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
Pride flag raised at Stonewall after National Park Service took it down
‘Our flag represents dignity and human rights’
A Pride flag was raised at the site of the Stonewall National Monument days after a National Park Service directive banned flying the flag at the birthplace of the LGBTQ rights movement in the U.S.
The flag-raising was led by Manhattan Borough President Brad Hoylman-Sigal and supported by other elected officials.
“The community should rejoice. We have prevailed,” Hoylman-Sigal said shortly after the flag was hoisted. “Our flag represents dignity and human rights.”
The flag now sits in Christopher Street Park, feet away from the Stonewall Inn, where in 1969 a police raid of the gay bar sparked outrage and led to a rising of LGBTQ people pushing back on NYPD brutality and unjust treatment.
Elected officials brought a new flagpole with them, using plastic zip ties to attach it to the existing pole.
In 2016, President Barack Obama declared the site a national monument.
One day before the planned re-raising of the Pride flag, the National Park Service installed only an American flag on the flagpole, which days prior had flown a rainbow flag bearing the NPS logo.
The directive removing the flag was put forward by Trump-appointed National Park Service Acting Director Jessica Bowron.
This comes one day after more than 20 LGBTQ organizations from across the country co-signed a letter to Interior Secretary Doug Burgum and General Services Administrator Ed Forst, demanding the flag be restored to the monument.
“It is our understanding that the policy provides limited exceptions for non-agency flags that provide historical context or play a role in historic reenactments. Simply put, we urge you to grant this flag an exception and raise it once again, immediately,” the letter read. “It also serves as an important reminder to the 30+ million LGBTQ+ Americans, who continue to face disproportionate threats to our lives and our liberty, that the sites and symbols that tell our stories are worth honoring … However, given recent removals of the site’s references to transgender and bisexual people — people who irrefutably played a pivotal role in this history — it is clear that this is not about the preservation of the historical record.”
The letter finished with a message of resilience the LGBTQ community is known for: “The history and the legacy of Stonewall must live on. Our community cannot simply be erased with the removal of a flag. We will continue to stand up and fight to ensure that LGBTQ+ history should not only be protected — it should be celebrated as a milestone in American resilience and progress.”
When asked about the directive, the NPS responded with this statement:
“Current Department of the Interior policy provides that the National Park Service may only fly the U.S. flag, Department of the Interior flags, and the Prisoner of War/Missing in Action flag on flagpoles and public display points. The policy allows limited exceptions, permitting non-agency flags when they serve an official purpose. These include historical context or reenactments, current military branch flags, flags of federally recognized tribal nations affiliated with a park, flags at sites co-managed with other federal, state, or municipal partners, flags required for international park designations, and flags displayed under agreements with U.S. Citizenship and Immigration Services for Naturalization ceremonies.”
An Interior Department spokesperson on Thursday called the move to return the flag to the monument a “political stunt.”
“Today’s political pageantry shows how utterly incompetent and misaligned the New York City officials are with the problems their city is facing,” a department spokesperson said when reached for comment.
The clash comes amid broader efforts by the Trump-Vance administration to minimize LGBTQ history and political power. The White House has spent much of President Donald Trump’s second presidency restricting transgender rights — stopping gender-affirming care for transgender youth, issuing an executive order stating the federal government will recognize only two sexes, male and female, and blocking Medicaid and Medicare from being used for gender-affirming care.
State Department
FOIA lawsuit filed against State Department for PEPFAR records
Council for Global Equality, Physicians for Human Rights seeking data, documents
The Council for Global Equality and Physicians for Human Rights have filed a Freedom of Information Act lawsuit against the State Department for PEPFAR-related data and documents.
The groups, which Democracy Forward represents, filed the lawsuit in U.S. District Court for the Southern District of New York on Wednesday.
Then-President George W. Bush in 2003 signed legislation that created PEPFAR. UNAIDS Executive Director Winnie Byanyima last March said PEPFAR has saved 26 million lives around the world.
The Trump-Vance administration in January 2025 froze nearly all U.S. foreign aid spending for at least 90 days. Secretary of State Marco Rubio later issued a waiver that allowed PEPFAR and other “life-saving humanitarian assistance” programs to continue to operate during the freeze.
The Washington Blade has previously reported PEPFAR-funded programs in Kenya and other African countries have been forced to suspend services and even shut down because of gaps in U.S. funding. HIV/AIDS activists have also sharply criticized the Trump-Vance administration over reported plans it will not fully fund PEPFAR in the current fiscal year.
The lawsuit notes the Council for Global Equality and Physicians for Human Rights have “filed several FOIA requests” with the State Department for PEPFAR-related data and documents. The groups filed their most recent request on Jan. 30.
“On Jan. 30, 2026, plaintiffs, through counsel, sent State a letter asking it to commit to prompt production of the requested records,” reads the lawsuit. “State responded that the request was being processed but did not commit to any timeline for production.”
“Plaintiffs have received no subsequent communication from State regarding this FOIA request,” it notes.
“Transparency and inclusion have been hallmarks of PEPFAR’s success in the last decade,” said Beirne Roose-Snyder, a senior policy fellow at the Council for Global Equality, in a press release that announced the lawsuit. “This unprecedented withholding of data, and concurrent ideological misdirection of foreign assistance to exclude LGBTQI+ people and others who need inclusive programming, has potentially devastating and asymmetrical impacts on already marginalized communities.”
