National
What’s next for health care reform?
After court ruling, focus turns to state plans for Medicaid
Now that the Supreme Court has upheld the constitutionality of President Obama’s health care reform law, advocates are pushing for additional efforts to extend coverage of the law to LGBT people and people with HIV/AIDS to the fullest extent possible.
For the most part, the next step in the process involves looking to the states to determine whether they will adopt health policies afforded to them under the law — foremost among them is the Medicaid expansion to cover all people with incomes up to 133 percent of the federal poverty level.
Although the Supreme Court ruled the majority of the health care law is constitutional, it prevented the federal government from withholding all Medicaid funds from states if they decline to take part in the Medicaid expansion. As a result, states can decide whether or not to enter the expansion without fear of losing money.
Patrick Paschall, a policy advocate at the National Gay & Lesbian Task Force, said the Medicaid expansion is particularly important for LGBT people because they disproportionately live below the poverty level.
“The Medicaid expansions are going to end up being hugely important for LGBT people because it expands coverage to low-income people, and LGBT people are disproportionately low-income,” Paschall said. “We know this because of rampant employment discrimination and housing discrimination.”
A report on transgender people published earlier this year by the Task Force and the National Center for Transgender Equality, titled “Injustice at Every Turn: A Report of the National Transgender Discrimination Survey,” found that transgender people experience unemployment at rates twice that of the national population, and black transgender people experience it at a rate of four times as much.
Carl Schmid, deputy executive director of the AIDS Institute, said the Medicaid expansion is particularly important for people with HIV/AIDS because of 50 percent of those in care rely on that program for support and those numbers will “grow substantially” if states decide to participate.
“Those who are really poor, they’re going to be covered under Medicaid,” Schmid said. “The question is what are we expecting from the states.”
But a number of states may not take part. According to a report in The Hill newspaper, at least 15 governors have signaled they won’t participate in the Medicaid expansion now that the Supreme Court has enabled them to wiggle out of participation.
Florida Gov. Rick Scott, a Republican elected to office during the Tea Party wave in 2010, was among those saying his state wouldn’t take part in the Medicaid expansion — or other parts of the health care law that are optional to the states.
“We’re not going to implement Obamacare in Florida,” Scott said last week on Fox News. “We’re not going to expand Medicaid because we’re going to do the right thing. We’re not going to do the exchange.”
Under the health care reform law, the federal government will pay for the Medicaid expansion for the first few years. Expenses for states come up in 2017, when the federal government will pay 95 percent; That’s reduced to 94 percent in 2018 and in 2019 it goes down to 93 percent. Starting in 2010 and then on out, the federal government will pay 90 percent of the total amount.
Schmid said the bargain that was set up for states under the health care law makes the governors’ decision not to participate in the law questionable.
“Here their taxpayers are going to be paying their taxes to pay for this; this is federal funds,” Schmid said. “Their state is not going to take responsibility for covering. The hospitals? Don’t they want people to be covered? They’re going to have unconstituted care if they don’t.”
For the states that don’t participate in the Medicaid expansion, Schmid said people living there with HIV/AIDS will have to continue relying on the Ryan White Care Program, which provides funds for AIDS medications for low-income people with HIV. The program will be up for reauthorization in 2013.
As advocates push for states to adopt the Medicaid expansion, the law has several key components that already offer protections and benefits for LGBT people and people with HIV/AIDS. State and federal health insurance will be set up in the law starting in 2014.
For the first time, the law extends federal non-discrimination protection in the health care system on the basis of gender.
Paschall noted that provision is key as courts and agencies have determined that discrimination against transgender people amounts to gender discrimination.
“We know that federal agencies like the Equal Employment Opportunity Commission, the Department of Housing & Urban Development as well as federal courts have interpreted sex-based discrimination to include protections on the basis of gender identity and sex stereotypes,” Paschall said. “What this means is that in the context of health care, LGBT people, especially transgender people have now for the first time protections in that setting, which is hugely important.”
Earlier this year, the Department of Health & Human Services issued rules saying that no program activity in an exchange, nor a health plan, can discriminate on the basis of sexual orientation and gender identity. The rule takes effect when exchanges open in 2014.
The administration has taken additional efforts to help the LGBT community when it comes to accessing health care. Same-sex couples can now search for health plans that cover domestic partners through the health care finder tool at healthfinder.gov. HHS has also undertaken data collection efforts to include questions about sexual orientation and gender identity in surveys like the National Health Interview Survey.
Still, advocates are looking for additional efforts from the administration — in addition to the adoption of the Medicaid expansion by the states — to ensure LGBT people are included in health care reform to the greatest extent possible.
Paschall said the Task Force wants to see data collection efforts expanded beyond the federal surveys already designated by the administration.
