrimination.
“Students across races, places, and genders prove every day that they can do great things, especially when there are strong Title IX protections in place, which is why the Biden administration’s updates to the Title IX rules are essential to ensure every student can thrive at school,” said Rahaman.
The new rule is slated to take effect on Aug. 1 and will apply to complaints of alleged conduct that occurs on or after that date, according to the Department of Education.
Protections
While the ruling protects students and employees from all sex-based harassment and discrimination, it will also impact LGBTQ students and employees, including providing complete protection from sex-based harassment, and prohibiting schools from sharing personal information.
Schools must act “promptly and effectively” to protect and treat all students and staff who make complaints “equitably.” Schools must also provide support measures to complainants and respondents, and act to end any sex discrimination in their programs and prevent any recurrence.
The rule further clarifies the definition of “sex-based harassment,” which means to treat someone unfairly because of their gender; and the scope of sex discrimination, including schools’ obligations not to discriminate based on sex stereotypes, sex characteristics, pregnancy or related conditions, sexual orientation, and gender identity.
The federal agency said the changes will empower and support students and families by requiring schools to disclose their nondiscrimination policies and procedures to all students, employees, and other participants in their education programs so that students and families understand their rights.
The final rule also protects against retaliation for students, employees, and others who exercise their Title IX rights, and supports the rights of parents and guardians to act on behalf of their elementary school and secondary school children.
The rule also protects student privacy by prohibiting schools from disclosing personally identifiable information with limited exceptions, which is something the Youngkin administration has opposed.
Advocates say one of the rights students should have is the power to decide who finds out about their transgender status, to protect them from being bullied or harassed.
Virginia policies
In 2021, the first model policies for trans students were designed under former Gov. Ralph Northam to provide school officials guidance on the treatment of trans and nonbinary students and to protect the privacy and rights of these students.
However, some schools declined to adopt the model policies, and the state law that led to them lacked enforcement incentives or penalties.
The current policies adopted by the Youngkin administration were revised to require parental approval for any changes to students’ “names, nicknames, and/or pronouns,” direct schools to keep parents “informed about their children’s well-being” and require that student participation in activities and athletics and use of bathrooms be based on sex, “except to the extent that federal law otherwise requires.”
Virginia schools have also not fully adopted the newly revised policies, and state law has not changed since the policies were overhauled in 2023.
The Virginia Department of Education faces two lawsuits over the policies adopted by the Youngkin administration.
“All Virginia students, including our transgender and nonbinary students deserve to feel safe and welcomed at schools,” said Wyatt Rolla, a senior trans rights attorney with the ACLU of Virginia. “Accessing restrooms, locker rooms and other facilities that are necessary when you are at school learning is a key part of our schools being inclusive of those transgender [and] non binary students that are part of our community.”
Athletics not included
The provisions under the new Title IX rule did not mention anything about requiring schools to allow trans students to play on teams that align with their gender identity. Virginia has taken its own shot at banning trans athletes from competing in sports through legislation.
In February, the Youngkin administration attempted to challenge the Virginia High School League’s policy on transgender athletes, the Daily Progress reported.
The proposed policy would have matched with the administration’s current policies that students should be placed on teams based on their biological sex rather than their gender identity.
The Virginia High School League, which oversees interscholastic athletic competition for Virginia’s public high schools, allows for trans athletes to participate on teams that match their gender identity, but under certain conditions.
Simultaneously, lawmakers in the Virginia General Assembly controlled by Democrats killed bills, including Senate Bill 68, during the previous session that would have essentially banned transgender students from competing in sports.
State Sen. Tammy Brankley Mulchi (R-Mecklenburg), who carried Senate Bill 723, said students like her 6-year-old granddaughter should have a choice to play with their own gender during a Feb. 1 Senate Education subcommittee hearing.
Mulchi’s bill would have required schools and colleges to have separate sports for boys and girls based on their biological sex. Any dispute would require a note from a doctor.
