Right now, members of Congress are considering a budget proposal that would rip away life-saving health care coverage, particularly Medicaid from millions of people in the United States. This isn’t just unjust—it’s dangerous.

Since the late 1970s, there has been a strong push to advance the rights and well-being of LGBTQ+ elders, including the growing number of people aging with HIV. This community faces unique and often complex quality of life issues that require consistent, comprehensive care. Medicaid provides essential coverage for these services, including access to HIV medications, primary and specialist care, long-term care, and behavioral health support. Proposed cuts to Medicaid would destabilize this vital lifeline, threatening the health and dignity of one of the most medically vulnerable and historically marginalized communities in our country.

Congress is deciding just how deeply Medicaid could be cut. What’s at stake amounts to one of the most significant threats to public health in recent memory—one that would have a devastating impact on people aging with HIV.

The facts are clear: Medicaid is the single largest source of health care coverage for people living with HIV in the United States, covering roughly 4 in 10 people living with the disease. Many of those individuals are older people who rely on Medicaid not just for access to HIV treatments, but for managing other conditions that often accompany aging with HIV—such as cardiovascular disease, cognitive issues, and diabetes.

We have made remarkable progress in responding to HIV. Today, with effective treatment, people living with HIV can lead long, healthy lives. When HIV is suppressed to undetectable levels, it cannot be transmitted sexually. But this progress depends on consistent access to care. Without Medicaid, many people risk losing access to the medications that keep them healthy and alive—and that help prevent the transmission of HIV.

Moreover, Medicaid expansion has been directly associated with increased access to PrEP, a medication that is up to 99% effective at preventing HIV acquisition. Scaling back Medicaid would not only affect people already living and aging with HIV, but it would also limit preventive care that is essential to reducing new cases of HIV. In a world that too often dismisses older people as non-sexual and overlooks their need for HIV prevention services, the last thing we need is to further restrict access to sexual health services.

Older people with HIV often experience higher levels of isolation, stigma, and economic insecurity. They are more likely to be housing insecure and to have little to no family support. Medicaid helps older people maintain independence and age with dignity. Cutting Medicaid isn’t just a policy decision—it would create real hardship and suffering in the community.

Across the country, advocates and service providers see this reality every day. Countless LGBTQ+ elders and people aging with HIV rely on Medicaid for basic care and services. But that security can disappear quickly. That’s why taking action—right now—to help protect Medicaid is critical.

Here’s what you can do:

Call your members of Congress at 866-426-2631 and tell them “No cuts to Medicaid.” 

Write your members of Congress and tell them that Medicaid must be protected for people aging with HIV. Our colleagues at AIDS United have created a simple and effective tool to help you reach your representatives directly.

Join the SAGE Action Squad. When you sign up, you’ll receive alerts and updates on urgent advocacy issues affecting LGBTQ+ elders and people aging with HIV. It’s a powerful way to stay informed and engaged—and to ensure your voice is part of this movement.

We understand that budget decisions are complex. But we also believe that protecting health care for the most vulnerable members in our community should never be negotiable. Cutting Medicaid doesn’t just reduce spending—it puts lives at risk. It creates new barriers for people aging with HIV to access care, manage their health, and live with dignity. It also limits critical prevention services for those vulnerable to acquiring HIV, undermining efforts to end the HIV epidemic.

If enough of us act, we can help stop these Medicaid cuts from happening. We can ensure that Medicaid continues to serve the people who need it most.

SAGE has been at the forefront of this fight for decades. We’ve helped secure victories in access, equity, and representation. But we can’t do it alone. We must come together to defend the programs that safeguard the health, dignity, and future of our community. Cutting Medicaid would not only roll back progress—it would deepen disparities, put lives at risk, and send a dangerous message about whose lives are deemed worth protecting. We must speak out and demand that our elected leaders prioritize care over cuts. Let’s protect Medicaid. Let’s protect people aging with, and vulnerable to, HIV. Let’s protect our community—and build a future where every older person with HIV can age with health, respect, and pride.

Terri L Wilder, MSW is the HIV/Aging Policy Advocate at SAGE where she implements the organization’s federal and state HIV/aging policy priorities. 

My heart goes out to the transgender community and their families, after the Supreme Court ruling. The court has ruled their health, and lives, are less important, and we know they are not. 

The felon in the White House, and his MAGA acolytes, his cult, have done everything to make their lives hell. The rest of us can never back down until that is changed. It is not only the LGBTQ community that needs to fight this, but every decent person needs to as well. We should take to the streets and protest; yet the reality is the one sure way to stop all the madness is at the ballot box. We all need to vote, and get every decent person to do the same. I hate to say it, but right now there are apparently no ‘decent’ Republicans to vote for, because any decent Republican would be speaking out against the egregious policies of this felon and there is silence from them. 

