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.
New York
Gay ICE detainee freed after 150 days in detention
Cayman Islands native taken into custody before green card interview
Following nearly half a year in U.S. Immigration and Customs Enforcement detention, Allan Marrero has been released and is back home with his husband in New York.
Marrero spent 150 days in ICE custody, held in multiple detention centers across the U.S. after missing an immigration court hearing while in a rehabilitation program for alcohol addiction — a circumstance widely considered “good cause” for failing to appear.
The Washington Blade first reported on Marrero’s case in March after the Cayman Islands native was detained by ICE officers during what was supposed to be a routine marriage-based green card interview at 26 Federal Plaza in New York City.
Marrero had been married to his husband, Matthew Marrero, for two years at the time of the interview. But almost immediately, the experience turned hostile.
The Rev. Amanda Hambrick Ashcraft, a minister at Middle Church in Manhattan who accompanied the couple to provide spiritual support, later described the process as “dehumanizing” and “barbaric.”
During the interview, it became clear the couple was facing an uphill battle. At one point, when asked how they met, Matthew Marrero instinctively looked over at his husband and was “snapped at” and told not to look at him. As the interview continued, the outlook only grew more grim.
Unaware that he had a prior removal order tied to the missed court date while he was in rehab, Allan Marrero was detained on the spot.
Over the following months, Allan Marrero was transferred through multiple detention facilities, including centers in Arizona and Texas, the Everglades Detention Facility — also known as “Alligator Alcatraz,” which has been described as having “unsanitary inadequate conditions” — and ultimately a detention center in Mississippi.
While in custody, Allan Marrero was denied access to prescription medication and, according to advocates, was psychologically pressured by ICE agents to self-deport rather than remain detained while his legal case proceeded.
Although a judge later reopened his case and granted bond after Allan Marrero provided proof that he had been in rehab — a valid medical reason for missing his court date — ICE used procedural mechanisms to keep him detained. A separate judge later issued a ruling denying relief, leaving Allan Marrero in custody.
On the outside, Matthew Marrero said his life felt as though it had been put on pause so ICE could meet enforcement quotas.
“[It feels like] somebody came in and kidnapped someone close to you and took away all of your control and power,” Matthew Marrero told the Blade on March 7. “You shouldn’t be able to have this much control over somebody’s life, especially if they are trying to do the right thing … You’re not going after criminals, you’re not going after the worst of the worst. You’re trying to fill a quota.”
Alexandra Rizio, Allan Marrero’s attorney with Make the Road New York, a progressive grassroots immigrant-led organization, told the Blade that “there seems to be an underlying element of cruelty baked into not only this administration, but everything.”
“It didn’t have to go down that way,” Rizio continued. “If someone goes in for a green card interview and their marriage interview, and they learn that they have a removal order, what the USCIS officer could have done is say, ‘Look, you have a removal order in your name. You need to go hire an attorney right away to get this taken care of. I can’t adjudicate your green card…’ And if you hire a lawyer, you know, you might be able to get it straightened out. Of course, that’s not what happened. And so ICE, which was in the building, were called and they did arrest Allan.”
The Marreros are scheduled to hold a press conference on Tuesday at Middle Church, where Allan Marrero will speak publicly for the first time about his detention.
For additional information on the press conference please visit middlechurch.org.
Federal Government
Republicans attach five anti-LGBTQ riders to State Department funding bill
Spending package would restrict Pride flags on federal buildings, trans healthcare, LGBTQ envoys
As Congress finalizes its funding for fiscal year 2027, Republicans are attempting to include five anti-LGBTQ riders in the National Security and Department of State Appropriations Act.
A rider is an unrelated provision tacked onto a bill that must pass — in this instance, the bill provides funding for national security policy and for the State Department.
The riders range from restricting Pride flags in federal buildings to banning transgender healthcare, but all aim to limit the visibility and rights of LGBTQ Americans.
The five riders are:
Section 7067(a) prohibits Pride flags from being flown over federal buildings.
Section 7067(c) restricts the United States’ ability to appoint special envoys, representatives, or coordinators unless expressly authorized by Congress. These roles have historically been used to promote U.S. interests in international forums — including advancing human and LGBTQ and intersex rights and other policy priorities. The change would halt what the Congressional Equality Caucus describes as providing “critical expertise to U.S. foreign policy and leadership abroad.”
Section 7067(d) reinforces multiple anti-equality executive orders signed by President Donald Trump, effectively requiring that foreign assistance funded by the United States comply with those orders. This includes rescinding federal contractor nondiscrimination protections, including for LGBTQ people.
