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What’s next for health care reform?

After court ruling, focus turns to state plans for Medicaid

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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.”

Paschall continued, “We’re also working with them to ensure that those questions are developed and included in other federal health surveys across the board so that we can have more data in more areas identify where those disparities are.”

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.

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Ghana

Ghanaian president welcomed to Philadelphia amid backlash over anti-LGBTQ bill

Lincoln University cancelled event with John Mahama

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Ghanaian President John Mahama (Photo via John Dramani Mahama Official Instagram)

Philadelphia Gay News published this article on March 25. The Washington Blade republished it with permission.

Ghanaian President John Dramani Mahama, known for making anti-LGBTQ legislative promises, was scheduled to appear at two local colleges this week — but plans have changed. Although Mahama will still attend a community dialogue at Temple University, he will no longer be honored at Lincoln University — a Chester County HBCU. He will, however, be presented with an award by the World Affairs Council of Philadelphia. The cancellation of the Lincoln event came shortly after LGBTQ activists spoke out about his appearances.

“Due to unforeseen circumstances, the university is cancelling the visit from President John Dramani Mahama,” Athena Griffith-Howard, associate vice president of marketing and communications at Lincoln University, told PGN.

According to a press release about the scheduled event, Mahama was set to receive an honorary doctorate from Lincoln University on Thursday, March 26, “in recognition of his outstanding contributions to public service, democratic governance, peaceful international and inter-African relationships, and global advocacy for justice, equality, and education.”

Although Griffith-Howard did not respond to additional questions about the matter, Joy News — an independent news organization that markets itself as the “most credible” journalism in Ghana — reports that the university has rescinded his honorary degree and cancelled the visit due to Mahama’s anti-LGBTQ stance.

“It is both surprising and regrettable that, just hours ago, the Embassy received a communication from the university indicating that concerns had been raised by a group regarding President Mahama’s perceived position on Ghana’s Human Sexual Rights and Family Values Bill,” a statement released by the Ghana Embassy on March 24 reads.

Mahama has repeatedly vowed to sign the Human Sexual Rights and Family Values Bill into law if it passes out of parliament. He has also made statements against queer and transgender people.

“The position of my government [is that] marriage is between a man and a woman. A person’s gender is determined at birth. And then also, that the family is the foundation of our nation. That is our position,” Mahama said in a speech on Nov. 18, 2025.

Intimacy laws — which criminalize LGBTQ sex and the use of sex toys — already hold a three-year prison sentence under Ghana law, stemming from legal frameworks that previously governed the country when it was controlled by the British government. Ghana became the first African country to gain independence from European colonization in 1957 — but rather than repeal the antiquated law, leaders chose to incorporate it into their own penal code in 1960. The country’s supreme court upheld the law in 2024.

The Human Sexual Rights and Family Values Bill — often simply referred to as “the anti-LGBTQ+ bill” — would further criminalize LGBTQ people and expression and add new risks for allyship. If passed, the punishment for intimacy violations would increase to a possible five-year prison sentence. LGBTQ people could also be punished for simply identifying as LGBTQ with a new three-year prison sentence.

The proposal would also ban LGBTQ serving organizations, even those that only partly serve LGBTQ people. Violations would include up to five years in prison. Allies could face 10 years in prison for supporting LGBTQ people or promoting LGBTQ rights online, in newspapers, or through other verbal or written communications. Journalists who report on LGBTQ topics are also at risk.

The bill would force families and community members to report those found in violation of the statute to local law enforcement.

“If the parliament of the people of Ghana endorse the bill and vote on it and pass it and it comes to me as president, I will sign it,” Mahama said during his November speech.

Since the Human Sexual Rights and Family Values Bill was introduced in 2021, LGBTQ Ghanaians and allies have experienced widespread discrimination and physical violence — including harassment and arrests, raids on LGBTQ centers (which have led to at least one closure), as well as a hostile media landscape. When the bill was first passed by parliament in 2024, anti-LGBTQ incidents more than doubled.

