Local
Will health reform make AIDS groups obsolete?
HIV clinics face new competition as clients obtain insurance by 2014
‘Health care reform has been a real motivator around us improving the quality of what we do because we know we’re going to have to get better,’ said Don Blanchon, executive director of Whitman-Walker Clinic. (Washington Blade photo by Michael Key)
When the AIDS epidemic burst on the scene in the 1980s, a cadre of volunteers –many from the LGBT community — emerged to provide compassionate and dedicated care for the sick and dying, services that government agencies and existing charitable groups were not providing.
Since that time, the mostly volunteer-driven, community-based AIDS clinics and advocacy groups created back then have evolved into professionally run facilities receiving millions of dollars in state and federal funds. Like the Whitman-Walker Clinic in D.C., many of the clinics and advocacy groups provide a vast array of services for people with HIV and AIDS, most of whom can’t afford private health insurance.
But in March, Congress approved and President Obama signed into law a sweeping health care reform measure called the Patient Protection and Affordable Care Act. Obama administration officials say it will result in more than 94 percent of all Americans being covered by some form of private or public health insurance by 2014.
Although most AIDS activists and officials with local and national AIDS organizations have hailed the health care reform measure as an unprecedented benefit to people with HIV and AIDS, some believe the law could prompt large numbers of patients to leave the community-based clinics and seek medical care elsewhere.
With a possible loss of clients, community AIDS clinics would be in jeopardy of losing government funding, which is based on the number of clients served. It would be ironic, some have said, if the benefits of healthcare reform result in the closing of community institutions that have served people with AIDS during a time of need.
“The LGBT community and people living with HIV are going to have options that they may not have now,” said Don Blanchon, executive director of the Whitman-Walker Clinic, which has served people with HIV and AIDS since the epidemic began.
“And so for us, health care reform has been a real motivator around us improving the quality of what we do because we know we’re going to have to get better,” Blanchon said. “We know at some point in time almost every District resident is going to have some type of public or private insurance, which means they, in theory, are going to be able to go to a lot of different places for their care.”
Blanchon noted that a financial crisis that Whitman-Walker faced four years ago forced it to take steps that have placed it in an excellent position to flourish under the health care reform law. The Clinic’s board hired Blanchon, a managed care expert, to help the Clinic survive at a time when private donations and fundraising efforts were faltering.
With the board’s full approval and over the objections of some of the Clinic’s longtime supporters and volunteers, Blanchon transformed the Clinic from a volunteer model operation into a managed care type facility with the status known as a “federally qualified health center look alike.”
According to Blanchon and other Clinic officials, the new status enables the Clinic to accept a greater number of Medicaid patients as well as patients with a wide range of private health insurance. Patients covered by these programs allow the Clinic to obtain reimbursement for its services by doctors, its own pharmacy, and other service providers, eliminating the need to rely more on private donors.
Unlike other community-based AIDS clinics, Whitman-Walker will be in an excellent position to take on new patients or retain its existing ones as the new health care reform measure enables the majority of patients to obtain private insurance or Medicaid.
Under the Patient Protection and Affordable Care Act, all lower income individuals, including people with HIV, will be eligible for Medicaid coverage if they fall below 133 percent of the federal poverty level, where an individual has an income of about $15,000 a year or lower.
Under current federal law, low-income people with full-blown AIDS are already eligible for Medicaid coverage. For years, Congress has declined to pass legislation proposed by AIDS advocacy groups calling for Medicaid coverage for low-income people with HIV, with the intent of providing medical services to prevent them from advancing to AIDS.
The new law makes that legislation unnecessary after 2014, when the Medicaid provision takes effect.
Jeffrey Crowley, director of the White House Office of National AIDS Policy, calls the Patient Protection and Affordable Care Act one of the nation’s most significant advances for the care and treatment for people with HIV/AIDS.
