National
Debt deal could jeopardize HIV/AIDS funds
Prevention, drug programs threatened by agreement
President Obama signed the debt deal into law Tuesday (Blade file photo by Michael Key).
The resolution of the debt ceiling negotiations between the White House and congressional leaders has HIV/AIDS advocates concerned that federal funds for prevention and drug initiatives could be on the chopping block as a result of the agreement.
The agreement — which enables President Obama to raise the debt ceiling by $2.1 trillion and eliminates the need for another increase until 2013 — also requires a total of nearly $2.5 trillion in spending cuts to reduce the federal deficit, which could affect federally funded HIV/AIDS programs.
Carl Schmid, deputy executive director of the AIDS Institute, said any cuts to federal spending as a result of the deal will likely “impact HIV programs in a negative way.”
“There will be less money to go around and it will be more competition over that smaller amount of funding,” Schmid said. “And there can be direct cuts to our programs particularly if they are taken across the board. Not going in the right direction if we are going to end AIDS let alone prevent new infections and provide care and treatment to people with HIV/AIDS.”
All federal funding of discretionary HIV/AIDS programs could see an impact as a result of the decision, Schmid said, including the Centers for Disease Control & Prevention, the Ryan White HIV/AIDS Program and AIDS research programs. Additionally, Schmid said AIDS Drug Assistance Programs could be cut and already lengthy wait lists to receive medication through this program could be extended.
“It’s going to be harder and harder to make the case for our programs, but, hopefully, Congress will be receptive to our voices and concerns about the importance of preventing HIV in our country and to provide care and treatment for people who are HIV positive,” Schmid said.
The concerns come as the CDC on Wednesday unveiled new numbers showing that HIV incidence in the United States continues to be a problem affecting young gay and bisexual men, although as a whole infection rates have been relatively stable in recent years.
New infections among among young men who have sex with men increased 34 percent between 2006 and 2009, while infections among young, black men who have sex with men increased 48 percent from 4,400 in 2006 to 6,500 in 2009.
Fred Sainz, vice president of the Human Rights Campaign, said any concerns HRC would have over the debt deal depends on what cuts to federal programs are eventually made. However, he noted for time being, those cuts have yet to be identified and maintained it’s too early to cry foul.
“We are consulting with our coalition partners to better assess the situation,” Sainz said. “We would be concerned, for instance, if programs that fund critical HIV/AIDS were cut. There is no knowledge yet so we’re not in a position to know.”
Obama signed the deal into law on Tuesday after both chambers of Congress approved the measure. The Democratic-controlled Senate approved the measure on Tuesday by a vote of 74-26 while the Republican-controlled House passed the measure by a vote of 269-161.
Prior to the signing, Obama delivered a statement in the White House Rose Garden in which he said the federal government will have to make tough choices to reduce spending, and no programs will be excluded from cuts.
“This compromise requires that both parties work together on a larger plan to cut the deficit, which is important for the long-term health of our economy,” Obama said. “And since you can’t close the deficit with just spending cuts, we’ll need a balanced approach where everything is on the table.”
The agreement calls for a first tranche of spending cuts that total nearly $1 trillion over 10 years. Those cuts include $350 billion from the defense budget, but the remaining cuts could impact discretionary HIV/AIDS initiatives. However, Medicare and Medicaid — as well as the services they provide to people with living with HIV/AIDS — are protected under this first round of cuts.
To institute more cuts, the deal creates a bipartisan panel that has become known as a “Super Congress” made up of congressional leaders and will be required to identify an additional $1.5 trillion in deficit reduction that could include cuts to entitlement programs and tax reform. Both Medicare and Medicaid as well as discretionary HIV/AIDS initiatives could be on the chopping block for this round of cuts. The committee must report out legislation by Nov. 23 and Congress is required to vote on committee recommendations by Dec. 23.
Should Congress fail to act on the committee’s recommendations, a trigger mechanism will be enacted for mandatory spending cuts. Those cuts — which would begin in January 2013 — will be split 50/50 between domestic and defense spending, although Social Security, Medicare beneficiaries and “low-income programs” would be exempt from those cuts. Additionally, Obama has pledged to veto any extension of the Bush-era high-income tax cuts as a means to increase government revenue should Congress fail to come up with a balanced deal.
In a joint statement, Kathleen Squires, chair of the HIV Medicine Association, and Jim Raper, c0-chair of the Ryan White Medical Providers Coalition, urged Congress not to target HIV/AIDS programs in its search for funding cuts in federal programs.
“Congress has outlined a framework for enacting major cuts to the federal budget over the next decade that could have far reaching consequences for people living with, and at risk for, HIV infection here and abroad,” Squires and Raper said. “We urge members of Congress to seriously consider the human impact of the funding and policy decisions that they will be making in the coming months.”
Squires and Raper maintained that continued federal funding for HIV/AIDS initiatives is important because they extend the lives of those living with the disease and stop new infections. Access to HIV care, Squires and Raper said, reduces transmission by 96 percent, but only 50 percent of people with HIV in the United States have reliable access to treatment. Further, Squires and Raper said as many as 15 million people in developing countries await access to lifesaving therapy.
