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
Demonstrators disrupt OMB director hearing over PEPFAR
Capitol Police arrested five protesters
A group of protesters interrupted Office of Management and Budget Director Russell Vought during his testimony before Congress on Wednesday.
Vought was at the Cannon House Office Building to give testimony to the House Budget Committee.
Committee Chair Jodey Arrington (R-Texas) began the hearing by touting what he described as economic accomplishments of the Trump-Vance administration’s economic accomplishments. Ranking Member Brendan Boyle (D-Pa.) disputed those claims in his opening statement.
Boyle went on to admonish Vought for not attending a committee hearing in the previous year.
Vought, the “Project 2025” architect, was invited to speak after Arrington and Boyle made their statements.
Shortly after Vought began reading his statement, Housing Works CEO Charles King stood up in the gallery and began shouting, “PEPFAR saves lives: spend the money!”
The U.S. Capitol Police moved quickly to escort King from the room. Other activists began chanting with King as they unfolded signs bearing a picture of Vought’s face and statements such as, “Vought’s cuts kill people with AIDS,” and “Protect PEPFAR from Vought.”
The group of HIV/AIDS activists included independent activists, former U.S. Agency for International Development and PEPFAR staff, members of Health GAP, Housing Works, and the Treatment Action Group. Six activists were escorted from the hearing and the U.S. Capitol Police detained five of them.
The HIV/AIDS treatment activists protested at the hearing in response to the dismantling of global health programs, including PEPFAR, a federally-funded program credited with saving millions of lives from HIV/AIDS, particularly in sub-Saharan Africa.
“Russell Vought is directly responsible for illegally withholding Congressionally appropriated funds for PEPFAR and related global health initiative,” King said in a statement provided to the Washington Blade. “These funding disruptions have already contributed to preventable deaths and threaten to reverse decades of progress in the fight against HIV worldwide. Enough is enough. Congress must ensure Vought stops this deadly sabotage.”
National
HIV/AIDS group NMAC is ‘destabilized’ and in financial crisis: sources
Organization disputes allegations of mismanagement by new CEO
A statement sent to the Washington Blade by an anonymous source claiming to be a current staff member at NMAC, formerly known as the National Minority AIDS Council, alleges that the prominent HIV/AIDS advocacy organization is facing “a rapid and systemic collapse of leadership, governance, and ethical standards.”
The three-page detailed statement sent on April 4 by someone identifying himself only as “John Doe” includes multiple specific allegations that NMAC CEO Harold Phillips, who began his position in October 2025, “has destabilized the organization at every level,” including hiring nine new high-level appointees with salaries of $220,000 each who are performing “duplicative and unjustifiable roles.”
The Blade was able to corroborate some of the allegations by talking to two other knowledgable sources who spoke on condition of anonymity. Those sources said they had received the John Doe statement and believed many, if not most, of its allegations were accurate.
With a total staff of about 30 to 35 employees, the John Doe statement claims the high salaries of the nine new staff members have added to financial problems NMAC has been facing in recent years. It says that at least two NMAC staffers who raised concerns about Phillips’s actions were terminated on grounds of insubordination.
One of the two anonymous sources who spoke to the Blade said one of the dismissed staff members was considering filing a lawsuit against NMAC in response to the firing.
“An external firm was recently brought in to assess the organizational health,” the John Doe statement to the Blade says. “The findings were staggering — more than 50% of staff reported they are actively seeking employment elsewhere,” it says.
The Blade sent the John Doe statement to NMAC this week and asked for a response to the allegations.
NMAC spokesperson Jennifer Moore Phillips, who serves as chief strategy officer and who is not related to Harold Phillips, sent the Blade a short statement calling the John Doe allegations “false and purposefully misleading,” but which did not comment on each of the specific allegations.
“A recent anonymous letter containing unfounded allegations about NMAC makes claims that are simply false and purposefully misleading,” the NMAC statement says. “Evidenced by our new strategic plan and recent successful Biomedical HIV Prevention Summit in Chicago, NMAC’s new leadership is laser focused on delivering on our mission serving the HIV community with renewed energy and vision,” the statement concludes.
The Biomedical HIV Prevention Summit referred to in the statement, which took place in Chicago April 8-10 of this year, is one of the two largest HIV/AIDS related conferences that NMAC organizes each year. Jennifer Phillips said more than 1,400 people attended the event.
The largest NMAC event, the United States Conference on HIV/AIDS, the most recent of which was held in D.C. Sept. 4-7, drew more than 2,400 participants and was hailed by AIDS activists as a highly successful gathering of a diverse group of experts seeking to push for the end to the HIV/AIDS epidemic.