“It will fundamentally expand access to insurance coverage for people living with HIV,” he said. “Much of that will be through the mandatory expansion of the Medicaid program.”
He said that similar to all Americans, people with HIV will also be eligible for private insurance coverage through a variety of options based on their income. Among the options will be the purchase of insurance coverage through competitive insurance exchanges. He noted that by 2014, no insurance company can deny coverage based on pre-existing conditions such as HIV or other illnesses.
Keith Maley, a spokesperson for the U.S. Department of Health and Human Services, which will administer most of the provisions of the new health care law, said people with HIV and other illnesses could be immediately eligible for private insurance coverage through high-risk pools.
Those eligible for the immediate coverage must show that they have had no health insurance coverage for six consecutive months, have a chronic health condition, and are not eligible for employer provided insurance or Medicaid.
Crowley noted that the new law has other immediate benefits for people with HIV and other chronic health conditions. As of July 1, private health insurers can no longer use a rescission, a practice that cancels a policy when someone gets sick and needs expensive treatment.
He said the law also immediately prohibits insurers from imposing a lifetime “cap” on insurance benefits. Annual limits on coverage or benefits will end in 2014, he said.
Crowley, a gay man who previously worked for the National Association of People with AIDS before joining the White House staff, said he expects most community-based AIDS clinics and local and national AIDS advocacy organizations to continue to exist after the health care law is fully implemented in 2014. However, he said most will have to change the way they do business.
“I think we know from our experience with HIV that we’ve built up a great HIV workforce,” he said. “We have a lot of expertise. I want to make sure as we build and expand an insurance system through the Affordable Care Act that these HIV medical providers are making sure that they’re part of this new system.”
“Some of them might only receive funding through the Ryan White programs, and I would say they need to look at their future and say that they need to be part of the new insurance system,” he said. “But there’s no question that we’re going to need their expertise and commitment at providing medical care going forward.”
Crowley’s reference to the Ryan White CARE Act, the largest existing federal program created to provide care for low-income people with HIV/AIDS, is expected to change significantly following the full implementation of the Patient Protection and Affordable Care Act, according to officials with a number of national AIDS groups.
Nearly everyone, including Crowley, agrees that the Ryan White program should remain, but most likely in a scaled back form. Congress passed the act in the 1990s as a means of helping cities and states that were grappling with the enormous burden of providing care for people with HIV/AIDS who lacked health insurance coverage and were overwhelming local and state hospitals and health care facilities.
Carl Schmid, director of federal affairs for the AIDS Institute, a national advocacy organization; Michael Weinstein, executive director of the AIDS Healthcare Foundation, the nation’s largest AIDS-related medical care provider; and Jose Zuniga, executive director of the International Association of Physicians in AIDS Care, each said they believe the Ryan White program will be needed for at least some services the new law does not provide.
“It will not solve all of our access issues,” said Schmid of the new health care measure.
Weinstein said that state programs to expand health insurance have been slow to enroll as many people as expected for a variety of reasons, some bureaucratic in nature.
“So I wouldn’t expect an overnight change in 2014,” he said, pointing to a need to keep the Ryan White program operating for some time after 2014.
Weinstein said that in some states, including California, Medicaid reimbursement for medical services is far lower than that provided by private insurance companies. He predicted that people with HIV or AIDS who obtain coverage under the new law through Medicaid might be turned away by private doctors who declined to take all Medicaid patients.
“The reimbursement that we receive from Medicaid or from private insurance is far below our cost and far below what we get from Ryan White,” he said of the AIDS Healthcare Foundation. “So we will suffer a hit in that regard as well as most providers.”
Weinstein said his organization has a wide variety of income streams and the lower reimbursements under the new law “won’t be a fatal blow to us.”
Blanchon of Whitman-Walker said the benefits of the new law greatly outweigh its possible shortfalls.
“Health care reform is going to be a real help to our patients and clearly to the Clinic because more of our patients are going to be insured under more comprehensive benefit programs,” he said.
