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What’s next for health care reform?

After court ruling, focus turns to state plans for Medicaid

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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.”

Paschall continued, “We’re also working with them to ensure that those questions are developed and included in other federal health surveys across the board so that we can have more data in more areas identify where those disparities are.”

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.

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Puerto Rico

Bad Bunny shares Super Bowl stage with Ricky Martin, Lady Gaga

Puerto Rican activist celebrates half time show

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Bad Bunny performs at the Super Bowl halftime show on Feb. 8, 2026. (Screen capture via NFL/YouTube)

Bad Bunny on Sunday shared the stage with Ricky Martin and Lady Gaga at the Super Bowl halftime show in Santa Clara, Calif.

Martin came out as gay in 2010. Gaga, who headlined the 2017 Super Bowl halftime show, is bisexual. Bad Bunny has championed LGBTQ rights in his native Puerto Rico and elsewhere.

“Not only was a sophisticated political statement, but it was a celebration of who we are as Puerto Ricans,” Pedro Julio Serrano, president of the LGBTQ+ Federation of Puerto Rico, told the Washington Blade on Monday. “That includes us as LGBTQ+ people by including a ground-breaking superstar and legend, Ricky Martin singing an anti-colonial anthem and showcasing Young Miko, an up-and-coming star at La Casita. And, of course, having queer icon Lady Gaga sing salsa was the cherry on the top.”

La Casita is a house that Bad Bunny included in his residency in San Juan, the Puerto Rican capital, last year. He recreated it during the halftime show.

“His performance brought us together as Puerto Ricans, as Latin Americans, as Americans (from the Americas) and as human beings,” said Serrano. “He embraced his own words by showcasing, through his performance, that the ‘only thing more powerful than hate is love.’”

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Human Rights Watch sharply criticizes US in annual report

Trump-Vance administration ‘working to undermine … very idea of human rights’

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(Washington Blade photo by Yariel Valdés González)

Human Rights Watch Executive Director Philippe Bolopion on Wednesday sharply criticized the Trump-Vance administration over its foreign policy that includes opposition to LGBTQ rights.

“The U.S. used to actually be a government that was advancing the rights of LGBT people around the world and making sure that it was finding its way into resolutions, into U.N. documents,” he said in response to a question the Washington Blade asked during a press conference at Human Rights Watch’s D.C. offices. “Now we see the opposite movement.”

Human Rights Watch on Wednesday released its annual human rights report that is highly critical of the U.S., among other countries.

“Under relentless pressure from U.S. President Donald Trump, and persistently undermined by China and Russia, the rules-based international order is being crushed, threatening to take with it the architecture human rights defenders have come to rely on to advance norms and protect freedoms,” said Bolopion in its introductory paragraph. “To defy this trend, governments that still value human rights, alongside social movements, civil society, and international institutions, need to form a strategic alliance to push back.”

From left: Human Rights Watch Executive Director Philippe Bolopion and Human Rights Watch Washington Director Sarah Yager at a press conference at Human Rights Watch’s D.C. offices on Feb. 4, 2026. (Photo courtesy of Human Rights Watch)

The report, among other things, specifically notes the U.S. Supreme Court’s Skrmetti decision that uphold a Tennessee law banning gender-affirming medical interventions for minors.

The Trump-Vance administration has withdrawn the U.S. from the U.N. LGBTI Core Group, a group of U.N. member states that have pledged to support LGBTQ and intersex rights, and the U.N. Human Rights Council. Bolopion in response to the Blade’s question during Wednesday’s press conference noted the U.S. has also voted against LGBTQ-inclusive U.N. resolutions.

Maria Sjödin, executive director of Outright International, a global LGBTQ and intersex advocacy group, in an op-ed the Blade published on Jan. 28 wrote the movement around the world since the Trump-Vance administration took office has lost more than $125 million in funding.

The U.S. Agency for International Development, which funded myriad LGBTQ and intersex organizations around the world, officially shut down on July 1, 2025. The Trump-Vance administration last month announced it will expand the global gag rule, which bans U.S. foreign aid for groups that support abortion and/or offer abortion-related services, to include organizations that promote “gender ideology.”

“LGBTQ rights are not just a casualty of the Trump foreign policy,” said Human Rights Watch Washington Director Sarah Yager during the press conference. “It is the intent of the Trump foreign policy.”

The report specifically notes Ugandan authorities since the enactment of the country’s Anti-Homosexuality Act in 2023, which punishes “‘carnal knowledge’ between people of the same gender” with up to life in prison, “have perpetrated widespread discrimination and violence against lesbian, gay, bisexual, and transgender (LGBT) people, their families, and their supporters.” It also highlights Russian authorities “continued to widely use the ‘gay propaganda’ ban” and prosecuted at least two people in 2025 for their alleged role in “‘involving’ people in the ‘international LGBT movement’” that the country’s Supreme Court has deemed an extremist organization.

The report indicates the Hungarian government “continued its attacks on and scapegoating of lesbian, gay, bisexual, and transgender (LGBT) people” in 2025, specifically noting its efforts to ban Budapest Pride that more than 100,000 people defied. The report also notes new provisions of Indonesia’s penal code that took effect on Jan. 2 “violate the rights of women, religious minorities, and lesbian, gay, bisexual, and transgender (LGBT) people, and undermine the rights to freedom of speech and association.”

“This includes the criminalization of all sex outside of marriage, effectively rendering adult consensual same-sex conduct a crime in Indonesia for the first time in the country’s history,” it states.

Bolopion at Wednesday’s press conference said women, people with disabilities, religious minorities, and other marginalized groups lose rights “when democracy is retreating.”

“It’s actually a really good example of how the global retreat from the U.S. as an actor that used to be very imperfectly — you know, with a lot of double standards — but used to be part of this global effort to advance rights and norms for everyone,” he said. “Now, not only has it retreated, which many people expected, but in fact, is now working against it, is working to undermine the system, is working to undermine, at times, the very idea of human rights.”

“That’s definitely something we are acutely aware of, and that we are pushing back,” he added.

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Maryland

4th Circuit dismisses lawsuit against Montgomery County schools’ pronoun policy

Substitute teacher Kimberly Polk challenged regulation in 2024

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(Photo by Sergei Gnatuk via Bigstock)

A federal appeals court has ruled Montgomery County Public Schools did not violate a substitute teacher’s constitutional rights when it required her to use students’ preferred pronouns in the classroom.

The 4th U.S. Circuit Court of Appeals in a 2-1 decision it released on Jan. 28 ruled against Kimberly Polk.

The policy states that “all students have the right to be referred to by their identified name and/or pronoun.”

“School staff members should address students by the name and pronoun corresponding to the gender identity that is consistently asserted at school,” it reads. “Students are not required to change their permanent student records as described in the next section (e.g., obtain a court-ordered name and/or new birth certificate) as a prerequisite to being addressed by the name and pronoun that corresponds to their identified name. To the extent possible, and consistent with these guidelines, school personnel will make efforts to maintain the confidentiality of the student’s transgender status.”

The Washington Post reported Polk, who became a substitute teacher in Montgomery County in 2021, in November 2022 requested a “religious accommodation, claiming that the policy went against her ‘sincerely held religious beliefs,’ which are ‘based on her understanding of her Christian religion and the Holy Bible.’”

U.S. District Judge Deborah Boardman in January 2025 dismissed Polk’s lawsuit that she filed in federal court in Beltsville. Polk appealed the decision to the 4th Circuit.

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