“A retreat in the battle against HIV disease will be costly whether measured in lives lost or federal dollars,” Squires and Raper conclude. “As the deficit reduction process moves forward, we urge members of Congress to consider the impact of their decisions on people with HIV disease and other medically vulnerable populations.”
Shin Inouye, a White House spokesperson, said the debt agreement is “a down payment on deficit reduction so that we begin to live within our means,” but maintained the details of which programs will be cut have yet to be decided.
“The nearly $1 trillion in discretionary spending cuts are achieved through spending caps both on security and non-security spending,” Inouye said. “Specifics about how these levels will be met will be determined through discussions between the administration and appropriators in Congress over the coming months.”
National
United Methodist Church removes 40-year ban on gay clergy
Delegates also voted for other LGBTQ-inclusive measures
The United Methodist Church on Wednesday removed a ban on gay clergy that was in place for more than 40 years, voting to also allow LGBTQ weddings and end prohibitions on the use of United Methodist funds to “promote acceptance of homosexuality.”
Overturning the policy forbidding the church from ordaining “self-avowed practicing homosexuals” effectively formalized a practice that had caused an estimated quarter of U.S. congregations to leave the church.
The New York Times notes additional votes “affirming L.G.B.T.Q. inclusion in the church are expected before the meeting adjourns on Friday.” Wednesday’s measures were passed overwhelmingly and without debate. Delegates met in Charlotte, N.C.
According to the church’s General Council on Finance and Administration, there were 5,424,175 members in the U.S. in 2022 with an estimated global membership approaching 10 million.
The Times notes that other matters of business last week included a “regionalization” plan, which gave autonomy to different regions such that they can establish their own rules on matters including issues of sexuality — about which international factions are likelier to have more conservative views.
Rev. Kipp Nelson of St. Johns’s on the Lake Methodist Church in Miami shared a statement praising the new developments:
“It is a glorious day in the United Methodist Church. As a worldwide denomination, we have now publicly proclaimed the boundless love of God and finally slung open the doors of our church so that all people, no matter their identities or orientations, may pursue the calling of their hearts.
“Truly, all are loved and belong here among us. I am honored to serve as a pastor in the United Methodist Church for such a time as this, for our future is bright and filled with hope. Praise be, praise be.”
Federal Government
Republican state AGs challenge Biden administration’s revised Title IX policies
New rules protect LGBTQ students from discrimination
Four Republicans state attorneys general have sued the Biden-Harris administration over the U.S. Department of Education’s new Title IX policies that were finalized April 19 and carry anti-discrimination protections for LGBTQ students in public schools.
The lawsuit filed on Tuesday, which is led by the attorneys general of Kentucky and Tennessee, follows a pair of legal challenges from nine Republican states on Monday — all contesting the administration’s interpretation that sex-based discrimination under the statute also covers that which is based on the victim’s sexual orientation or gender identity.
The administration also rolled back Trump-era rules governing how schools must respond to allegations of sexual harassment and sexual assault, which were widely perceived as biased in favor of the interests of those who are accused.
“The U.S. Department of Education has no authority to let boys into girls’ locker rooms,” Tennessee Attorney General Jonathan Skrmetti said in a statement. “In the decades since its adoption, Title IX has been universally understood to protect the privacy and safety of women in private spaces like locker rooms and bathrooms.”
“Florida is suing the Biden administration over its unlawful Title IX changes,” Florida Gov. Ron DeSantis wrote on social media. “Biden is abusing his constitutional authority to push an ideological agenda that harms women and girls and conflicts with the truth.”
After announcing the finalization of the department’s new rules, Education Secretary Miguel Cardona told reporters, “These regulations make it crystal clear that everyone can access schools that are safe, welcoming and that respect their rights.”
The new rule does not provide guidance on whether schools must allow transgender students to play on sports teams corresponding with their gender identity to comply with Title IX, a question that is addressed in a separate rule proposed by the agency in April.
LGBTQ and civil rights advocacy groups praised the changes. Lambda Legal issued a statement arguing the new rule “protects LGBTQ+ students from discrimination and other abuse,” adding that it “appropriately underscores that Title IX’s civil rights protections clearly cover LGBTQ+ students, as well as survivors and pregnant and parenting students across race and gender identity.”
Federal Government
4th Circuit rules gender identity is a protected characteristic
Ruling a response to N.C., W.Va. legal challenges
BY ERIN REED | The 4th U.S. Circuit Court of Appeals ruled Monday that transgender people are a protected class and that Medicaid bans on trans care are unconstitutional.
Furthermore, the court ruled that discriminating based on a diagnosis of gender dysphoria is discrimination based on gender identity and sex. The ruling is in response to lower court challenges against state laws and policies in North Carolina and West Virginia that prevent trans people on state plans or Medicaid from obtaining coverage for gender-affirming care; those lower courts found such exclusions unconstitutional.
In issuing the final ruling, the 4th Circuit declared that trans exclusions were “obviously discriminatory” and were “in violation of the equal protection clause” of the Constitution, upholding lower court rulings that barred the discriminatory exclusions.