“Generally speaking, we would like to see sexual orientation and gender identity questions added to all federal surveys where demographic data is collected,” he said. “Our priorities include a number of federal surveys, maybe most notably the American Community Survey, which is an annual survey that collects demographic data and is considered one of the largest annual data sources on the American population.”
For people living with HIV/AIDS, Schmid said he is awaiting from the administration regulatory guidance in the next couple months on essential health benefits to cover people in the Medicaid program and federal exchanges.
“We’ll see if the coverage will be strong enough for medications and for all different other services,” Schmid said.
Federal Government
Trump-appointed EEOC leadership rescinds LGBTQ worker guidance
The EEOC voted to rescind its 2024 guidance, minimizing formally expanded protections for LGBTQ workers.
The U.S. Equal Employment Opportunity Commission voted 2–1 to repeal its 2024 guidance, rolling back formally expanded protections for LGBTQ workers.
The EEOC, which is composed of five commissioners, is tasked with enforcing federal laws that make workplace discrimination illegal. Since President Donald Trump appointed two Republican commissioners last year — Andrea R. Lucas as chair in January and Brittany Panuccio in October — the commission’s majority has increasingly aligned its work with conservative priorities.
The commission updated its guidance in 2024 under then-President Joe Biden to expand protections to LGBTQ workers, particularly transgender workers — the most significant change to the agency’s harassment guidance in 25 years.
The directive, which spanned nearly 200 pages, outlined how employers may not discriminate against workers based on protected characteristics, including race, sex, religion, age, and disability as defined under federal law.
One issue of particular focus for Republicans was the guidance’s new section on gender identity and sexual orientation. Citing the 2020 U.S. Supreme Court’s Bostock v. Clayton County decision and other cases, the guidance included examples of prohibited conduct, such as the repeated and intentional use of a name or pronoun an individual no longer uses, and the denial of access to bathrooms consistent with a person’s gender identity.
Last year a federal judge in Texas had blocked that portion of the guidance, saying that finding was novel and was beyond the scope of the EEOC’s powers in issuing guidance.
The dissenting vote came from the commission’s sole Democratic member, Commissioner Kalpana Kotagal.
“There’s no reason to rescind the harassment guidance in its entirety,” Kotagal said Thursday. “Instead of adopting a thoughtful and surgical approach to excise the sections the majority disagrees with or suggest an alternative, the commission is throwing out the baby with the bathwater. Worse, it is doing so without public input.”
While this now rescinded EEOC guidance is not legally binding, it is widely considered a blueprint for how the commission will enforce anti-discrimination laws and is often cited by judges deciding novel legal issues.
Multiple members of Congress released a joint statement condemning the agency’s decision to minimize worker protections, including U.S. Reps. Teresa Leger Fernández (D-N.M.), Grace Meng (D-N.Y.), Mark Takano (D-Calif.), Adriano Espaillat (D-N.Y.), and Yvette Clarke (D-N.Y.) The rescission follows the EEOC’s failure to respond to or engage with a November letter from Democratic Caucus leaders urging the agency to retain the guidance and protect women and vulnerable workers.
“The Equal Employment Opportunity Commission is supposed to protect vulnerable workers, including women, people of color, and LGBTQI+ workers, from discrimination on the job. Yet, since the start of her tenure, the EEOC chair has consistently undermined protections for women, people of color, and LGBTQI+ workers. Now, she is taking away guidance intended to protect workers from harassment on the job, including instructions on anti-harassment policies, training, and complaint processes — and doing so outside of the established rule-making process. When workers are sexually harassed, called racist slurs, or discriminated against at work, it harms our workforce and ultimately our economy. Workers can’t afford this — especially at a time of high costs, chaotic tariffs, and economic uncertainty. Women and vulnerable workers deserve so much better.”
Minnesota
Lawyer representing Renee Good’s family speaks out
Antonio Romanucci condemned White House comments over Jan. 7 shooting
A U.S. Immigration and Customs Enforcement agent shot and killed Renee Good in Minneapolis on Jan. 7 as she attempted to drive away from law enforcement during a protest.
Since Good’s killing, ICE has faced national backlash over the excessive use of deadly force, prompting the Trump-Vance administration to double down on escalating enforcement measures in cities across the country.
The Washington Blade spoke with Antonio Romanucci, the attorney representing Good’s family following her death.
Romanucci said that Jonathan Ross — the ICE agent seen on video shooting Good — acted in an antagonizing manner, escalated the encounter in violation of ICE directives, and has not been held accountable as ICE and other federal agents continue to “ramp up” operations in Minnesota.
A day before the fatal shooting, the Department of Homeland Security began what it described as the largest immigration enforcement operation ever carried out by the agency, according to DHS’s own X post.