Section 7067(e) prohibits funding for any organization that provides or promotes medically necessary healthcare for trans people or “promotes transgenderism” — effectively banning funds for organizations that recognize trans people exist. This is despite the practice of gender-affirming care being supported by nearly every major medical association.
Section 7067(g) reinforces two global gag rules put forward by the Trump-Vance administration. One is the Trans Global Gag Rule, which prohibits foreign assistance funding for organizations that acknowledge the existence of trans people or advocate for nondiscrimination protections for them, among other activities. The second is the DEI Global Gag Rule, which prohibits foreign assistance funding for organizations that engage in efforts to address the ongoing effects of racism, sexism, and other forms of bigotry outside the United States.
The global gag rule has its roots in anti-abortion policy introduced by President Ronald Reagan in 1984, when the 40th president barred foreign organizations receiving U.S. global health assistance from providing information, referrals, or services for legal abortion, or from advocating for access to abortion services in their own countries. Planned Parenthood notes that the policy also affects programs beyond abortion, including efforts to expand access to contraception, prevent and treat HIV/AIDS, combat malaria, and improve maternal and child health.
If organizations funded by the State Department engage in these activities, they could lose funding.
This anti-LGBTQ push aligns with broader actions from the Trump-Vance administration since the start of Trump’s second term, which have focused on restricting human rights — particularly those of trans Americans.
The House Appropriations Committee is responsible for drafting the appropriations legislation. U.S. Rep. Tom Cole (R-Okla.) serves as chair, with U.S. Rep. Rosa DeLauro (D-Conn.) as ranking member. The committee includes 34 Republicans and 27 Democrats.
For FY27 appropriations, Congress is supposed to pass and have the president sign the funding bills by Sept. 30, 2026.
Noticias en Español
The university that refuses to let go
Joanna Cifredo is a trans woman participating in University of Puerto Rico strike
Over the past days, I have been walking with a question that refuses to leave me. Not the kind of question you answer from a desk or from a distance, but one that grows out of what you witness in real time, at the gates, in the faces of those who remain there without knowing how any of this will end. What is truly happening inside the University of Puerto Rico, and why have so many students decided to risk everything at a moment when they can least afford to lose anything.
I write as someone who lives just steps away from the Río Piedras campus. These days, the silence has replaced the constant movement that once defined this space. The absence is felt in every corner where students used to pass at all hours. Since arriving in Puerto Rico three years ago, I have come to know firsthand stories that rarely make it into reports or official statements. One of the reasons I chose to stay was precisely this, to serve the university community, to help create a space where students could find something as basic as a safe meal at night and, in some way, ease burdens that are often carried in silence.
I have listened, asked questions, and tried to understand without imposing answers. What I have found is not a collective outburst or a generational whim. What exists is a fracture, a deep break between those making decisions and those living with their consequences every single day.
There has been an effort to reduce this strike to an issue of order, scheduling, or academic disruption. Conversations revolve around missed classes, delayed semesters, and students supposedly unaware of the consequences of their actions. What is rarely addressed are the conditions that lead an entire student body to pause its own future to sustain a protest that offers no guarantees.
Because that is the reality. These are students who fully understand what they are risking, and yet they remain. When someone reaches that point, the least they deserve is not judgment, but to be heard.
From the outside, there have also been attempts to discredit what is happening. Familiar narratives are repeated, legitimacy is questioned, and doubt is cast over intentions. It is easier to do that than to acknowledge that this did not begin at the gates, but long before, in decisions made without building trust.
And something must be said clearly. This is not limited to the gates of Río Piedras. What we are witnessing extends across every unit of the University of Puerto Rico system. Mayagüez, Ponce, Arecibo, Bayamón, Cayey, Humacao, Carolina, Aguadilla, Utuado, and the Medical Sciences Campus. This is not an isolated reaction. It is a movement that runs through the entire institution. Río Piedras may be more visible, but it is not alone. What is happening there reflects a broader unrest felt across the system.
Within that context, one demand has grown increasingly present, the call for the resignation of University of Puerto Rico President Zayira Jordán Conde. This is not the voice of a small group. It reflects a deeper level of mistrust that has spread across multiple campuses.
The Puerto Rican Association of University Professors has also made it clear that this is not solely a student issue. There is real concern among faculty, and a shared recognition of the conditions currently shaping the university. When students and professors arrive at the same conclusion, the problem can no longer be minimized.