The 4th Circuit ruling focused on two cases in states within its jurisdiction: North Carolina and West Virginia. In North Carolina, trans state employees who rely on the State Health Plan were unable to use it to obtain gender-affirming care for gender dysphoria diagnoses.
In West Virginia, a similar exclusion applied to those on the state’s Medicaid plan for surgeries related to a diagnosis of gender dysphoria. Both exclusions were overturned by lower courts, and both states appealed to the 4th Circuit.
Attorneys for the states had argued that the policies were not discriminatory because the exclusions for gender affirming care “apply to everyone, not just transgender people.” The majority of the court, however, struck down such a claim, pointing to several other cases where such arguments break down, such as same-sex marriage bans “applying to straight, gay, lesbian, and bisexual people equally,” even though straight people would be entirely unaffected by such bans.
Other cases cited included literacy tests, a tax on wearing kippot for Jewish people, and interracial marriage in Loving v. Virginia.
See this portion of the court analysis here:
Of particular note in the majority opinion was a section on Geduldig v. Aiello that seemed laser-targeted toward an eventual U.S. Supreme Court decision on discriminatory policies targeting trans people. Geduldig v. Aiello, a 1974 ruling, determined that pregnancy discrimination is not inherently sex discrimination because it does not “classify on sex,” but rather, on pregnancy status.
Using similar arguments, the states claimed that gender affirming care exclusions did not classify or discriminate based on trans status or sex, but rather, on a diagnosis of gender dysphoria and treatments to alleviate that dysphoria.
The majority was unconvinced, ruling, “gender dysphoria is so intimately related to transgender status as to be virtually indistinguishable from it. The excluded treatments aim at addressing incongruity between sex assigned at birth and gender identity, the very heart of transgender status.” In doing so, the majority cited several cases, many from after Geduldig was decided.
Notably, Geduldig was cited in both the 6th and 11th Circuit decisions upholding gender affirming care bans in a handful of states.
The court also pointed to the potentially ridiculous conclusions that strict readings of what counts as proxy discrimination could lead to, such as if legislators attempted to use “XX chromosomes” and “XY chromosomes” to get around sex discrimination policies:
Importantly, the court also rebutted recent arguments that Bostock applies only to “limited Title VII claims involving employers who fired” LGBTQ employees, and not to Title IX, which the Affordable Care Act’s anti-discrimination mandate references. The majority stated that this is not the case, and that there is “nothing in Bostock to suggest the holding was that narrow.”
Ultimately, the court ruled that the exclusions on trans care violate the Equal Protection Clause of the Constitution. The court also ruled that the West Virginia Medicaid Program violates the Medicaid Act and the anti-discrimination provisions of the Affordable Care Act.
Additionally, the court upheld the dismissal of anti-trans expert testimony for lacking relevant expertise. West Virginia and North Carolina must end trans care exclusions in line with earlier district court decisions.
The decision will likely have nationwide impacts on court cases in other districts. The case had become a major battleground for trans rights, with dozens of states filing amicus briefs in favor or against the protection of the equal process rights of trans people. Twenty-one Republican states filed an amicus brief in favor of denying trans people anti-discrimination protections in healthcare, and 17 Democratic states joined an amicus brief in support of the healthcare rights of trans individuals.
Many Republican states are defending anti-trans laws that discriminate against trans people by banning or limiting gender-affirming care. These laws could come under threat if the legal rationale used in this decision is adopted by other circuits. In the 4th Circuit’s jurisdiction, West Virginia and North Carolina already have gender-affirming care bans for trans youth in place, and South Carolina may consider a similar bill this week.
The decision could potentially be used as precedent to challenge all of those laws in the near future and to deter South Carolina’s bill from passing into law.
The decision is the latest in a web of legal battles concerning trans people. Earlier this month, the 4th Circuit also reversed a sports ban in West Virginia, ruling that Title IX protects trans student athletes. However, the Supreme Court recently narrowed a victory for trans healthcare from the 9th U.S. Circuit Court of Appeals and allowed Idaho to continue enforcing its ban on gender-affirming care for everyone except the two plaintiffs in the case.
Importantly, that decision was not about the constitutionality of gender-affirming care, but the limits of temporary injunctions in the early stages of a constitutional challenge to discriminatory state laws. It is likely that the Supreme Court will ultimately hear cases on this topic in the near future.
Celebrating the victory, Lambda Legal Counsel and Health Care Strategist Omar Gonzalez-Pagan said in a posted statement, “The court’s decision sends a clear message that gender-affirming care is critical medical care for transgender people and that denying it is harmful and unlawful … We hope this decision makes it clear to policy makers across the country that health care decisions belong to patients, their families, and their doctors, not to politicians.”
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Erin Reed is a transgender woman (she/her pronouns) and researcher who tracks anti-LGBTQ+ legislation around the world and helps people become better advocates for their queer family, friends, colleagues, and community. Reed also is a social media consultant and public speaker.
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The preceding article was first published at Erin In The Morning and is republished with permission.
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