Voting for a third party because you are not happy with everything Democrats are doing, will only help Republicans. History tells us that. Don’t be fooled, you need to vote for Democratic candidates up and down the ballot. Please, understand how our system works. There are only two parties today that will control the legislatures, state or federal, the governor’s office, or the White House. Third parties may try to fool you, but they have no chance at this time. 

We see what Republicans have done to the country. Grocery prices are up, your rent is up, the promise to end the wars around the world on their first day in office, have failed. The felon has actually started another war, this one against Iran. We will see where that leads. They are making a mess of their promise to expel immigrants, actually trying to do it without regard for our Constitution. I am for kicking out criminals who are here illegally, but we have a way to do that. We are not a banana republic. The felon in the White House is bowing down to kiss Putin’s ass, deserting the proud people in Ukraine. His sycophants in the Republican Congress refuse to stand up to him in any way. So, we have to kick them all out. 

One of the things that amazes me is how people make excuses for the felon, and the general slime he appointed to his Cabinet. Listening to Pete Hegseth at congressional hearings can literally make you sick. Then there is Marco Rubio, twisting himself into a pretzel for Trump, going against everything he once said he believed in. It’s disgusting what some people will do for a Cabinet post.

Then there are the Log Cabin Republicans, who find it OK to support someone who is a racist and homophobe, and make excuses for him. Some of them posting on Facebook how they enjoyed WorldPride, having no compunction at all being major hypocrites, when the felon in the White House they support, refused to acknowledge it. The highest-ranking gay member of his administration won’t acknowledge it; and another slimy gay man is named as acting CEO of the Kennedy Center and his first act is to cancel a gay chorus concert. When his Secretary of Defense tells us he is taking Harvey Milk’s name off a ship, and at one point says they will hide recognition of the ‘Enola Gay’ because they think it refers to the gay community. With all this, Log Cabin Republicans, I gather because of some self-hatred, or fear of losing a job, continue to support all he is doing. They won’t speak out when transgender people literally have their lives put in danger by the felon’s policies. When trans persons who have served with honor and distinction, in defense of all of our freedoms, are thrown out of the military. When veterans, including those in the LGBTQ community, are thrown out of their jobs in the federal government, and have their healthcare put at risk. They remain silent even in cases where silence = death. 

One of them on Facebook asked me whether it gets tiresome speaking about these things all the time, and suggests if I don’t like the felon in the White House, it’s too bad, I will just have to work harder next time. My answer is yes; I will work harder next time. But in the meantime, I will never tire of speaking out, and making sure anyone who hears my voice, will know what the felon, racist, homophobe, misogynist, found liable for sexual assault, currently in the White House, and his supporters, are doing to screw so many decent people. 

Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.

We at the Leonard Litz LGBTQ+ Foundation, along with the entire LGBTQ+ community, are justifiably devastated by the US Supreme Court’s decision upholding Tennessee’s ban on gender affirming care for minors. In a 6-3 ruling that will likely have major implications for the entire community’s rights going forward, the court held that the law, which prohibits certain forms of medical treatment based on the recipient’s assigned sex at birth, did not violate the US constitution’s equal protection clause.

The Skrmetti decision held that Tennessee could ban gender-affirming care to minors based on medical diagnosis (gender dysphoria, gender incongruence or gender identity disorder) without violating the US constitution. In its analysis, the court ignored that these TGNCNBI-specific conditions were being differentiated on the basis of sex, rather than age (minority status) and/or medical diagnosis. Thus, instead of applying the “strict scrutiny” required for sex-based discrimination, the court applied a much lower “rational basis” standard to the law and allowed it to stand. The court cited “fierce scientific and policy debates” around gender-affirming care as the state’s rational basis, in spite of the vehement disagreement of all major medical associations. State laws in 24 other states are substantially similar, so this ruling could affect as many as 100,000 youth. Ironically, the ban contains an exception for nonconsensual surgeries on intersex youth.

This decision also does not bode well for people with other medical conditions that offer potential for discrimination, and may even expose people with TGNCNBI-specific conditions to future discriminatory treatment, legislation, or action. In fact, the court’s ruling has major implications for the bodily autonomy of every American.

We at the Leonard Litz LGBTQ+ Foundation are more committed than ever to supporting the TGNCNBI community in their fight for equal rights and access to the healthcare they deserve. As we all know, this decision has potentially deadly consequences. As one united LGBTQ+ community, we need to make ourselves more visible than ever to show that we exist, have always existed, and will not be silenced by a political and judicial movement that is trying to erase us.

Leonard Litz is responding to this moment by increasing our support in both our TransPLUS and Advocacy initiatives. We are also reaching out to offer support to organizations that serve the needs of trans and intersex youth who are being affected by this draconian decision. Additionally, the TransPLUS Resource Center will continue to offer services to the community as its needs grow and evolve.

We appreciate everyone’s support of our TGNCNBI youth and thank you all that you do for the LGBTQ+ community!

Robyn Schlesinger is a Trustee of the Leonard Litz LGBTQ+ Foundation and Director of the TransPLUS Resource Center