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.
National
Top 10 LGBTQ national news stories of 2025
Trump, Supreme Court mount cruel attacks against trans community
President Trump’s anti-LGBTQ agenda dominated national news in 2025, particularly his cruel attacks on trans Americans. Here are our picks for the top 10 LGBTQ news stories the Blade covered in 2025.
10. Trump grants clemency to George Santos
President Donald Trump granted clemency to disgraced former Long Island Rep. George Santos. Santos was sentenced to 87 months in federal prison after pleading guilty to wire fraud and aggravated identity theft and had served just 84 days of his more than seven-year sentence. He lied to both the DOJ and the House Ethics Committee, including about his work and education history, and committed campaign finance fraud.
9. U.S. Olympics bans trans women athletes
The United States Supreme Court decided in 2025 to take up two cases — Little v. Hecox and West Virginia v. B.P.J.— both of which concern the rights of transgender athletes to participate on sports teams. The cases challenge state laws under the Equal Protection Clause of the 14th Amendment, which prevents states from offering separate boys’ and girls’ sports teams based on biological sex determined at birth. Both cases are set to be heard in January 2026. The developments follow a decision by the United States Olympic & Paralympic Committee to change eligibility rules to prohibit transgender women from competing in women’s sporting events on behalf of the United States, following Trump’s Executive Order 14201, “Keeping Men Out of Women’s Sports.”
8. FDA approves new twice-yearly HIV prevention drug
The U.S. Food and Drug Administration on June 18 approved a newly developed HIV/AIDS prevention drug that needs to be taken only twice a year, with one injection every six months. The new drug, lenacapavir, is being sold under the brand name Yeztugo by pharmaceutical company Gilead Sciences. According to trial data, 99.9 percent of participants who received Yeztugo remained HIV negative. This emerging technology comes amid direct cuts to HIV/AIDS research measures by the Trump–Vance administration, particularly targeting international HIV efforts such as PEPFAR.
7. LGBTQ people ‘erased’ from gov’t reports
Politico reported in March that the Trump–Vance administration is slashing the State Department’s annual human rights report, cutting sections related to the rights of women, people with disabilities, the LGBTQ+ community, and more. Members of Congress objected to the removal of the subsection on “Acts of Violence, Criminalization, and Other Abuses Based on Sexual Orientation, Gender Identity or Expression, or Sex Characteristics (SOGIESC)” from the State Department’s Annual Country Reports on Human Rights Practices.
In a Sept. 9 letter to Secretary of State Marco Rubio, U.S. Reps. Robert Garcia (D-Calif.), Julie Johnson (D-Texas), and Sarah McBride (D-Del.) urged the department to restore the information or ensure it is integrated throughout each report, noting that the reports serve as key evidence for asylum seekers, attorneys, judges, and advocates assessing human rights conditions and protection claims worldwide.
6. Trump admin redefines ‘sex’ in all HHS programs
The Trump administration canceled more than $800 million in research into the health of sexual and gender minority groups. More than half of the National Institutes of Health grants scrapped through early May involved studies of cancers and viruses that disproportionately affect LGBTQ people.
The administration is also pushing to end gender-affirming care for transgender youth, according to a new proposal from the Department of Health and Human Services, NPR reported. The administration is considering blocking all Medicaid and Medicare funding for services at hospitals that provide pediatric gender-affirming care. “These rules would be a significant escalation in the Trump administration’s attack on access to transgender health care,” said Katie Keith, director of the Center for Health Policy and Law at Georgetown University.
5. FBI plans to label trans people as ‘violent extremists’
The Human Rights Campaign, Transgender Law Center, Equality Federation, GLAAD, PFLAG, and the Southern Poverty Law Center condemned reports that the FBI, in coordination with the Heritage Foundation, may be working to designate transgender people as “violent extremists.” The concerns followed a report earlier this month by independent journalist Ken Klippenstein, who cited two anonymous national security officials saying the FBI is considering treating transgender subjects as a subset of a new threat category.
That classification—originally created under the Biden administration as “Anti-Authority and Anti-Government Violent Extremists” (AGAAVE) — was first applied to Jan. 6 rioters and other right-wing extremists. Advocates said the proposal appears to stem from the false claim that the assassination of Charlie Kirk was committed by a transgender person.
4. Pentagon targets LGBTQ service members
Acting in agreement with the growing anti-LGBTQ sentiment from the Trump administration, during a televised speech to U.S. military leaders at Marine Corps Base Quantico in late September, Defense Secretary Pete Hegseth denounced past military leadership for being too “woke,” citing DEI initiatives and LGBTQ inclusion within the Department of Defense. During the 45-minute address, Hegseth criticized inclusive policies and announced forthcoming directives, saying they would ensure combat requirements “return to the highest male standard only.”
Since 2016, a Navy replenishment oiler had borne the name of gay rights icon Harvey Milk, who served in the Navy during the Korean War and was separated from service under other than honorable conditions due to his sexuality before later becoming one of the first openly LGBTQ candidates elected to public office. In June 2025, the ship was renamed USNS Oscar V. Peterson.
