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.
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.
President Donald Trump removed Attorney General Pam Bondi from her post Thursday, following growing criticism over how she and the Department of Justice handled a range of issues, including matters related to sex offender and Trump ally Jeffrey Epstein.
Trump announced Bondi’s removal on Truth Social, where he also said Todd Blanche will serve as acting head of the Justice Department.
“Pam Bondi is a great American patriot and a loyal friend, who faithfully served as my attorney general over the past year,” Trump wrote on the platform. “Pam did a tremendous job overseeing a massive crackdown on crime across our country, with murders plummeting to their lowest level since 1900.”
Trump was seen as recently as Wednesday with the now-former attorney general at a Supreme Court hearing on citizenship.
The decision contrasts with Trump’s previous public praise of Bondi, the 87th U.S. attorney general and former 37th attorney general of Florida, who served in that role from 2011-2019 before joining the Trump-Vance administration. He has frequently lauded her loyalty and said he speaks with her often. Bondi was also one of president’s defense lawyers during his first impeachment trial.
Privately, however, Trump had grown frustrated that Bondi was not “moving quickly enough” to prosecute critics and political adversaries he wanted to face criminal charges, according to multiple sources. The New York Times reported that her inability to charge former FBI Director James B. Comey and New York Attorney General Letitia James with any crimes is a large factor in the president’s choice to fire her from the government’s primary law enforcement agency.
The move comes as Trump has sought to minimize public turmoil within his administration, avoiding the perception of a revolving-door Cabinet that defined his first term.
Lee Zeldin, a former Republican congressman from New York who unsuccessfully ran for governor, has emerged as a leading contender to lead the Justice Department. He has been one of Trump’s most reliable allies.
“He’s our secret weapon,” Trump said of Zeldin in February during a White House event promoting the coal industry, adding, “He’s getting those approvals done in record-setting time.”
Bondi has also growing faced scrutiny from Congress.
The House Oversight Committee recently subpoenaed her to testify about the department’s handling of certain files, where she declined to answer key questions during a contentious House Judiciary Committee hearing in February.
The Tampa native has a long history of opposing LGBTQ rights through her roles in government. As Florida attorney general, she fought against the legalization of same-sex marriage, arguing it would cause “serious public harm,” pushing forward a legal battle that cost taxpayers nearly half a million dollars. She also asked the Florida Supreme Court to overturn a lower court ruling that found the state’s same-sex marriage ban unconstitutional.
More recently, Bondi established a “Title IX Special Investigations Team” within the Justice Department focused on restricting transgender women and girls from participating in women’s and girls’ sports teams and accessing facilities aligned with their gender identity. She also told Children’s Hospital of Philadelphia to turn over the medical records of anyone under 19 who received gender-affirming care.
Her removal follows Trump’s decision last month to oust another controversial female Cabinet figure, Kristi Noem.
The White House
VIDEO: Gay journalist detained for booing Trumps at ‘Chicago’ opening night
Eugene Ramirez booed first family at Kennedy Center
President Donald Trump and first lady Melania Trump attended the opening night of “Chicago” at the John F. Kennedy Center for the Performing Arts on Tuesday. They were greeted by a mix of cheers, applause, and some audible boos.
Among them was Eugene Ramirez, a gay Washington resident, who later shared his account of the night after being briefly detained by security for booing the president and giving a thumbs-down gesture — an expression of what many would call a textbook definition of constitutionally protected speech to criticize the government.
Ramirez attended the opening night performance with a group of friends, hoping to catch a final show before the center undergoes two years of major changes under Trump oversight. The musical, based on a 1926 play of the same name, has become synonymous with Broadway success.
With music by John Kander, lyrics by Fred Ebb, and a book by Ebb and Bob Fosse, “Chicago” has cemented itself as a cultural staple — known for its signature Fosse choreography, stripped-down staging, and sleek, campy aesthetic. The story follows Roxie Hart and Velma Kelly, women who murder their husbands but — with the help of the manipulative, charismatic, and narcissistic attorney Billy Flynn — walk away scot-free.
It remains the longest-running American musical in Broadway history, and its 2002 film adaptation famously won the Academy Award for Best Picture. On this night, however, the production also became the backdrop for a very modern moment of political protest.
“I accompanied five friends to opening night of ‘Chicago’, as a way to enjoy a final performance in the Kennedy Center as we know it,” Ramirez began to recount to the Washington Blade, describing the moment his group settled into their seats inside the ornate Opera House theater.
Just before the performance began, the twice impeached president and first lady appeared in the balcony box, drawing immediate attention from the audience below. Theatergoers stood, cheered, clapped, and waved, while Ramirez made a different choice.
While accounts of the crowd’s reaction have varied, Ramirez said his response was intentional, immediate, and within his rights. Moments after booing and giving a thumbs-down while recording on his iPhone, security intervened.
The video of Ramirez booing the Trump’s is here:
“Within moments, the director [of security] and another guard approached and escorted me to a side area where several other security guards were waiting,” he said. “I was detained until everyone was seated and the lights dimmed.”