The proposal was not signed into law by the former President Nana Akufo-Addo, who characterized the proposal as a backsliding of human rights. At the time, Ghana’s finance ministry also warned that signing the bill would place several billions of dollars in funding in jeopardy as a similar anti-LGBTQ bill in Uganda led the World Bank to suspend new funding to that country.

This threat would be especially difficult for Ghana to bear given recent funding cuts made by the Trump administration, which have been especially problematic for some African countries.

Ghana previously relied on USAID funding for social programs and health services, but Trump’s funding cuts led to a $156 million loss — including approximately $78 million that previously funded malaria prevention, maternal and child health, family planning, reproductive health, nutrition, and the fight against HIV/AIDS.

Despite the funding cuts, anti-LGBTQ leaders — including those in Ghana — have been emboldened and empowered by the Trump administration’s own anti-LGBTQ efforts, citing that they no longer fear economic sanctions if their own anti-LGBTQ bill passes.

According to activists, Mahama urged parliament to reintroduce the bill after he took office in January 2025 — around the same time Trump began issuing executive orders, which have negatively impacted LGBTQ Americans.

Mahama is currently in the U.S. to lead a delegation at the United Nations to advocate for reparatory justice for the Transatlantic Slave Trade. He will present a landmark resolution to the United Nations General Assembly in New York City on March 25 — seeking a formal declaration of the Transatlantic Slave Trade as a crime against humanity. The visit also includes a wreath-laying ceremony to honor the lives of enslaved Africans who perished in the U.S.

LGBTQ rights advocates keenly understand the importance of holding the U.S. accountable as direct drivers of the Transatlantic Slave Trade and for the atrocities that occurred to African people on American soil as the country built its economic and social power off of their oppression.

In a press release about Mahama’s visit to Philadelphia, a growing coalition of Philadelphia’s LGBTQ and allied leaders — including Philly Pride 365, GALAEI and ACT UP Philadelphia — called the invitation to speak at Temple University “even more concerning” given the human rights focus of the delegation.

“You cannot come to a global stage calling for justice, repair and recognition of historical harm while simultaneously supporting or advancing policies that criminalize and endanger another marginalized group,” said Tyrell Brown of Philly Pride 365 in the joint statement. “That contradiction is not just political. It reflects a fundamental failure to understand intersectionality and the interconnected nature of oppression.”

“Justice is not selective. Human rights are not conditional,” Brown continued. “If we are serious about repair, it must extend to all people — especially those currently being targeted by state-sanctioned harm.”

There is a colonialist link between the continued oppression of LGBTQ Africans with harmful rhetoric and money coming from the U.S. At least 20 US-based conservative Christian groups, which have spent over $54 million since 2007 on anti-LGBTQ efforts in Africa, are linked to anti-LGBTQ bills and laws across the continent.

“We support the reparations resolution. The argument it rests on is morally sound,” reads a press release issued by JustRight Ghana — a Ghana-based human rights organization. “The transatlantic slave trade classified human beings as property based on what they were born as. It said that certain categories of people, by virtue of their birth, had no rights, no dignity, and no protection from the power of the state.”

“That is the same logic that runs through every clause of the Human Sexual Rights and Family Values Bill 2025. Section 3 says that being born with a particular sexual orientation makes you a criminal,” the press release goes on to state. “The moral architecture is identical. The only thing that has changed is who the target is.”

The World Affairs Council of Philadelphia still intends to present Mahama with its International Statesperson Award on March 27.

A blurb about the award on the institution’s website reads, “The International Statesperson Award of the World Affairs Council of Philadelphia is the highest honor the Council bestows — a tribute for global leadership. It is presented periodically and awarded to distinguished international figures and world leaders whose work has advanced the twin goals of peace and freedom and resulted in a significant positive impact on world affairs.”