Meanwhile, the administration continues to speak in the language of dialogue. But dialogue is not a word, it is a practice. And when trust has been broken, it cannot be restored through statements alone, but through decisions that prove a willingness to truly listen.
In the midst of all of this, there are voices that cannot be ignored. Voices grounded not in theory, but in lived experience. One of them is Joanna Cifredo, a student at the Mayagüez campus, a young Puerto Rican trans woman, and someone widely recognized for her advocacy.
I spoke with her in recent days. What follows is her voice, exactly as it is.
How would you describe what is happening inside the University of Puerto Rico right now, beyond what people see from the outside?
Estamos viviendo momentos muy difíciles, en el sentido de que hay mucha incertidumbre y una presión constante por parte de la administración para reabrir el recinto, pero, entre todo el caos e inestabilidad provocado por las decisiones de esta administración, también hemos vivido momentos muy poderosos. Esta lucha ha sacado lo mejor de nuestra comunidad.
Lo vimos en las asambleas y plenos, donde 1,500, 1,700, hasta 1,800 estudiantes llegaron —bajo lluvia, bajo advertencias de inundaciones— y aun así se quedaron, participaron y votaron a favor de una manifestación indefinida hasta que se atiendan nuestros reclamos.
He conocido a tantas personas en los diferentes portones, estudiantes graduados, aletas, estudiantes de intercambio, estudiantes de todo tipo de concentraciones y se unieron para apoyar el movimiento estudiantil. Estudiantes que vienen a los portones después del trabajo o antes de trabajar. Estudiantes que vienen a dejar agua y suministros entre turnos de trabajo. Viejitos que vienen a los portones con desayuno, almuerzo o cena.
Más allá de lo que se ve desde afuera, lo que estamos viviendo es una mezcla de tensión y resistencia, pero también de comunidad, solidaridad y compromiso colectivo.
Much of what is discussed remains at the level of headlines or social media. From your direct experience, what specific decisions or actions from the administration have led to this level of mobilization?
Desde el inicio, la designación de la Dra. Zayira Jordán Conde careció de respaldo dentro de la comunidad universitaria. No contaba con experiencia administrativa en la UPR ni con un conocimiento básico de nuestros procesos, cultura y reglamentos. Por eso, en asamblea, el estudiantado votó para solicitarle a la Junta de Gobierno que no considerara su candidatura, y múltiples organizaciones docentes hicieron lo mismo. Existía un consenso amplio de que no tenía la experiencia necesaria para liderar una institución como la nuestra.
A pesar de ese rechazo claro, la Junta de Gobierno decidió ignorar los reclamos de la comunidad universitaria e imponer su nombramiento.
Una vez en el cargo, su estilo de gobernanza ha sido poco transparente y poco colaborativo. Sin embargo, el detonante principal de la movilización en el Recinto Universitario de Mayagüez fue su decisión de destituir, de manera unilateral y en medio del semestre, a cinco rectores, incluyendo al nuestro, el Dr. Agustín Rullán Toro, para reemplazarlo por un rector interino, el Dr. Miguel Muñoz Muñoz.
Esta acción, tomada de forma abrupta, provocó de inmediato un clima de caos e inestabilidad dentro de la institución. Y deja una pregunta inevitable: ¿no anticipó el impacto de esa decisión, lo que evidenciaría una falta de experiencia? ¿O lo anticipó y aun así decidió proceder? No está claro cuál de las dos es más preocupante.
Además, esta decisión tuvo consecuencias concretas para el estudiantado, incluyendo el retiro de becas educativas para nuevos integrantes del RUM por parte de la Fundación Ceiba, que calificó la movida como “sorprendente” y “preocupante”. Decisiones impulsivas como la que tomó la presidenta ponen en peligro la estabilidad de nuestra institución y la acreditación de la universidad.
As a trans woman within this movement, how does your identity intersect with what is happening, and why does this also shape the future of people like you?
Soy una de varias chicas trans que formamos parte activa de este movimiento estudiantil.
For those outside the UPR who believe this does not affect them, what are the real consequences of this crisis?
La Universidad de Puerto Rico se fundó para servir al pueblo.
It is impossible to overstate the role the University of Puerto Rico and its students have played in shaping the social, cultural, and economic life of this country. Its impact extends into science, medicine, and every profession that has sustained Puerto Rico over time. No other educational institution has contributed more.
After listening to her, one thing becomes undeniable. This is not just another protest, but a generation refusing to let go of what little remains within its reach. And when a generation reaches that point, the issue is no longer the strike, the issue becomes the country itself.
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