“And what that means at the end of the day is the Clinic is not going to have to shell out as much free care. So we’re going to be in a position to be able to offer more services to more patients and keep them healthy, and ultimately that’s what we’re here for.”
Baltimore
Charles Bowers, former owner of Baltimore gay bar the Hippo, dies
Prominent activist died at his Mount Vernon home
By WESLEY CASE | Charles “Chuck” Bowers, former owner of the storied Baltimore gay club the Hippo and a prominent advocate for Maryland’s LGBTQ community, died Tuesday. He was 81.
Bowers turned the Mount Vernon club — located at the corner of North Charles and West Eager streets — into a judgment-free refuge for queer and straight locals looking to find and express their authentic selves on a packed dance floor.
“He truly tried to make the Hippo a place for everybody — a safe space,” said an emotional Rik Newton-Treadway, who befriended his “mentor” Bowers at the club in 1979.
Bowers, of Mount Vernon, died Tuesday evening in Baltimore of natural causes, said his niece, Cathy Bowers.
The rest of this article can be read on the Baltimore Banner’s website.
District of Columbia
Being a female firefighter comes with unique risks, and rewards
Well-fitting gear can be a safety issue
Firefighters are known for running into danger to save lives, but they may face another danger after the fire is out. Studies on firefighter health point to rising concerns about cancer risk, mental health struggles, and exposure to toxic “forever chemicals” found in firefighting foam and protective gear.
Nearly 40 percent of firefighters report “clinically significant levels” of anxiety or depression and 10 percent report this level of posttraumatic stress disorder, according to a national survey of public safety workers published last year in the journal Psychological Services. Lawmakers from several states are also pushing for stronger federal protections and compensation for firefighters exposed to hazardous chemicals on the job.
Female firefighters can also face a higher risk of injury, heat-related illness, and even greater carcinogen exposure due to ill-fitting equipment that wasn’t designed for their bodies. Their risk of psychological and workplace stress is higher, as well, due in part to the isolation of being in a slim minority in fire departments across the country. Only 5 to 9 percent of firefighters are women.
To understand the risks and rewards of being a female firefighter, Youthcast Media Group interviewed Connie Reid, a firefighter with the DC Fire and EMS Department. Meredith McQuerry, an associate professor of textile science at Florida State University who studies how to improve firefighting gear and other personal protective equipment to better protect women in the fire service, also responded to student questions via email. Reid’s and McQuerry’s responses have been edited for clarity and length.
HOW LONG HAVE YOU BEEN IN YOUR CAREER, AND WHAT DREW YOU TO IT?
REID: I’ve been a firefighter for seven years. I wasn’t sure if I wanted to be a firefighter or police officer, but I do have uncles that were firefighters, so I leaned towards the firefighter side. So I’m happy I made that decision.
McQUEERY: During my PhD, a colleague and I realized we never saw any female firefighters come through our research center. We began looking in the literature and found very few studies focused on PPE for women in the fire service.
DOES FIREFIGHTING GEAR ACTUALLY FIT WOMEN, AND DOES IT MATTER?
REID: In D.C., if you have an issue, you just send an email, and we have people who will properly size us. I don’t think any female that I know has complained about gear not fitting.
McQUERRY: Wearing protective clothing designed for the opposite sex can lead to restricted mobility, greater opportunity for thermal and particulate exposure, and a lack of functionality that can mean life or death, such as accessing a tool in a pocket that is completely closed off due to anthropometric differences.
There is a culture in the fire service, and especially for women in a male-dominated field, that suppresses the likelihood of advocating for better-fitting gear. While not within our area of expertise, we have done our best to raise awareness for the need for properly fitting gear for women in the fire service and to champion their self-advocacy.
Female firefighters report the inability to throw a ladder, step onto the truck, or cinch their pants down adequately due to ill-fitting protective clothing and equipment. One example is the interference between the helmet and the self-contained breathing apparatus which prevents many female firefighters from looking upward to throw a ladder without first twisting their neck sideways to avoid the lid of the helmet knocking into the respirator bottle. This type of modification can lead to acute and long term injury.