Mahama is also still invited to participate in a community dialogue event that will be held at Temple University on the evening of March 26. The event is advertised as celebrating Ghanaian music and artistic culture, comedy, and heritage — featuring celebratory performances as well as a dialogue with Mahama and other national leaders.

“Attendees will have the opportunity to hear firsthand from the president on Ghana’s vision and emerging opportunities, engage in conversations that help shape diaspora partnerships, and explore business, investment, and cultural collaboration opportunities,” reads an Instagram post about the event. “The evening also marks a historic moment as part of the president’s first official visit to Philadelphia.”

The event was planned before Lincoln University canceled its conferment and according to a press release, Mahama intends to convene with people of the Ghanaian diaspora during the Temple University visit.

“This conversation reflects something bigger than a single event,” reads an Instagram post published by Temple University Black Alumni Alliance about the event. “It represents connection across the diaspora, leadership across borders, and the importance of creating spaces where global perspectives and lived experiences can meet.”

In response to PGN’s request for comments and answers to questions, Steve Orbanek, Temple University’s executive director of communications and media relations, emailed the following statement:

“Temple University unequivocally opposes the exclusion of or discrimination against members of the LGBTQIA+ community. Temple takes pride in providing an inclusive and welcoming environment for all students, faculty, staff, alumni, neighbors and friends regardless of their race, nationality, religion, gender, sexual orientation or identity.

“President Mahama will be in the United States to attend the United Nations General Assembly during the International Day of Remembrance of the Victims of Slavery and the Transatlantic Slave Trade. The US-Ghana Chamber of Commerce invited him to participate in a community event and approached Temple about using a venue on campus.

“As a public university, Temple regularly provides space for speakers as part of our ongoing commitment to academic inquiry, open dialogue and public service. We have made venues available for third-party organizations, including political parties or campaigns, regardless of their political viewpoint or stance. The presence of any speaker on campus is not an endorsement by Temple University of the speaker or their views.

The Human Sexual Rights and Family Values Bill that has been recently reintroduced in Ghana’s Parliament is deeply troubling and runs counter to the mission and values of Temple University. Temple’s strength is its people, and every member of our community adds to the cultural richness of our institution. We are committed to cultivating an educational environment founded on respect, open-mindedness, and the appreciation of others.”

The Philadelphia coalition of LGBTQ leaders rejects the idea that hosting a speaker does not reflect the views of the host institution and underlined that platforming political leaders with ties to problematic policies still produces harm.

“Providing a platform to a leader advancing policies that endanger LGBTQ lives and undermine HIV prevention is deeply irresponsible. Institutions of higher education should not normalize or legitimize harm under the guise of dialogue,” said Sam Sitrin of ACT UP Philadelphia in the joint statement.

“Universities should be spaces that uphold human rights and evidence-based public health,” added Jose Demarco of ACT UP Philadelphia. “Hosting leaders associated with policies that criminalize LGBTQ people and undermine HIV prevention sends the wrong message at a time when lives are at stake.”

Temple’s Center for Anti-Racism — an initiative of Temple’s Office of Institutional Diversity, Equity, Advocacy, and Leadership (IDEAL) — which is promoted on flyers and social media as hosting the event, has not responded to PGN’s questions or requests for comments. The event, which was previously included on the university’s events listings, is no longer visible but has not been canceled as of Wednesday, March 25. It is unclear if the university is taking any steps to protect or uplift LGBTQ students during the event.

The Philadelphia coalition of LGBTQ leaders called the decision to host the event in light of the local community’s response “harmful and careless.” They also raised concerns about Temple University’s process to repair wounds and are pressuring Temple to cancel the event and formally apologize to Philadelphia’s LGBTQ community.

“According to organizers, the university had knowledge of the concerns surrounding President Mahama’s [anti-LGBTQ] record as early as Thursday [March 19] but did not conduct meaningful outreach to community partners, nonprofits, or local leaders most impacted by the issue,” the coalition’s press release reads.