One of the keynote speakers at that conference was Paul Kawata, who served as executive director and CEO of NMAC for 36 years and who delivered his farewell address at the conference following the announcement that he would retire on Oct. 7, 2025.
Many of the conference speakers praised Kawata, who became NMAC’s leader two years after its founding in 1987, as the leading force behind its growth and evolution into one of the nation’s leading HIV/AIDS advocacy organizations with a special outreach to people of color.
It was at that time that Harold Phillips, who served as director of the White House Office of AIDS Policy under then-President Joe Biden and who later joined NMAC as deputy director before the NMAC board named him Kawata’s successor as CEO, emerged as NMAC’s next leader.
“The Board has exuberantly elected Harold Phillips as our new CEO,” said Lance Toma, chair of the NMAC Board of Directors at the time Phillips’s appointment was announced. “In this unprecedented moment, there is no one more strategically positioned and experienced to lead our movement through what we know will be some of the most tumultuous and complicated times ahead,” the statement said.
The John Doe statement raising questions about Phillips’s actions and leadership says NMAC staff members formally appealed to the board of directors to intervene.
“The Board has remained silent, while Harold arrogantly told the staff that ‘the board has my back,’” the statement says.
The Blade has also attempted to reach out to Kawata by email for comment on how he feels NMAC is doing six months after his retirement. As of April 14, Kawata had not responded to the Blade’s inquiry.
According to the John Doe statement, NMAC officials have recently “sought external financial rescue,” including a visit by an NMAC official to California to request assistance from the pharmaceutical company Gilead Sciences. “Without such intervention, layoffs seem imminent,” the statement says.
“This is not a functioning nonprofit,” the John Doe statement concludes. “It is an organization in crisis – bleeding resources, hemorrhaging staff, and operating without transparency, accountability, or governance,” it says, adding, “The communities NMAC serves, the donors who fund its mission, and the public at large deserve to know what is happening behind closed doors.”
By contrast, the NMAC website describes the organization as a highly functioning nonprofit continuing to lead the fight against HIV/AIDS.
“Launched in 1987 during the early years of the HIV/AIDS crisis in the United States, NMAC is a national HIV organization that offers capacity building, leadership development, policy education, and public engagement to end the HIV epidemic among communities most impacted in the United States,” a statement on the NMAC website says.
“In 2026, we mark 45 years of the HIV movement,” the statement adds. “NMAC continues to pivot to center the needs of people of color impacted by HIV by responding to political challenges that threaten federal funding and programs that have provided an essential survival safety net,” it says. “Simultaneously, as HIV treatment allows people to age with HIV, our whole-person approach extends to achieving optimal quality of life beyond attaining viral suppression.”
In its most recent action, NMAC issued a detailed press release on April 14 criticizing President Donald Trump’s proposed fiscal year 2027 budget provisions that call for cutting more than $1.5 billion in HIV prevention, substance use, housing and other programs. The release provides details on how the cuts would negatively impact important HIV prevention programs and urges Congress to reject the proposed cuts.
Federal Government
Inside the LGBTQ records of Todd Blanche and Markwayne Mullin
Two men are acting attorney general, DHS secretary
President Donald Trump became famous for his use of the phrase “You’re fired!” while hosting the reality TV show “The Apprentice” in the early 2000s. However, during his time in the Oval Office, he has attempted to distance himself from that image.
Despite those efforts, the phrase once again comes to mind as Trump has fired two high-level female Cabinet members within the past month: Pam Bondi and Kristi Noem.
Their replacements — Todd Blanche at the Justice Department and Markwayne Mullin at the Department of Homeland Security — bring records that, while different in depth, both reflect limited support for LGBTQ protections and, in some cases, direct opposition.
Todd Blanche
Acting attorney general
Little has been found regarding Todd Blanche’s LGBTQ history prior to his role as acting head of the Department of Justice. Unlike those who have worked within the Justice Department’s Civil Rights Division or served as state attorneys general, he has not developed a public-facing legal ideology on LGBTQ issues.
Blanche attended American University for his undergraduate studies — like fellow Trump attorney Michael Cohen — where he met his future wife, Kristin, who was studying at nearby Catholic University in D.C.
He began his legal career as an intern at the U.S. Attorney’s Office in Washington, which eventually became a full-time position. He later worked as a paralegal in the U.S. Attorney’s Office for the Southern District of New York while attending Brooklyn Law School at night. Blanche graduated cum laude in 2003. He and his wife later married and had two children.
Blanche left the U.S. attorney’s office in 2014, taking a job in the Manhattan office of the law firm WilmerHale. In September 2017, he moved to Cadwalader, Wickersham & Taft LLP, where he was a partner in the White Collar Defense and Investigations practice.