“This data is vital to understanding who’s getting access to care and who’s being left behind,” added Roose-Snyder.
“We filed this lawsuit to seek transparency: the administration’s PEPFAR data blackout withholds information the public, health providers, and affected communities need to track the HIV epidemic and prevent avoidable illness and death, obscuring the true human cost of these policy decisions,” said Physicians for Human Rights Research, Legal, and Advocacy Director Payal Shah.
The State Department has yet to respond to the Blade’s request for comment on the lawsuit.
New York
N.Y. lawmaker vows ‘Pride flag will fly again’ at Stonewall Monument
After a Jan. 21 policy shift, Pride flags were banned at national parks, prompting backlash from Bottcher and LGBTQ advocates.
Hours after news broke that the National Park Service would no longer allow Pride flags to fly at the Stonewall National Monument — the birthplace of the modern LGBTQ rights movement in the United States — the Washington Blade spoke with New York State Sen. Erik Bottcher, who represents the area surrounding the Stonewall Inn and the national monument.
During the interview, Bottcher, who is gay, spoke about the policy change and outlined steps he plans to take in the coming days to push for its reversal.
“This is another act of erasure,” Bottcher told the Blade. “It’s a cowardly attempt to rewrite history and to intimidate our community. This is Stonewall — it’s where we fought back, where we ignited a global movement for equality — and we refuse to go back. We’re not going to accept these acts of erasure.”
The Stonewall Inn became a flashpoint in 1969 after NYPD officers raided the bar, part of a longstanding pattern of police harassment of LGBTQ spaces. The raid sparked days of protest and resistance along Christopher Street, now widely recognized as the catalyst for the modern LGBTQ rights movement.
While the events are often referred to as the “Stonewall Riots,” many activists and historians prefer the term “Stonewall Uprising,” emphasizing that the resistance was a response to systemic oppression rather than senseless violence. LGBTQ patrons and community members fought back — shouting “Gay Power!” and “Liberate Christopher Street!” — as crowds grew and frustration with police abuse boiled over.
Since the uprising, LGBTQ people and allies have gathered annually in June to commemorate Stonewall and to celebrate Pride, honoring the movement that placed LGBTQ voices at the center of the fight for equality.
In June 2016, then President Barack Obama officially designated the space as the Stonewall National Monument, making it the United States’s first national monument designated for an LGBTQ historic site.
Now, nearly 10 years later, President Trump’s appointed NPS acting director Jessica Bowron changed policy on Jan. 21 regarding which flags are allowed to be flown in national parks. Many, including Bottcher, say this is part of a larger targeted and deliberate attempt by the administration to erase LGBTQ history.
“It’s clear they’re making a conscious decision to erase the symbols of our community from a monument to our community’s struggle,” he said. “This is a calculated and premeditated decision, and it could be — and should be — reversed.”
“Let’s be clear,” Bottcher added, “they wish we didn’t exist … But we’re not going anywhere. We refuse to go back into the shadows.”
When asked why it is critical to challenge the policy, Bottcher emphasized the importance of visibility in preserving LGBTQ history.
“This is why it’s so important that we not let this stand,” he said. “Visibility is critical. When people see us, learn about us, and get to know us, that’s how we break down prejudice and stereotypes. We cannot allow them to push us back into the shadows.”
Other LGBTQ leaders and elected officials were quick to condemn the removal of the Pride flag, which had flown since the site’s official designation as a national monument.
New York City Mayor Zohran Mamdani called the decision “outrageous.”
“I am outraged by the removal of the Rainbow Pride Flag from Stonewall National Monument,” Mamdani said in a statement. “New York is the birthplace of the modern LGBTQ+ rights movement, and no act of erasure will ever change or silence that history.”
“Our city has a duty not just to honor this legacy, but to live up to it,” he added. “I will always fight for a New York City that invests in our LGBTQ+ community, defends their dignity, and protects every one of our neighbors — without exception.”
Senate Minority Leader Chuck Schumer also condemned the move.
“The removal of the Pride Rainbow Flag from the Stonewall National Monument is a deeply outrageous action that must be reversed immediately,” Schumer said in a statement to The Advocate. “Stonewall is a landmark because it is the birthplace of the modern LGBTQ rights movement, and symbols of that legacy belong there by both history and principle.”
Cathy Renna, communications director for the National LGBTQ Task Force, said the flag’s removal will not erase the movement it represents.
“They can take down a flag, but they can’t take down our history,” Renna said. “Stonewall is sacred ground rooted in resistance, liberation, and the legacy of trans and queer trailblazers who changed the course of history.”
Human Rights Campaign National Press Secretary Brandon Wolf echoed that sentiment.
“Bad news for the Trump administration: these colors don’t run,” Wolf said. “The Stonewall Inn and Visitors Center are privately owned, their flags are still flying high, and that community is just as queer today as it was yesterday.”
Tyler Hack, executive director of the Christopher Street Project, said the removal was aimed squarely at LGBTQ visibility.
“The Pride flag was removed from Stonewall for one reason: to further erase queer and trans people from public life,” Hack said. “Stonewall marks the moment when queer and trans people fought back and demanded dignity. Our history is not theirs to erase.”
Bottcher closed with a promise to his constituents — and to the broader LGBTQ community — that the Pride flag’s removal would not be permanent.
“We will not be erased. We will not be silenced,” he said. “And the Pride flag will fly again at the birthplace of our movement.”
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