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.
State Department
State Department implements anti-trans bathroom policy
Memo notes directive corresponds with White House executive order
The State Department on April 20 announced employees cannot use bathrooms that correspond with their gender identity.
The Daily Signal, a conservative news website, reported the State Department announced the new policy in a memo titled “Updates Regarding Biological Sex and Intimate Spaces, Including Restrooms.”
The State Department has not responded to the Washington Blade’s request for comment on the directive.
“The administration affirms that there are two sexes — male and female — and that federal facilities should operate on this objective and longstanding basis to ensure consistency, privacy, and safety in shared spaces,” State Department spokesperson Tommy Piggot told the Daily Signal. “In line with President Trump’s executive order this provides clear, uniform guidance to the department by grounding policy in biological sex as determined at birth.”
President Donald Trump shortly after he took office in January 2025 issued an executive order that directed the federal government to only recognize two genders: male and female. The sweeping directive also ordered federal government agencies to “effectuate this policy by taking appropriate action to ensure that intimate spaces designated for women, girls, or females (or for men, boys, or males) are designated by sex and not identity.”
The Daily Signal notes the new State Department policy “does not prohibit single-occupancy restrooms.”
National
I’m telling the scared little girl I once was it’s okay to feel free
This week is Lesbian Visibility Week
Uncloseted Media published this article on April 23.
By SOPHIE HOLLAND | At 13 years old, I remember looking in the mirror in my Toronto bathroom and thinking, “Yeah, I’m a lesbian.” At the time, I thought it was a dirty word. Thinking back, it could be because the first time I heard it was when a family member said, “I don’t know what a lesbian is, they are like aliens.”
And although I walked around in camouflage Crocs with a rainbow My Little Pony charm, plaid knee-length shorts and a shark tooth necklace (yes, these are all, in my opinion, stereotypically lesbian apparel!), I didn’t feel like I fit the mold. The longer I thought about it, the worse I felt, so I buried my feelings deep inside.
Now I am 25, and I have been out since I was 22. Three years ago, I never could have imagined that I’d be working for a queer news publication and celebrating Lesbian Visibility Week, an annual event meant to honor and uplift lesbian perspectives and highlight the hardships our community faces. To me, LVW is so important because, frankly, it has been an absolute shit show getting here, to a place where I feel love and joy most days.
I think back to the frustration of constantly being asked, “Do you have a boyfriend?” Of watching princess movies and seeing a broken girl only find herself when her prince charming arrives. I remember listening to music that was always about heterosexual relationships. I remember feeling left out in high school when, one by one, my friends got boyfriends.
I tried the boyfriend, and I tried really hard for it to work at a large detriment to my wellbeing. I brainwashed myself into thinking I was probably bisexual, which I told my closest friends around 16 and unsuccessfully told my parents at the same age. I was probably subconsciously using this as a litmus test of their acceptance and to soothe the anxiety I felt around my sexuality.
Learning to love who I am did not only come from me unraveling my internalized lesbophobia and dissecting the oppressive societal messages of heteronormativity. It came from meeting an awesome community of lesbians and queers. I found people who understood my worldview and who showed me the ropes. I no longer had to stutter over concepts like lesbian loneliness or my frustration with misogynistic straight men.
They all just got it.
Without this community, I am not sure if I could be as warm and confident in myself as I am today.
And while I still experience homophobia, like being spat on while walking with an ex in downtown Toronto or having a stranger yell in my face “Are you fucking lesbians?” in Kensington Market, the joy and love still outweighs the nasty.
So, as the sentimental dyke that I have become, I decided to ask a set of lesbians in my orbit — including my friends as well as Uncloseted staffers, board members and followers — if they would share a little bit about what makes them love being a lesbian. And now, I can share it with all of you. Here they are. Happy LVW!
Timi Sotire
Falling in love with her was a reset. I felt like a kid again, hopeful about the future. We’ve had to overcome many obstacles to be together, but I’d choose her in every lifetime. I was sick with a long-term health condition when we met, and hanging out with Sophia really helped me with my recovery after my surgery.
Bella Sayegh
Being a lesbian is one of the most beautiful things in the world. To be authentically yourself in resistance and joy is so special within the lesbian community.
Parker Wales
When I met Liv, I finally understood why almost every song is about love.
Gillian Kilgour
There is no connection quite as perfect as between lesbians, no one sees me like my lesbians do.
Chyna Price
There’s many things I love about being a lesbian. But here are my top three:
- There’s just a deeper understanding when it comes to being loved by another woman.
- The next one would be the sense of community, especially being a POC masculine-presenting lesbian. I don’t feel like I’m cosplaying as someone else like I felt like I was doing before I came out.
- There’s so much history going back to the 1800s on how we found and fought for our love. That fight makes me proud because it shows me … that we’ve [found] ways to express our love even when it was misunderstood, illegal and deemed as madness.
Hope Pisoni
Before I knew I was a lesbian, romantic relationships seemed suffocating — it felt like everyone would expect me to act my part in the meticulous performance that is heterosexuality. But meeting my spouse and discovering our identities together showed me just how freeing it could be to love without a script to follow.
Leital Molad
It was the joy of watching the New York Sirens defeat the Toronto Sceptres at our first professional women’s hockey game — surrounded by hundreds (maybe thousands?) of cheering lesbians.
Angela Earl
I spent years building a life that looked right. But I never felt settled, and eventually I started asking what would actually make me happy. Coming out was about more than who I love, it was letting go of everything I was told to be. The last few years have felt like coming home to a life that had been waiting for me.