The U.S. Air Force also announced that transgender service members who have served between 15 and 18 years would be denied early retirement and instead separated from the military without benefits. Transgender troops will be given the option of accepting a lump-sum payout offered to junior service members or being removed from service.
In February, the Pentagon said it would draft and submit procedures to identify transgender service members and begin discharging them from the military within 30 days.
3. Trump blames Democrats, trans people for gov’t shutdown
Republicans failed to reach an agreement with Democrats and blamed them for the government shutdown, while Democrats pointed to Republicans for cutting health care tax credits, a move they said would result in millions of people paying significantly higher monthly insurance premiums next year. In the White House press briefing room, a video of Democrats discussing past government shutdowns played on a loop as the president continued to blame the Democratic Party and “woke” issues, including transgender people.
“A lot of good can come from shutdowns. We can get rid of a lot of things. They’d be Democrat things,” Trump said the night before the shutdown. “They want open borders. Men playing in women’s sports. They want transgender for everybody.”
2. Supreme Court joins attacks on LGBTQ Americans
The U.S. Supreme Court issued multiple rulings this year affecting LGBTQ people. In Mahmoud v. Taylor (6–3), it ruled that public schools must give parents advance notice and the option to opt children out of lessons on gender or sexuality that conflict with their religious beliefs. The case arose after Montgomery County, Md., schools added LGBTQ-inclusive storybooks to the elementary curriculum.
In June, the court upheld Tennessee’s ban on gender-affirming care for transgender minors, protecting similar laws in more than 20 states. Lawmakers and advocates criticized the ruling, and a coalition of seven medical associations warned it strips families of the right to direct their own health care.
The Court also allowed the Trump administration to enforce a ban on transgender military personnel and to implement a policy blocking passports with “X” gender markers, with the federal government recognizing only male and female designations.
1. Trump inaugurated for second time
President Donald Trump became the 47th president after winning Wisconsin, securing 277 of the 270 electoral votes needed. His guidebook, Project 2025, outlined the Republican Party’s goals under his new leadership, with a particular focus on opposing transgender rights.
Trump nominated openly gay hedge fund executive Scott Bessent as U.S. Treasury Secretary, a role he eventually assumed. Bessent became the highest-ranking openly gay U.S. government official in American history.
Honorable mention: The war on rainbow crosswalks escalates around the country
Florida Gov. Ron DeSantis (R) ordered state transportation officials to remove a rainbow-colored crosswalk in Orlando next to the Pulse gay nightclub, where 49 mostly LGBTQ people were killed in a 2016 mass shooting. The move follows a July 1, 2025, announcement by U.S. Transportation Secretary Sean Duffy that, with support from President Trump, the department adopted a “nationwide roadway safety initiative” that political observers say could be used to require cities and states to remove rainbow street crosswalks.
Federal Government
Holiday week brings setbacks for Trump-Vance trans agenda
Federal courts begin to deliver end-of-year responses to lawsuits involving federal transgender healthcare policy.
While many Americans took the week of Christmas to rest and relax, LGBTQ politics in the U.S. continued to shift. This week’s short recap of federal updates highlights two major blows to the Trump-Vance administration’s efforts to restrict gender-affirming care for minors.
19 states sue RFK Jr. to end gender-affirming care ban
New York Attorney General Letitia James announced on Tuesday that the NYAG’s office, along with 18 other states (and the District of Columbia), filed a lawsuit to stop U.S. Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. from restricting gender-affirming care for minors.
In the press release, Attorney General James stressed that the push by the Trump-Vance administration’s crusade against the transgender community — specifically transgender youth — is a “clear overreach by the federal government” and relies on conservative and medically unvalidated practices to “punish providers who adhere to well-established, evidence-based care” that support gender-affirming care.
“At the core of this so-called declaration are real people: young people who need care, parents trying to support their children, and doctors who are simply following the best medical evidence available,” said Attorney General James. “Secretary Kennedy cannot unilaterally change medical standards by posting a document online, and no one should lose access to medically necessary health care because their federal government tried to interfere in decisions that belong in doctors’ offices. My office will always stand up for New Yorkers’ health, dignity, and right to make medical decisions free from intimidation.”
The lawsuit is a direct response to HHS’ Dec. 18 announcement that it will pursue regulatory changes that would make gender-affirming health care for transgender children more difficult, if not impossible, to access. It would also restrict federal funding for any hospital that does not comply with the directive. KFF, an independent source for health policy research, polling, and journalism, found that in 2023 federal funding covered nearly 45% of total spending on hospital care in the U.S.
The HHS directive stems directly from President Donald Trump’s Jan. 28 Executive Order, Protecting Children From Chemical and Surgical Mutilation, which formally establishes U.S. opposition to gender-affirming care and pledges to end federal funding for such treatments.
The American Medical Association, the nation’s largest and most influential physician organization, has repeatedly opposed measures like the one pushed by President Trump’s administration that restrict access to trans health care.
“The AMA supports public and private health insurance coverage for treatment of gender dysphoria and opposes the denial of health insurance based on sexual orientation or gender identity,” a statement on the AMA’s website reads. “Improving access to gender-affirming care is an important means of improving health outcomes for the transgender population.”
