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.
South Carolina
Man faces first S.C. ‘hate intimidation’ charge
Timothy Truett allegedly shot at gay club in Myrtle Beach on April 1
A South Carolina man remains in custody on a more than $300,000 bond after he allegedly opened fire at a Myrtle Beach nightclub on April 1, according to WMBF.
Reports say 37-year-old Timothy James Truett Jr., of Clover, S.C., was detained by the Myrtle Beach Police Department after the April 1 incident outside Pulse Ultra Club. He was later arrested and charged with possession of a weapon during a violent crime, discharging a firearm into a dwelling, discharging a firearm within city limits, malicious injury to real property valued over $5,000, and assault or intimidation due to political opinions or the exercise of civil rights.
At 10:57 a.m. on April 1, officers responded to a call about a possible shooting at Pulse Ultra Club, located in the 2700 block of South Kings Highway.
In an affidavit released later, the club’s owner, Ken Phillips, said he was doing paperwork that morning when he heard “five or six” gunshots. He went outside and found a window and the windshield of his SUV shattered by bullets. An SUV with blue plastic covering one window was left at the scene.
Police later reviewed footage that showed a silver vehicle stopping in the middle of the road. The video appeared to capture muzzle flashes coming from the passenger-side window.
According to the affidavit, an officer later pulled over a vehicle driven by Truett and found spent shell casings in the back seat, along with a gun.
Documents do not detail why Truett was ultimately charged under the state law covering assault or intimidation tied to political opinions or the exercise of civil rights.
As of April 1, records show Truett is being held in Horry County on a combined bond of more than $312,000.
WMBF spoke with Phillips after the incident and asked whether there was any prior conflict that might have led to the shooting.
“I don’t know if it’s personal, I don’t know if it’s related to being gay, I don’t know if it’s related to the bar issues,” Phillips told WMBF. “Anybody with a mindset of pulling out a weapon in broad daylight is not right.”
“My primary concern has and always will be the safety of my community and my customers,” he added. “It’s given me great concern … as to how far people will go.”
WMBF also spoke with Adam Hayes, vice chair of Myrtle Beach’s Human Rights Coalition, who was involved in pushing for the ordinance. He said that while the incident itself is troubling, it shows the policy is being put to use.
The ordinance is intended to deter “crimes that are motivated by bias or hate towards any person or persons, in whole or in part, because of the actual or perceived” identity, in the absence of a statewide hate crime law.
“It’s nice to see that something we put into policy is not just a piece of paper, that it’s actually being used,” said Hayes.
He said the shooting underscores the need for a statewide hate crime law in South Carolina and added that the incident has left the local LGBTQ community shaken.
South Carolina and Wyoming are the only two states in the U.S. without a comprehensive statewide hate crime law.
Truett remains in jail as of publication.
The White House
Trump budget would codify expanded global gag rule
Funding for LGBTQ health programs around the world would also be cut
The Trump-Vance administration’s fiscal year 2027 budget would codify the expanded global gag rule and eliminate funding for LGBTQ-specific programs in global health initiatives.
“The budget would ensure no funding supports abortion, unfettered access to birth control, and also eliminates funding for circumcision and lesbian, gay, bisexual, transgender, and queer services to better focus funds on life-saving assistance,” reads the proposed budget the White House released on April 3. “The United States should not pay for the world’s birth control and therapy.”
The proposed budget includes four examples of “eliminated activities.”
- In the last administration, PEPFAR funded health workers who performed over 21 abortions in Mozambique
- Promoting reproductive health education and access to birth control and other harmful programs couched under ‘family planning’ in Ghana
- A supply chain “control tower” to provide a “holistic commercial of the shelf solution” on the Office of Population and Reproductive Health (PRH)
- Promoting health equity and providing condoms and contraception in Kenya.
President Ronald Reagan in 1985 implemented the global gag rule, also known as the “Mexico City” policy, which bans U.S. foreign aid for groups that support abortion and/or offer abortion-related services.
Trump reinstated the rule during his first administration. The Biden-Harris administration shortly after it took office in January 2021 rescinded it.
The Trump-Vance White House earlier this year expanded the global gag rule to ban U.S. foreign aid for groups that promote “gender ideology.” The expansion took effect on Feb. 26.