Tali Bray
What I love about being a lesbian is what I love about being in love … the wonder and joy of “oh, this is what it’s supposed to feel like.” I love moving through the world with women.
Izzy Stokes
I didn’t fall in love until I realized that queerness was an option. My queer friends have helped me see so much more than I grew up seeing. I’m so proud of us, and I’m so grateful for my lesbian community.
Nandika Chatterjee
When I met my fiancée is when I started to feel most like myself. That meant loving myself for who I am and embracing my identity as a lesbian. I felt free in a way I have never before. That’s the long and short of it.
Liz Lucking
The love and joy of being a lesbian is getting to live the life I dreamed of but never thought I would get to have!
Reflections
As I read these beautiful entries, it’s not lost on me that we’re still living in a world where lesbians are more likely to struggle with maternity problems, fetishization, and compulsory heterosexuality — not to mention the intersectional pressures of racism from both inside and outside the queer community. That’s part of why, according to a 2024 survey, 22 percent of LGBTQ women have attempted suicide, and 66 percent have sought treatment for trauma.
So if you are a lesbian who isn’t out or doesn’t feel safe, I hope you read this and can glean some hope from these messages. So when you look in the mirror, you know that it’s okay to release the weight — which can feel so heavy — of a heteronormative world.
We still have a long fight until all lesbians can feel safe to be themselves, but this is a community that does not back away from the tough, from the joy, from being loud and from all the other things that it takes to start a small revolution.
Hell yeah, lesbians! Here’s to you.
*I am signing off with my cat on my lap and a pride flag over my head <3.
Cuba
Trans parent charged with kidnapping, allegedly fled to Cuba with child
Cuban authorities helped locate Rose Inessa-Ethington
Federal authorities have charged a transgender woman with kidnapping after she allegedly fled to Cuba with her 10-year-old child.
An affidavit that Federal Bureau of Investigation Special Agent Jennifer Waterfield filed in U.S. District Court for the District of Utah on April 16 notes the child is a “biological male who identifies as a female” and “splits time living with divorced parents who share custody” in Cache County, Utah.
Waterfield notes the child on March 28 “was supposed to be traveling by car to” Calgary, Alberta, “for a planned camping trip with his transgender mother, Rose Inessa-Ethington, Rose’s partner, Blue Inessa-Ethington, and Blue’s 3-year-old child.”
The affidavit notes the group instead flew from Vancouver, British Columbia, to Mexico City on March 29. Waterfield writes the Inessa-Ethingtons and the two children then flew from Mérida, Mexico, to Havana on April 1.
The 10-year-old child called her biological mother on March 28 after they arrived in Canada. The custody agreement, according to the affidavit, required Rose Inessa-Ethington to return the child to her former spouse on April 3.
“Interviews of MV [Minor Victim] 1’s family members provided significant concerns for MV 1’s well-being, as MV 1 was born a male, however, identifies as a female child, which is largely believed to be due to manipulation by Rose Inessa-Ethington,” reads the affidavit. “Concerns exist that MV 1 was transported to Cuba for gender reassignment surgery prior to puberty.”
The affidavit indicates authorities found a note in the Inessa-Ethingtons’ home with “instruction from a mental health therapist located in Washington, D.C., including instruction to send the therapist the $10,000.00 and instructions on gender-affirming medical care for children.”
The affidavit does not identify the specific “mental health therapist” in D.C.
A Utah judge on April 13 ordered Rose Inessa-Ethington to “immediately” return the child to her former spouse. The former spouse also received sole custody.
“Your affiant believes that due to the extensive planning and preparation exhibited by both Rose Inessa-Ethington and Blue Inessa-Ethington to isolate MV 1 and take MV 1 to Havana, Cuba, without notifying or requesting permission from MV 1’s mother indicates they are likely not planning to return to the United States,” wrote Waterfield.
The affidavit notes Cuban authorities found the Inessa-Ethingtons and the child.
A press release the U.S. Attorney’s Office for the District of Utah issued notes the Inessa-Ethingtons “were deported from Cuba” on Monday “with the assistance of the FBI.”
The couple has been charged with International Parental Kidnapping. The Inessa-Ethingtons were arraigned in Richmond, Va., on Monday. The press release notes a federal court in Salt Lake City will soon handle the case.
The New York Times reported the child is now back with their biological mother.
“We are grateful to law enforcement for working swiftly to return the child to the biological mother,” said First Assistant U.S. Attorney Melissa Holyoak of the District of Utah in the press release.
The case is unfolding against the backdrop of increased tensions between Washington and Havana after U.S. forces on Jan. 3 seized now former Venezuelan President Nicolás Maduro and his wife, Cilia Flores.
President Donald Trump shortly after he took office in January 2025 issued an executive order that directed the federal government to only recognize two genders: male and female. A second White House directive banned federally-funded gender-affirming care for anyone under 19.
The U.S. Supreme Court last year in the Skrmetti decision upheld a Tennessee law that bans gender-affirming care for minors.
Cuba’s national health care system has offered free sex-reassignment surgeries since 2008.
Activists who are critical of Mariela Castro, the daughter of former President Raúl Castro who spearheads LGBTQ issues as director of Cuba’s National Center for Sexual Education, have previously told the Washington Blade that access to these procedures is limited. The Blade on Wednesday asked a contact in Havana to clarify whether Cuban law currently allows minors to undergo sex-reassignment surgery.
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