The lawsuit also names Oregon, Washington, California, Colorado, Connecticut, Delaware, the District of Columbia, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Mexico, Pennsylvania, Rhode Island, Vermont, and Wisconsin as having joined New York in the push against restricting gender-affirming care.
At the HHS news conference last Thursday, Jim O’Neill, deputy secretary of the department, asserted, “Men are men. Men can never become women. Women are women. Women can never become men.”
DOJ stopped from gaining health care records of trans youth
U.S. District Judge Cathy Bissoon blocked an attempt by the Department of Justice (DOJ) to gain “personally identifiable information about those minor transgender patients” from the University of Pittsburgh Medical Center (UPMC), saying the DOJ’s efforts “fly in the face of the Supreme Court.”
Journalist Chris Geidner originally reported the news on Dec. 25, highlighting that the Western District of Pennsylvania judge’s decision is a major blow to the Trump-Vance administration’s agenda to curtail transgender rights.
“[T]his Court joins the others in finding that the government’s demand for deeply private and personal patient information carries more than a whiff of ill intent,” Bissoon wrote in her ruling. “This is apparent from its rhetoric.”
Bissoon cited the DOJ’s “incendiary characterization” of trans youth care on the DOJ website as proof, which calls the practice politically motivated rather than medically sound and seeks to “…mutilate children in the service of a warped ideology.” This is despite the fact that a majority of gender-affirming care has nothing to do with surgery.
In United States v. Skrmetti, the Supreme Court ruled along party lines that states — namely Tennessee — have the right to pass legislation that can prohibit certain medical treatments for transgender minors, saying the law is not subject to heightened scrutiny under the Equal Protection Clause of the Fourteenth Amendment because it does not involve suspect categories like race, national origin, alienage, and religion, which would require the government to show the law serves a compelling interest and is narrowly tailored, sending decision-making power back to the states.
“The government cannot pick and choose the aspects of Skrmetti to honor, and which to ignore,” Judge Bissoon added.
The government argued unsuccessfully that the parents of the children whose records would have been made available to the DOJ “lacked standing” because the subpoena was directed at UPMC and that they did not respond in a timely manner. Bissoon rejected the timeliness argument in particular as “disingenuous.”
Bissoon, who was nominated to the bench by then-President Obama, is at least the fourth judge to reject the DOJ’s attempted intrusion into the health care of trans youth according to Geidner.
A Wider Bridge on Friday announced it will shut down at the end of the month.
The group that “mobilizes the LGBTQ community to fight antisemitism and support Israel and its LGBTQ community” in a letter to supporters said financial challenges prompted the decision.
“After 15 years of building bridges between LGBTQ communities in North America and Israel, A Wider Bridge has made the difficult decision to wind down operations as of Dec. 31, 2025,” it reads.
“This decision comes after challenging financial realities despite our best efforts to secure sustainable funding. We deeply appreciate our supporters and partners who made this work possible.”
Arthur Slepian founded A Wider Bridge in 2010.
The organization in 2016 organized a reception at the National LGBTQ Task Force’s Creating Change Conference in Chicago that was to have featured to Israeli activists. More than 200 people who protested against A Wider Bridge forced the event’s cancellation.
A Wider Bridge in 2024 urged the Capital Pride Alliance and other Pride organizers to ensure Jewish people can safely participate in their events in response to an increase in antisemitic attacks after Hamas militants attacked Israel on Oct. 7, 2023.
The Jewish Telegraphic Agency reported authorities in Vermont late last year charged Ethan Felson, who was A Wider Bridge’s then-executive director, with lewd and lascivious conduct after alleged sexual misconduct against a museum employee. Rabbi Denise Eger succeeded Felson as A Wider Bridge’s interim executive director.
A Wider Bridge in June honored U.S. Rep. Debbie Wasserman Schultz (D-Fla.) at its Pride event that took place at the Capital Jewish Museum in D.C. The event took place 15 days after a gunman killed two Israeli Embassy employees — Yaron Lischinsky and Sarah Milgrim — as they were leaving an event at the museum.
“Though we are winding down, this is not a time to back down. We recognize the deep importance of our mission and work amid attacks on Jewish people and LGBTQ people – and LGBTQ Jews at the intersection,” said A Wider Bridge in its letter. “Our board members remain committed to showing up in their individual capacities to represent queer Jews across diverse spaces — and we know our partners and supporters will continue to do the same.”
Editor’s note: Washington Blade International News Editor Michael K. Lavers traveled to Israel and Palestine with A Wider Bridge in 2016.
A pledge to keep fighting in 2026
Top 10 LGBTQ national news stories of 2025
Looking back at the 10 biggest A&E stories of 2025
Kazakh president signs anti-LGBTQ propaganda bill
Top 10 LGBTQ local news stories of 2025
Your guide to D.C.’s queer New Year’s Eve parties
Holiday week brings setbacks for Trump-Vance trans agenda
Out actor talks lead role in ‘Fiddler on the Roof’
This gay author sees dead people