That escalation, Romanucci said, is critical context in understanding how Good was shot and why, so far, the agent who killed her has faced no consequences for killing a queer mother as she attempted to disengage from a confrontation.
“You have to look at this in the totality of the circumstances … One of the first things we need to look at is what was the mission here to begin with — with ICE coming into Minneapolis,” Romanucci told the Blade. “We knew the mission was to get the worst of the worst, and that was defined as finding illegal immigrants who had felony convictions. When you look at what happened on Jan. 7 with Renee and Rebecca [Good, Renee’s wife], certainly that was far from their mission, wasn’t it? What they really did was they killed a good woman — someone who was a mother, a daughter, a sister, a committed companion, an animal lover.”
Romanucci said finding and charging those responsible for Good’s death is now the focus of his work with her family.
“What our mission is now is to ensure that we achieve transparency, accountability, and justice … We aim to get it in front of, hopefully, a judge or a jury one day to make that determination.”
Those are three things Homeland Security Secretary Kristi Noem and DHS has outright rejected while smearing Good in the official record — including accusing her of being a “domestic terrorist” without evidence and standing by Ross, who Noem said acted in self-defense.
The version of events advanced by Noem and ICE has been widely contradicted by the volume of video footage of the shooting circulating online. Multiple angles show Good’s Honda Pilot parked diagonally in the street alongside other protesters attempting to block ICE agents from entering Richard E. Green Central Park Elementary School.
The videos show ICE officers approaching Good’s vehicle and ordering her to “get out of the car.” She then puts the car in reverse, backs up briefly, shifts into drive, and steers to the right — away from the officers.
The abundance of video evidence directly contradicts statements made by President Donald Trump, Noem, and other administration officials in interviews following Good’s death.
“The video shows that Renee told Jonathan Ross that ‘I’m not mad at you,’ so we know that her state of mind was one of peace,” Romanucci said. “She steered the car away from where he was standing, and we know that he was standing in front of the car. Reasonable police practices say that you do not stand in front of the car when there’s a driver behind the wheel. When you leave yourself with only the ability to use deadly force as an option to escape, that is not a reasonable police practice.”
An autopsy commissioned by Good’s family further supports that account, finding that her injuries were consistent with being shot from the direction of someone driving away.
The autopsy found three gunshot wounds: one to Good’s left forearm, one that struck her right breast without piercing major organs, and a third that entered the left side of her head near the temple and exited on the right side.
Romanucci said Ross not only placed himself directly in harm’s way, but then used deadly force after creating the conditions he claimed justified it — a move that violates DHS and ICE policy, according to former Assistant Homeland Security Secretary Juliette Kayyem.
“As a general rule, police officers and law enforcement do not shoot into moving cars, do not put themselves in front of cars, because those are things that are easily de-escalated,” Kayyem told PBS in a Jan. 8 interview.
“When he put himself in a situation of danger, the only way that he could get out of danger is by shooting her, because he felt himself in peril,” Romanucci said. “That is not a reasonable police practice when you leave yourself with only the ability to use deadly force as an option. That’s what happened here. That’s why we believe, based on what we’ve seen, that this case is unlawful and unconstitutional.”
Romanucci said he was appalled by how Trump and Noem described Good following her death.
“I will never use those words in describing our client and a loved one,” he said. “Those words, in my opinion, certainly do not apply to her, and they never should apply to her. I think the words, when they were used to describe her, were nearly slanderous … Renee Good driving her SUV at two miles per hour away from an ICE agent to move down the street is not an act of domestic terrorism at all.”
He added that his office has taken steps to preserve evidence in anticipation of potential civil litigation, even as the Justice Department has declined to open an investigation.
“We did issue a letter of preservation to the Department of Justice, Department of Homeland Security, and other agencies to ensure that any evidence that’s in their possession be not destroyed or altered or modified,” Romanucci said. “We’ve heard Todd Blanche say just in the last couple of days that they don’t believe that they need to investigate at all. So we’re going to be demanding that the car be returned to its rightful owner, because if there’s no investigation, then we want our property back.”
The lack of accountability for Ross — and the continued expansion of ICE operations — has fueled nationwide protests against federal law enforcement under the Trump-Vance administration.
“The response we’ve seen since Renee’s killing has been that ICE has ramped up its efforts even more,” Romanucci said. “There are now over 3,000 ICE agents in a city where there are only 600 police officers, which, in my opinion, is defined as an invasion of federal law enforcement officers into a city … When you see the government ramping up its efforts in the face of constitutional assembly, I think we need to be concerned.”
As of now, Romanucci said, there appears to be no meaningful accountability mechanism preventing ICE agents from continuing to patrol — and, in some cases, terrorize — the Minneapolis community.
“What we know is that none of these officers are getting disciplined for any of their wrongdoings,” he said. “The government is saying that none of their officers have acted in a wrongful manner, but that’s not what the courts are saying … Until they get disciplined for their wrongdoings, they will continue to act with impunity.”