As he was escorted away, Ramirez said his instincts as a journalist kicked in. A former lead anchor for Sinclair’s national evening news broadcast, he said the situation immediately felt off — or more aptly put — as if he could see the strings being pulled from someone attempting to control the narrative.
“Journalism is a vocation, not just a job. I immediately knew there wasn’t just an uncomfortable interaction with security,” he said. “The Kennedy Center is a federally funded cultural institution, and being questioned about speech related to the president in that setting felt like something the public should know about.”
Ramirez explained the difference between a standard visit by a public official and this performance: the president’s appearance wasn’t just ceremonial; it was very clearly a media moment.
“The White House press pool was there, and it was clear this was an effort to manage the president’s image in the media,” Ramirez continued. “The irony was not lost on me that this was happening on opening night of ‘Chicago’, a musical about manipulating the press to shape public perception.”
According to Ramirez, the explanation he received from Kennedy Center Director of Safety and Security Karles C. Jackson Sr., was brief, but illuminating.
“He said, ‘they don’t want booing,’ and even called out my thumbs-down gesture. He never clarified who ‘they’ were, but whether it was the administration or the Kennedy Center, the distinction felt meaningless,” he explained. “Mr. Jackson ultimately told me he was just trying to do his job, shook my hand, and allowed me to return to my seat once the lights dimmed and the overture started playing.”
Ramirez said he didn’t blame the guard individually, noting the broader context of the Kennedy Center’s uncertain future and the pressures staff were under.
“With the center closing in the coming months, some of these security guards being pressured to restrict our freedom of speech may only have a few weeks of work left.”
He believes the decision to remove him was driven less by disruption than optics, particularly given the presence of the press.
“It was very clearly about protection — whether protecting the president from visible dissent, or his image before the media present. There was no disruption as almost everyone was standing and reacting loudly to the arrival of the president and first lady, with cheers, applause, and hand gestures. The difference was that my reaction, unlike most, was negative.”
Drawing on his experience covering public officials, Ramirez said the incident felt more about controlling perception than security.
“Usually, law enforcement may monitor or intervene if there’s a disruption, but here there was no disruption at all. Simply expressing dissent in a public, cultural space drew the attention of security. It made it feel less like a matter of decorum and more like an effort to control the narrative around the president,” he said. “It’s about what happens when dissent is treated as disruption rather than a right.”
“The show hadn’t started. I threatened no one. Billy Flynn would have approved of the optics. The rest of us should be paying attention.”
Ramirez framed the incident as part of a broader constitutional concern, one that is plaguing the Trump-Vance administration as they continue to reject rules and normalcy set forth by other reserved presidents.
“Being singled out by security at a federally funded institution for expressing dissent shouldn’t be brushed off; it undermines the First Amendment,” he said, looking at it slightly distanced from it now. “Being of Cuban heritage, and a journalist, it’s a right I’m not willing to give up readily.”
“Publicly funded cultural institutions should allow visible dissent, even in politically charged moments,” he added. “Of course, I understand the need to manage disruptions during a performance, but that was not the case here.”
The themes of “Chicago”, a long-running satire about media manipulation and public perception, added another layer of irony to the experience, Ramirez explained.
“The satire truly leapt off the stage! A show about controlling the narrative, manipulating the press, and covering up truths by leaning on showmanship and distractions. The show is decades old, but could’ve been written today. We’re being razzle-dazzled daily and it’s getting harder to tell fact from fiction, no matter where you get your news.”
He, being gay, also acknowledged how hard it must have been for the performers on stage, assuming that at least some in the cast were also members of the LGBTQ community — and artists — two things Trump doesn’t always get along with.
“It was not lost on me that many of the actors on that stage, that the president and first lady presumably applauded, are members of the LGBTQ community which this administration has rolled back protections for under the guise of religious liberty and free speech, resulting in blatant discrimination.”
He pointed to a particular number that felt surreal given the circumstances.
“Its ‘Razzle Dazzle’ number celebrates keeping audiences off balance; at its climax, a massive American flag descends as the song celebrates blinding audiences to what is real. Watching that scene after being detained for a thumbs-down was surreal.”
Ramirez said the show’s closing lines were especially sharp given the presidential audience and what he just experienced.
“At the end of the show,
Velma says: ‘You know, a lot of people have lost faith in America.’
Roxie replies: ‘And for what America stands for.’
Velma: ‘But we are the living examples of what a wonderful country this is.’
Roxie: ‘So we’d just like to say thank you and God bless you.’
They had both just gotten away with murder!”
His closing lines, however, were a bit more pointed than “scintillating sinners” Roxie Hart and Velma Kelly’s were in the show.
“Democracy only works when citizens are allowed to boo,” he said. “Tuesday night at the Kennedy Center, ‘Chicago’ made that point better than I ever could.”
The Blade reached out to the Kennedy Center but did not receive a comment back.
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