“When institutions fail to proactively engage communities on issues of this magnitude, it reveals a disconnect between stated values and actual practice.”

Coalition members joined additional Philadelphia-based leaders in sending a letter to Temple University’s IDEAL initiative and Center for Anti-Racism — noting their concern for the event but also openness to dialoguing directly with the event’s organizers to seek intentionality and transparency.

“This is not an abstract policy discussion. It is about the safety, dignity, and survival of LGBTQ people globally. For many in our communities, including African and Caribbean diaspora members here in Philadelphia, these policies have direct emotional, familial, and cultural impact,” the letter reads. “Hosting this dialogue without intentional accountability risks legitimizing rhetoric and policies that endanger lives.”

Those who signed the letter described themselves as leaders who are Black and Brown, LGBTQ, representatives of HIV/AIDS organizations, and individuals working in government, civil society and DEI spheres in Philadelphia. They include activists of ACT UP Philadelphia, representatives from SMUG International and Bebashi, Ronda Goldfein of the AIDS Law Project of Pennsylvania, Jacen Bowman of Philadelphia Black Pride, Andre Ford of The COLOURS Organization, Sappho Fulton of Womxn Beyond Borders, Hazel Edwards of GALAEI, Simon Trowell of Mazzoni Center, José Benitez of Philadelphia FIGHT, Tyrell Brown of Philly Pride 365, Darius McLean of William Way LGBT Community Center, state Rep. Andre Carroll, state Rep. Malcolm Kenyatta, Philadelphia Councilmember Kendra Brooks, and Philadelphia Councilmember Rue Landau.

They underline that proceeding without addressing concerns would risk harm to the very students and communities IDEAL purports to support.

“As Black and Brown and African LGBTQ leaders, with the support of our allies, we are requesting that the organizers of this event include questions about this truly dangerous legislation and highlight the real world impact on Ghanaian LGBTQ people, their families and their communities,” the letter insists. “Though we believe in autonomy for all nations, and that Americans should not dictate the policy of other nations, we also believe that these deadly policies should not go unquestioned or unchallenged, especially since this event is sponsored by IDEAL, which has a strong commitment to the BIPOC, LGBTQ, and Ghanaian students at Temple.”

They underlined that questions about the matter should come directly from the event’s organizers rather than become the responsibility of the community during a Q&A. The signed leaders hope to receive a response by Wednesday evening — and PGN will follow up with continued reporting when more information about the university and community’s plans are known.

“Silence, in this moment, is not neutrality: it is complicity,” the letter emphasizes.

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The White House

Trump tells Fox News he won the ‘gay vote’ — but polls tell a different story

Trump falsely claims LGBTQ support on Fox despite polling showing overwhelming opposition.

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President Donald Trump at the State of the Union in February 2025. (Washington Blade photo by Michael Key)

President Donald Trump claimed he won the “gay vote” in 2024, despite evidence showing otherwise.

While appearing by phone on Fox News’s panel show “The Five” on Thursday, Trump falsely claimed he performed particularly well among gay voters while discussing the ongoing war in Iran — a conflict he initiated without formal congressional approval.

“Now I think I did very well with the gay vote, OK? I even played the gay national anthem as my walk-off, OK?” Trump said on air.

“And I think it probably helped me. But I did great. No Republican’s ever gotten the gay vote like I did and I’m very proud of it, I think it’s great. Perhaps it’s because I’m from New York City, I don’t know…”

His claim contradicts 2024 polling from NBC News, which found that the GOP presidential ticket captured fewer than 1 in 5 LGBTQ male voters — a figure that may also include bisexual and transgender men. Trump’s support among LGBTQ female voters was even lower, at just 8%.

White LGBTQ voters favored Vice President Kamala Harris over Trump by a margin of 82% to 16%, while LGBTQ voters of color backed Harris by an even wider 91% to 5%.

Trump also used the appearance to criticize “Gays for Palestine,” saying: “Look at ‘Gays for Palestine’… they kill gays, they kill them instantly, they throw them off buildings, and I’m saying, ‘Who are the gays for Palestine?’”