“If she [my granddaughter] wants to play an all-girl sport, I want her to play against girls that were born girls and not play against someone that is much stronger than her or can hurt her and take away her chances of a scholarship,” Mulchi said.
However, state Sen. Stella Pekarsky (D-Fairfax) argued during the February hearing that whether students are competing with their respective biological sex or not “children of all ages, sexes have different builds and strengths and no children are alike on the same team.”
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Nathaniel is an award-winning journalist who’s been covering news across the country since 2007, including politics at the Loudoun Times-Mirror and the Northern Neck News in Virginia as well as sports for the Plain Dealer in Cleveland, Ohio. He has also hosted podcasts, worked as a television analyst for Spectrum Sports, and appeared as a panelist for conferences and educational programs. A graduate of Bowie State University, Nathaniel grew up in Hawaii and the United Kingdom as a military brat.
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The preceding article was previously published by the Virginia Mercury and is republished with permission.
Nonprofit. Nonpartisan. No paywalls. Fair and tough reporting on the policy and politics that affect all of us is more important than ever. The Mercury brings you coverage of the commonwealth’s biggest issues from a team of veteran Virginia journalists.
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The Comings & Goings column is about sharing the professional successes of our community. We want to recognize those landing new jobs, new clients for their business, joining boards of organizations and other achievements. Please share your successes with us at: [email protected].
The Comings & Goings column also invites LGBTQ+ college students to share their successes with us. If you have been elected to a student government position, gotten an exciting internship, or are graduating and beginning your career with a great job, let us know so we can share your success.
Congratulations to Manny Cosme, owner of CFO Services Group, who was named Small Business Owner of the Year, for Washington, D.C., by the Small Business Administration.
SBA Administrator Isabel Castillas Guzman said, “Our 2024 National Small Business Week award winners exemplify excellence, innovation, and commitment, and the SBA is proud to showcase their incredible achievements and impact on their communities and our economy.” Upon being notified of the award Manny said, “I am incredibly honored and humbled to receive the Small Business Owner of the Year award from the Small Business Administration. This recognition serves as a testament to my team’s hard work, dedication, innovation, and impact in our local community. As a small business owner, I have always strived to embody excellence in my company’s services and commitment to my clients. My team and I are proud to represent the thriving small business communities across the country, and we remain committed to driving innovation, growth, and positive change in our industry.”
Cosme is the founder and current president and CEO of CFO Services Group. The firm is focused on providing bookkeeping, outsourced accounting departments, and fractional CFO advisory services, to growing small businesses and non-profit organizations. The company is headquartered in D.C., with team members and clientele throughout the United States. In addition to working with private business and non-profit clients, CFO Services Group partners with various economic development agencies, such as local governments, chambers of commerce organizations, CDFIs and SBDC centers, to provide free financial literacy and technical assistance to businesses in underserved communities.
Manny has served as the Vice President of Finance & Administration for the United States Hispanic Chamber of Commerce. He recently served as the Finance Chair for the Greater Washington Hispanic Chamber of Commerce, and Vice President of the Equality Chamber of Commerce. He is often sought after in keynote discussions on entrepreneurism and finance for fellow business owners.
Maryland
What Anne Arundel County school board candidates think about book bans
State lawmakers passed Freedom to Read Act in April
BY ROYALE BONDS | Parents’ efforts to restrict content available to students in school libraries has become a contentious issue in Maryland. Conservative parent groups, such as Moms for Liberty, have been working to get books they believe are inappropriate removed from libraries in Carroll and Howard counties, sparking protests, new policies, and even a state law.
The Freedom to Read Act, passed in April, sets standards that books cannot be removed from public and school libraries due to an author’s background. Library staff that uphold the standard are protected under this act. The law, however, does not prohibit removing books deemed “sexually explicit,” the stated reason local Moms for Liberty chapters challenged school library books.
The rest of this article can be read on the Baltimore Banner website.
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