ARE THESE PROBLEMS MOSTLY ABOUT COMFORT? WHAT ARE SOME EXAMPLES OF SAFETY RISKS OR DANGERS THAT CAN HAPPEN WHEN GEAR DOES NOT FIT PROPERLY?
McQUERRY: All firefighters need properly fitting PPE as the primary threats center around carcinogen exposure, musculoskeletal injuries, and heat-related illnesses. For example, you have to work harder to do the same task in ill-fitting, mobility restrictive gear, which leads to faster metabolic heat production and build-up in the suit, quickening the onset of fatigue and other HRI.
Our previous work led us to hypothesize that oversized gear for women allowed for more particulate ingress in the interface areas including the collar/hood, sleeve/glove, boot/pant, and coat/pant areas. A recently funded study is allowing us to quantify this by correlating the gear fit of women’s structural turnout gear with their cancer biomarkers collected via urinalysis pre- and post-live fire burns.
HOW DO FIREFIGHTERS TRAIN TO STAY SAFE DURING DANGEROUS SITUATIONS?
REID: So we have trainings all the time. Safety is the number one priority of the job. They make sure they let us know all the time. We have annual trainings. We have quarterly trainings. We have online training if you need refreshers.
We are both on a medical side and a fire side so as a D.C. firefighter, you come in, and they teach you. You bring a positive attitude and just determination, because some people really don’t understand it’s not just physical, it’s mental. You have to be mentally prepared.
WERE THERE ANY FINDINGS IN YOUR RESEARCH THAT SURPRISED YOU?
McQUEERY: Yes, we were surprised to find in our nationwide survey [of 2,000 people] a few years ago that 15 percent of U.S. structural and 21 percent of wildland female firefighters sometimes or always leave off an essential item of their PPE due to limited mobility. Specifically, the turnout coat and pants or wildland shirt and pants were the most noted for being intentionally not worn, which is very surprising and concerning.
HAVE FIRE DEPARTMENTS OR EQUIPMENT COMPANIES STARTED MAKING IMPROVEMENTS SINCE YOUR STUDY, AND IF SO, WHY DO YOU THINK FIREFIGHTING EQUIPMENT HAS TAKEN SO LONG TO ADAPT TO WOMEN FIREFIGHTERS?
McQUEERY: It wasn’t until the post-Me Too movement that our research in this area was able to gain traction and support. It is a decades (or centuries) old problem of there not being enough “market share” for the 5-11 percent of the fire service. However, we have seen tremendous growth and innovation in this area since we began our funded research in 2019. Now, nearly every single structural firefighting manufacturer offers women’s protective clothing.
When we began this research, only two manufacturers offered women’s turnout gear. Now, to our knowledge, all but one [seven out of eight] does, which is a significant advancement across the industry. There is still much work to do in fine tuning these designs to fit the specific anthropometrics of female firefighters.
DO YOU WORRY ABOUT THE LONG TERM EFFECTS OF BEING A FIREFIGHTER?
REID: Do I worry? I wouldn’t say worry. I’m more mindful of it, because the material of today is different from years ago. It burns faster, and then there’s more chemically made things than like natural resources. So I’m aware of that. They also have training teaching us about things like that. And there’s smoke exposures, there’s a health risk like sleep deprivation or sleep disruption.
WHAT KIND OF EDUCATION OR TRAINING DO YOU NEED TO BECOME A FIREFIGHTER?
REID: So there’s a few routes to get onto the job. The cadet route would be … you have to be 18 to 21 years old, you have to be a D.C. resident, have a high school diploma from a D.C. school (public or private), or have a GED, and you have to have at least a learner’s permit at the time that you are applying for the job. To be a recruit, you have to be at least 18 years old, have a full driver’s license, (not just a permit), and you also have to have a high school diploma or GED. The third way [is as] a paramedic, and you have to come on the job with your paramedic license.