When asked what the public should remember about Good, Romanucci emphasized that she was a real person — a mother, a wife, and a community member whose life was cut short. Her wife lost her partner, and three children lost a parent.
“I’d like the public to remember Renee about is the stories that Rebecca has to tell — how the two of them would share road trips together, how they loved to share home-cooked meals together, what a good mother she was, and what a community member she was trying to make herself into,” Romanucci said. “They were new to Minneapolis and were really trying to make themselves a home there because they thought they could have a better life. Given all of that, along with her personality of being one of peace and one of love and care, I think that’s what needs to be remembered about Renee.”
The White House
Trump-Vance administration ‘has dismantled’ US foreign policy infrastructure
Current White House took office on Jan. 20, 2025
Jessica Stern, the former special U.S. envoy for the promotion of LGBTQ and intersex rights, on the eve of the first anniversary of the Trump-Vance administration said its foreign policy has “hurt people” around the world.
“The changes that they are making will take a long time to overturn and recover from,” she said on Jan. 14 during a virtual press conference the Alliance for Diplomacy and Justice, a group she co-founded, co-organized.
Amnesty International USA National Director of Government Relations and Advocacy Amanda Klasing, Human Rights Watch Deputy Washington Director Nicole Widdersheim, Human Rights First President Uzra Zeya, PEN America’s Jonathan Friedman, and Center for Reproductive Rights Senior Federal Policy Council Liz McCaman Taylor also participated in the press conference.
The Trump-Vance administration took office on Jan. 20, 2025.
The White House proceeded to dismantle the U.S. Agency for International Development, which funded LGBTQ and intersex rights organizations around the world.

Secretary of State Marco Rubio last March announced the State Department would administer the 17 percent of USAID contracts that had not been cancelled. Rubio issued a waiver that allowed PEPFAR and other “life-saving humanitarian assistance” programs to continue to operate during the U.S. foreign aid freeze the White House announced shortly after it took office.
The global LGBTQ and intersex rights movement has lost more than an estimated $50 million in funding because of the cuts. The Washington Blade has previously reported PEPFAR-funded programs in Kenya and other African countries have been forced to suspend services and even shut down.
Stern noted the State Department “has dismantled key parts of foreign policy infrastructure that enabled the United States to support democracy and human rights abroad” and its Bureau of Democracy, Human Rights, and Labor “has effectively been dismantled.” She also pointed out her former position and others — the Special Representative for Racial Equity and Justice, the Ambassador-at-Large for Global Women’s Issues, and the Ambassador-at-Large for Global Criminal Justice — “have all been eliminated.”
President Donald Trump on Jan. 7 issued a memorandum that said the U.S. will withdraw from the U.N. Entity for Gender Equality and the Empowerment of Women and more than 60 other U.N. and international entities.
Rubio in a Jan. 10 Substack post said UN Women failed “to define what a woman is.”
“At a time when we desperately need to support women — all women — this is yet another example of the weaponization of transgender people by the Trump administration,” said Stern.
US ‘conducting enforced disappearances’
The Jan. 14 press conference took place a week after a U.S. Immigration and Customs Enforcement agent killed Renee Good, a 37-year-old woman who left behind her wife and three children, in Minneapolis. American forces on Jan. 3 seized now former Venezuelan President Nicolás Maduro and his wife, Cilia Flores, at their home in Caracas, the Venezuelan capital, during an overnight operation. Trump also continues to insist the U.S. needs to gain control of Greenland.

Widdersheim during the press conference noted the Trump-Vance administration last March sent 252 Venezuelans to El Salvador’s Terrorism Confinement Center, a maximum-security prison known by the Spanish acronym CECOT.
One of them, Andry Hernández Romero, is a gay asylum seeker who the White House claimed was a member of Tren de Aragua, a Venezuelan gang the Trump-Vance administration has designated as an “international terrorist organization.” Hernández upon his return to Venezuela last July said he suffered physical, sexual, and psychological abuse while at CECOT.
“In 2025 … the United States is conducting enforced disappearances,” said Widdersheim.
Zeya, who was Under Secretary of State for Civilian Security, Democracy, and Human Rights from 2021-2025, in response to the Blade’s question during the press conference said her group and other advocacy organizations have “got to keep doubling down in defense of the rule of law, to hold this administration to account.”
-
Photos5 days agoPHOTOS: Mr. Mid-Atlantic Leather 2026
-
The White House4 days agoA full year of Trump and LGBTQ rights: all that’s been lost
-
Opinions5 days agoMedia obsess over ‘Heated Rivalry’ sex but ignore problem of homophobia in sports
-
Health4 days agoCVS Health agrees to cover new HIV prevention drug