In his personal capacity, he represented several figures associated with Donald Trump and former New York City Mayor Rudy Giuliani, including Trump’s former campaign manager Paul Manafort, businessman Igor Fruman, and attorney Boris Epshteyn.
In 2024, Blanche switched from Democrat to Republican, aligning himself with Trump’s political orbit. He later served as Trump’s personal defense attorney in the New York State case that led to Trump’s 2024 conviction on 34 felony counts of falsifying business records to cover up hush-money payments to bisexual adult film star Stormy Daniels.
Now the highest-ranking official at the Justice Department, Blanche has played a central role in overseeing the department and has been involved in leadership decisions tied to several controversial actions affecting LGBTQ people.
In a letter to New York Attorney General Letitia James, Blanche declared that the Justice Department “will not sit idly by while you attempt to use your office to force harmful procedures on our most vulnerable population,” if legal action were taken against NYU Langone. The hospital had “permanently” ended a program earlier that month after the Trump-Vance administration threatened to pull all federal funding if it continued prescribing puberty blockers and hormones to minors.
Blanche wrote that “the Justice Department believes the law is clear, and anti-discrimination laws cannot be used to force NYU Langone to perform sex-rejecting procedures on children.”
“As just one example, your office’s position would require a hospital to prescribe certain medications for certain diagnoses, regardless of the hospital’s or its doctors’ independent medical determination about the propriety of such treatment,” he said.
Blanche also echoed his predecessor’s public stance on limiting LGBTQ-related protections at the federal level, aligning with Bondi’s sentiments in June 2025 regarding the U.S. Supreme Court’s 6–3 decision that restricted LGBTQ history lessions in schools and limits lower federal courts from issuing nationwide injunctions — rulings that have often blocked Trump administration policies.
Calling it “another great decision that came down today,” Blanche argued that the ruling “restores parents’ rights to decide their child’s education,” adding: “It seems like a basic idea, but it took the Supreme Court to set the record straight, and we thank them for that. And now that ruling allows parents to opt out of dangerous trans ideology and make the decisions for their children that they believe is correct.”
In December 2025, a Justice Department memo stated that, “effective immediately,” prisons and jails would no longer be held responsible for violations of standards meant to protect LGBTQ people from harassment, abuse, and rape under the Prison Rape Elimination Act. The law, passed unanimously by Congress in 2003, requires that incarcerated people be screened for their risk of sexual assault, including consideration of LGBTQ status, and applies to all correctional facilities.
Additionally, when the Justice Department, under Blanche’s deputy leadership and at Trump’s behest, attempted to force Children’s National Hospital in D.C. to turn over medical records related to gender-affirming care, U.S. District Judge Julie R. Rubin ruled that the effort “appears to have no purpose other than to intimidate and harass.”
Blanche is also described as having a “strong belief in executive authority.”
Markwayne Mullin
Secretary of Homeland Security
While Blanche’s record is defined more by recent actions than a long paper trail, Markwayne Mullin brings a more established history on LGBTQ issues from his time in Congress.
The head of the Department of Homeland Security has served in Congress since 2013, in both the U.S. House of Representatives and U.S. Senate. He has been actively engaged in shaping restrictions and aligns with broader cultural rhetoric that frames anti-LGBTQ speech as protected expression.
In May 2016, Mullin criticized the Department of Education and the Justice Department’s “Dear Colleague” letter on transgender students, arguing that trans girls should not use girls’ restrooms in public schools.
By January 2021, Mullin and then-Hawaii Congresswoman Tulsi Gabbard had introduced a bill to prevent trans women from participating in women’s sports.
Mullin was not recorded as voting on the final passage of the Respect for Marriage Act, which codified federal recognition of same-sex and interracial marriage.
In 2023, Mullin received a rating of just 6 percent from the Human Rights Campaign.
While serving in the Senate and as a member of the Health, Education, Labor, and Pensions (HELP) Committee, Mullin has been a vocal critic of policies aimed at expanding LGBTQ inclusion in federal programs. He has participated in broader Republican efforts questioning equity-based implementation of the Older Americans Act, including guidance related to sexual orientation and gender identity in aging services, arguing such policies could have unintended consequences.
Mullin also makes history as the first Native American — and a citizen of the Cherokee Nation — to lead the Department of Homeland Security.
He was among the 147 Republicans who voted to overturn the 2020 presidential election results despite no evidence of widespread fraud, and was present in the House on Jan. 6.
The Washington Blade reached out to DHS and the DOJ for comment on the two cabinet choices’ records on LGBTQ rights. DHS responded, telling the Blade, “Secretary Mullin’s record at the Department of Homeland Security will be one of protecting ALL Americans,” while the DOJ has yet to respond.
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