He further pointed to his campaign’s use of the song “Y.M.C.A.” by the Village People — which he has repeatedly described as a “gay national anthem” — noting that it was frequently used as a walk-off song at rallies, as an indication that he and his campaign were supported by the gay community. The track, long associated with camp and hyper-masculine gay imagery, became a staple of Trump campaign events.

The Village People were later booked to perform at Turning Point USA’s inaugural ball celebrating Trump’s second inauguration. Lead singer Victor Willis previously criticized Trump’s use of the song dating back to 2020 and considered legal action to block it, but ultimately said there was “not much he can do about it.” He later acknowledged the renewed exposure was “beneficial” and “good for business,” boosting the song’s popularity and chart performance.

Despite Trump’s claims of strong support from gay voters, polling has consistently shown otherwise — even as several prominent gay men have held roles in or around his orbit, sometimes dubbed the “A-gays.” These include Richard Grenell, former executive director of the Kennedy Center and Special Presidential Envoy for Special Missions; Treasury Secretary Scott Bessent; Under Secretary of State Jacob Helberg; Department of Energy official Charles T. Moran; and longtime supporter Peter Thiel, co-founder and CEO of Palantir.

His efforts to portray himself as aligned with the gay community stand in conflict with policies advanced under his leadership. These include removing LGBTQ-related data from State Department reports, attempting to narrowly redefine gender identity in federal policy, restricting access to gender-affirming health care, and rolling back anti-discrimination protections. His administration also rescinded initiatives focused on LGBTQ health equity, data collection, and nondiscrimination in health care and education — moves advocates say contribute to stigma and worsen mental health outcomes.

Additionally, some HIV programs and community health centers have lost funding from the federal government after supporting initiatives inclusive of transgender people as a direct result of Trump-Vance policies.

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Anti-trans visa ruling echoes Nazi regime destroying trans documents

Trump administration escalates attacks on queer community

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The Trump administration has moved from identifying trans people as as threat to the family to claiming that trans people are a threat to the spiritual health of the nation. (Washington Blade photo by Michael Key)

The Lemkin Institute for Genocide Prevention and Human Security earlier this month released its third Red Flag Alert for the United States about the Trump administration’s anti-trans legislation. As the Lemkin Institute shared in the press release, “the Administration has moved from identifying transgender people as as threat to the family and to the nation’s military prowess to claiming that transgender people constitute a cosmic threat to the spiritual health of the nation and the great direct threat to the US national security in the world.”

The news came the same day that the State Department issued a new rule, “Enhancing Vetting and Combatting Fraud in the Immigrant Visa Program.” Under this new guidance, all visa applicants are required to disclose their “biological sex at birth” during all stages of the process, “even if that differs from the sex listed on the applicant’s foreign passport or identifying documentation.” 

This rule also orders that applicants to the green card lottery program share their passport information, so in knowingly collecting passport information that the agency knows will not match a person’s biological sex at birth, it’s creating grounds to deny trans peoples’ biases on the basis of “fraud,” Aleksandra Vaca of Transitics explains.

As is written in the new ruling, “the Department is replacing ‘gender’ with ‘sex’ in accordance with E.O. 14168, Defending Women From Gender Ideology Extremism and Restoring Biological Truth to the Federal Government, which provides that the term ‘sex’ shall refer to an individual’s sex at birth. Only male and female sex options are available for entrants completing the Diversity Visa entry form.” 

Along with outright denying the existence of nonbinary, genderqueer and gender expansive people, this policy creates a precedence for trans people to be stripped of their visas and deported because under 8 U.S.C. § 1182(a)(6)(C)(i), any foreigner found to have obtained or possess a visa “by fraud or willfully misrepresenting a material fact” will have their visa revoked and face deportation. 