WHAT’S YOUR ADVICE FOR YOUNG WOMEN CONSIDERING THIS PATH?
REID: I would say, welcome. Come on the job. We need females. I always think it’s awesome when we get young ladies that are interested in the fire side. A lot of females just only want to do EMS. There’s nothing against EMS, but the fire side is pretty cool, too. Don’t sell yourself short, just try to do both of them. It’s a very rewarding job. You have to also mentally prepare yourself and physically prepare yourself. But I think the job is a great experience. I wish I would have started younger myself.
Mariyah Matthews is in the class of 2027 at Bard High School Early College DC, one of Youthcast Media Group’s journalism class partners. Sarah Gandluri is a YMG intern who is studying political science and global studies at the University of North Carolina at Chapel Hill.
District of Columbia
Capital Pride chair resigns from board after just 10 months
Anna Jinkerson ‘taking step back to move forward’
Anna Jinkerson, who has served as chair of D.C.’s Capital Pride Alliance Board of Directors for the past 10 months and has served on the board for the past four years, confirmed she is resigning from the board effective Sept. 30.
Capital Pride Alliance serves as the lead organizer of D.C.’s annual LGBTQ Pride events.
“I am taking a step back to move forward and plan to stay engaged in the community,” Jinkerson told the Washington Blade in a statement. “Serving as a volunteer leader during a period of transition following World Pride was both an honor and a challenge,” she said.
“Throughout my tenure, I focused on strengthening accountability, improving communications, supporting staff and volunteers, and helping position the organization for long-term success,” she told the Blade in her statement. “Meaningful organizational progress requires collaboration, dedication, and a shared commitment to serving the community, and I am proud of the work accomplished during this period.”
In February of this year, during Jinkerson’s tenure on the board, Capital Pride announced it had expanded the size of its board from 12 to 25 members.
Around that same time one of the existing board members, transgender activist Taylor Lianne Chandler, announced in a letter to fellow board members that the Blade obtained from an anonymous sender that she was resigning from the board. Among her reasons for resigning, she said in the letter, was the board’s failure to address “sexual misconduct” within the Capital Pride organization.
In the letter, which she confirmed for the Blade was authentic, Chandler said she and other board members raised “credible concerns” of alleged sexual misconduct within the Capital Pride organization and the board chose not to adequately respond to those concerns.
Chandler told the Blade a Capital Pride investigation identified an individual implicated in a “pattern” of sexual harassment related behavior, but said she was bound by a Non-Disclosure Agreement that applied to all board members and she could not provide further details.
When the Blade contacted Capital Pride for comment on Chandler’s allegations, Jinkerson responded with a statement saying Capital Pride was addressing her concerns.
“When concerns are brought to CPA, we act quickly and appropriately to address them,” Jinkerson said. “As we continue to grow our organization, we’re proactively strengthening the policies and procedures that shape our systems, our infrastructure, and the support we provide to our team and partners,” she said.
In her statement to the Blade this week commenting on her planned resignation from the Capital Pride board, Jinkerson appeared to refer to the concern raised by Chandler.
“I am proud to have advocated for sexual harassment training, supported staff and volunteers when concerns were raised, engaged community leaders in important conversations, and helped advance practices that strengthen safety, transparency, and accountability,” she said.
“As I step away from board service, I do so with gratitude for the opportunity to serve and with confidence in the organization’s future,” she added. “I am taking a step back to move forward, and I look forward to remaining actively engaged in our community and continuing to support efforts that advance equality, belonging, and pride for all.”
Charles Bowers, former owner of Baltimore gay bar the Hippo, dies
Being a female firefighter comes with unique risks, and rewards
Writing a play about Lincoln leads down a rabbit hole to a closet
Trump-appointed judge restores White House TV pool access