US funding cuts have devastated global LGBTQ rights movement
The Trump-Vance administration after it took office in January 2025 moved to dismantle the U.S. Agency for International Development, which funded LGBTQ and intersex rights groups around the world. USAID officially shut down on July 1, 2025.
Secretary of State Marco Rubio in March 2025 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 these 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.
The Trump-Vance administration has signed healthcare-specific agreements with Kenya, Uganda, and other African countries through its American First Global Health Strategy. Advocacy groups with whom the Blade has spoken have expressed concern these partnerships will result in further exclusion and government-sanctioned discrimination based on sexual orientation or gender identity.
The proposed fiscal year 2027 budget includes $5.1 billion for “global health to end the previous administration’s abuse of these programs and to execute (the State Department’s) newly released America First Global Health Strategy.” This figure represents a $4.3 billion cut from the previous year.
“The president’s new vision of bilateral health assistance eliminates bloated Beltway Bandit contracts, does more with fewer dollars, and transitions recipient countries to self-reliance,” reads the proposed budget. “The budget would also eliminate disease-specific accounts and provide the department crucial agility to address the actual needs of each recipient country — across HIV/AIDS and other infectious diseases such as malaria, tuberculosis, and polio — to strengthen global health security and protect Americans from disease.”
“The budget would focus on new compacts that unify funding, achieving economies of scale in both implementation and oversight,” it adds. “Under the prior administration, only about 40 percent of PEPFAR funds supported actual service delivery, including medications, testing, commodities, and health workers, with the remaining 60 percent wasted on duplicative administrative costs, unwieldy supply chains, and layers of endless bureaucracy. The new AFGHS (America First Global Health Strategy) compacts would improve efficiency, cut red tape, and dismantle the bloated ecosystem of foreign assistance profiteers.”
The Council for Global Equality on April 3 reiterated its criticism of the expanded global gag rule, and urged Congress to reject the proposed budget.
“We won’t mince words: people are dying because of this policy,” said the Council for Global Equality in a statement. “Making this policy permanent will only ensure that U.S. foreign assistance discriminates against those who need services the most, all while forcing people around the world to adhere to the Trump administration’s extremist, ideological agenda that denies the very existence of transgender, nonbinary, and intersex persons.”
“We will not be silent as Trump threatens to upend decades of bipartisan foreign assistance programs to appease his extremist base,” added the group. “We call on Congress to immediately reject this budget and block implementation of the expanded global gag rules.”
Vice President JD Vance and his wife, second lady Usha Vance, will visit Hungary next week.
An announcement the White House released on Thursday said the Vances will be in Budapest, the Hungarian capital, from April 7-8.
JD Vance “will hold bilateral meetings with” Hungarian Prime Minister Viktor Orbán. The announcement further indicates the vice president “will also deliver remarks on the rich partnership between the United States and Hungary.”
The Vances will travel to Hungary less than a week before the country’s parliamentary elections take place on April 12.
Orbán, who has been in office since 2010, and his Fidesz-KDNP coalition government have faced widespread criticism over its anti-LGBTQ crackdown.
The Associated Press notes polls indicate Orbán is trailing Péter Magyar and his center-right Tisza party.
Police mental health struggles gain growing attention
Man faces first S.C. ‘hate intimidation’ charge
Trump budget would codify expanded global gag rule
D.C. is the place for the Democratic Socialists of America
Key lifestyle changes can help patients cope with diabetes
VIDEO: Gay journalist detained for booing Trumps at ‘Chicago’ opening night
Trans-driven ‘Serpent’s Skin’ delivers campy sapphic horror
D.C. not the place for antisemitic Democratic Socialists of America
Pam Bondi ousted as attorney general
Idaho Gov. signs harshest anti-trans bathroom bill in the country
-
The White House4 days agoVIDEO: Gay journalist detained for booing Trumps at ‘Chicago’ opening night
-
Movies4 days ago
Trans-driven ‘Serpent’s Skin’ delivers campy sapphic horror
-
Opinions4 days ago
D.C. not the place for antisemitic Democratic Socialists of America
-
The White House4 days ago
Pam Bondi ousted as attorney general