By requesting information on “biological sex at birth,” the State Department is forcing a mismatch between documents and enabling officials to accuse trans, nonbinary, and gender expansive immigrants of fraud. Thus, trans and nonbinary immigrants can have their visas revoked and can be deported, and information gathered from immigrants during the visa request process can be added to federal databases and used by immigration authorities, including ICE agents. 

With the Supreme Court’s decision this past year allowing ICE officers to use racial profiling, Vaca argues that “now, The Trump administration has given ICE the reason it needs. Under this rule, ICE agents now have the enforcement rationale to assert that trans people–especially those belonging to racial minority groups–are more likely than cis people to have ‘misrepresented’ themselves during the visa process, and therefore, are more likely to enter the country ‘unlawfully.’”

This would enable ICE agents to target trans individuals specifically for being trans. If the goal of this were unclear, a day later the Trump administration released its statement for Women’s History Month 2026, writing that “we are keeping men out of women’s sports, enforcing Title IX as it was originally written and ensuring colleges preserve–and, where possible, expand–scholarships and roster opportunities for female athletes. We are restoring public safety and upholding the rule of law in every city so women, children, and families can feel safe and secure.”

And this is not the first time that ICE has targeted and harmed trans and nonbinary immigrants. Last June, Vera reported that ICE is not including trans people in detection in their public reports, and back in 2020, AFSC reported that trans people held in ICE detention faced “dreadful, ugly” conditions. 

While it seems like a new development in Trump’s anti-trans escalation, it echoes a deeply upsetting history of denying and destroying transgender people’s documents following members of the Nazi party seizing power in 1933. 

In the early 20th century, Weimar, Germany was an epicenter for gender affirming care with Maganus Hirschfeld’s Institute for Sexual Science. One of the first book burnings of the rising Nazi regime destroyed the Institute’s extensive clinical records and library on trans health and history by Nazi students and stormtroopers. In doing so, the Nazis effectively destroyed the world’s first trans health clinic and one of the richest and most comprehensive collective of information about trans healthcare. 

Similarly, the Nazi government invalidated or refused to recognize what was called “transvestite passes,” or passing certificates that allowed trans people to avoid arrest under Paragraph 175 which prohibited cross-dressing. During the Weimar Republic — the regime that preceded the Third Reich — recognized and affirmed the identities of trans people (in limited ways) with specific documentation that helped prevent them from arrest. Invalidating and disregarding these passes allowed police and Nazi officials to target trans people and harass, extort and arrest them, and the record of passes themselves helped officials target trans people. 

The changes to visa guidelines — alongside Kansas’s move to revoke trans drivers’ licenses last month — is reflective of this escalation of violence against trans people during the Nazi’s rise to power, which scholars like Dr. Laurie Marhoefer is just beginning to uncover. And along with the revocation of identification documents this past week, a recent Fourth Circuit Court ruled that states can deny Medicaid coverage for gender-affirming surgery.

The Fourth Circuit Court decision affirmed the Supreme Court’s decision in Skrmetti, which ruled that bans on gender affirming healthcare for young people are constitutional. This ruling extends this ban to include adult healthcare bans, allowing West Virginia’s exclusion of Medicaid coverage for adult gender affirming healthcare to take full effect. Even more upsetting was what the ruling itself said, calling gender affirming healthcare “dangerous.” 

As was written in the Fourth Circuit Opinion, “it’s not irrational for a legislature to encourage citizens ‘to appreciate their sex’ and not ‘become disdainful of their sex’ by refusing to fund experimental procedures that may have the opposite effect.” 

In reality, what this ruling and the opinion reflect, is the next step in government regulation and oversight over marginalized peoples’ bodies. From the overturn of Roe v. Wade, which removed federal protection of access to abortion, this next step represents the denial of people’s access to vital, lifesaving care–and to be clear, gender affirming care is not just for trans, nonbinary, and intersex people. It’s a dangerous escalation and one that echoes previous violence against trans people under fascist regimes; the Lemkin Institute is right to raise concern.

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