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.”
Pride month festivities continue through the end of the month and there’s a new event for Rehoboth/Dewey Beach residents and visitors, Pride on the Bay, set for June 27.
Boaters will tie up at the sandbar near Massey’s Landing from 12-4 p.m. Visit Pride on the Bay’s Facebook page for a map of the exact location. You can rent pontoons for the day at Dewey Beach Watersports (deweybeachwatersports.com).
Aqua Bar & Grill is sponsoring the inaugural event and will provide a floating DJ for the afternoon. Aqua will then host an after-party back on land (57 Baltimore Ave., Rehoboth Beach).
Local part-time resident Brian Sparrow is organizing the gathering, citing the need for more Pride-oriented events at the beach.
“I decided to create an event in June for Pride month,” Sparrow told the Blade. “There aren’t many Pride events in Rehoboth and Dewey where we can take advantage of the Rehoboth Bay.”
He noted that there is another event called “Bay Pride” but that it is held in late summer on a Sunday. “Having the event on Saturday will allow for more boat renting options for visitors and friends to join,” Sparrow said, adding that he plans to make this an annual event.
District of Columbia
McDuffie on LGBTQ support and standing up to Trump
‘I’m committed to governing with the queer community at the table’
Former D.C. Council member Kenyan McDuffie is running for mayor as Muriel Bowser’s third term expires in January. He’s running in a crowded Democratic primary field; recent polls show him in second place behind Council member Janeese Lewis George. D.C.’s primary is Tuesday, June 16.
The Blade sat down with McDuffie on June 8 for a wide-ranging conversation about his pro-LGBTQ record and challenges now facing the community.
The Blade reached out to fellow mayoral candidates Lewis George and Rini Sampath, who identifies as queer, for interviews. Neither responded to repeated requests over several weeks.
Blade: Members of the D.C. LGBTQ community are receiving information that most if not all the seven Democratic candidates for mayor, including you and Council member Janeese Lewis George, are strong supporters of the LGBTQ community. What message would you have for LGBTQ voters on why they should support you rather than one of the other candidates?
McDuffie: Thank you for the question, Lou. And thank you for your work over the years with the Washington Blade. I’m really looking forward to having this conversation. You know, Washington, D.C. is the capital of the United States, and our city is one of the most beautifully diverse and inclusive cities in America because generations of LGBTQ+ residents, advocates, and organizations have fought to make it that way.
And throughout my time on the Council, I’ve been proud to support that work by advancing equity and opportunity and standing up for the rights and dignity of every resident across the District regardless of where they live, who they know, how much money they have. And as mayor, I’m going to build on that progress by ensuring D.C. remains a place where LGBTQ+ residents can live safely, where they can access quality healthcare and housing, they can build families and businesses and thrive in the neighborhoods of our city.
And now more than ever, making sure we protect residents from a hostile federal administration, including President Donald Trump, who seeks to roll back civil rights and civil liberties.
Blade: Some people, including members of the LGBTQ community, have criticized Mayor Bowser for what they say has been her position of not standing up forcefully enough against the Trump administration on various issues, including the deployment of National Guard soldiers in the city. What are your thoughts on that? How would you deal with the Trump administration if you were mayor?
McDuffie: Well, I’m going to deal with the Trump administration by prioritizing D.C. residents first. I’m going to stand up and fight back against federal infringement from Donald Trump and from Republicans in Congress or any other individual or organization that seeks to threaten Washington, D.C. residents.
And that means on day one rescind the executive order that permits cooperation between the Metropolitan Police Department and ICE and DHS [U.S. Department of Homeland Security]. And I know because of my work 13-and-a-half years on the Council doing research, authoring transformational legislation that protects people’s civil rights, that makes the Metropolitan Police Department more transparent, doing things like authoring the landmark NEAR Act [a 2016 D.C. law aimed at reducing violent crime].
I know from that work, and I know from my former work as a civil rights attorney in President Obama’s Department of Justice that you have to fight to ensure that we have a fair and more just society. I did that as a civil rights attorney traveling the country fighting to protect people’s civil rights. I did that as a prosecutor who fought crime and delivered justice for victims.
And I’m going to do that as mayor to ensure that we use every legal and political tool available as mayor to resist any federal effort to roll back LGBTQ+ protections in Washington, D.C. And I’m committed to governing with the queer community at the table and lifting up their contributions to this city at the center of every decision that I make as mayor. You know that I’ve been a champion making Washington, D.|C. more equitable, more just, and economically inclusive. And I plan to continue to build on that work that I have done and the work that so many important people have done in the LGBTQ+ community in Washington, D.C. to make sure that our residents can live safely and thrive in Washington, D.C.
And so, we’re going to fight back against Trump and any hostile federal administration to make sure we’re protecting the residents first. And we will work with the federal government where there is an opportunity to do transformational economic development projects like RFK, transformational infrastructure projects like expanding Union Station. Both of those will create thousands of jobs and thousands of opportunities for D.C.-based small businesses.
But I will draw a very bright line when it comes to protecting the civil rights of individuals across the District of Columbia, including the LGBTQ+ community and our vulnerable neighbors like our immigrant neighbors and families who in many cases today are living in the shadows, afraid to leave their homes, afraid to go to work, afraid to walk their kids to school because they’re being snatched off the streets in safe places around schools and places of worship. And it is utterly despicable what Donald Trump has done and how he’s weaponized our federal law enforcement.
Blade: As a follow-up to that, reports surfaced last year that the mayor had to cut the budget for the Office of LGBTQ Affairs for this year by $600,000 because of a large cut in the city’s budget by Republicans in the U.S. House of Representatives. Would you do something to try to restore the funds that were cut from that office?
McDuffie: Absolutely. I will as mayor fully fund the Mayor’s Office of LGBTQ+ Affairs and direct it to proactively identify gaps in city services while also ensuring that the Office of Human Rights has additional resources to vigorously enforce efforts against discrimination across government agencies and within the private sector where it arises. I am a civil rights attorney by training. And I will bring the full force of the District of Columbia government to bear when it comes to protecting the rights of our residents, including especially our vulnerable communities like LGBTQ+ community.
And we’re going to fully fund the Office of LGBTQ+ Affairs and make sure it is doing the work proactively to identify any gaps in services any gaps in resources that are needed to shore up the supports and services to the community. And that’s been my record on the Council, too. As you know, I’ve supported on the Council marriage equality. That I’ve supported helping to repeal D.C.’s anti-surrogacy laws, expanding opportunities for LGBTQ couples.
You know that I’ve supported polices that recognize diverse family structures and co-introduced and passed the birth certificate equality amendment act. I supported efforts to reduce bureaucratic barriers faced by transgender residents. So, that’s the kind of work that I’ve done as a Council member. And as mayor I’m going to really fight and deliver for our LGBTQ+ neighbors to ensure that they’re supported, seen, heard, continue to be woven into the fabric of our city.
Blade: Do you or your campaign have any plans for participating in any LGBTQ Pride events during Pride month?
McDuffie: Oh, we are going to be not only front and center in marching in the Pride parade but being there as a resources to work directly with the organizers to make sure that they have every single thing that they need to build on the strong legacy of Washington, D.C.’s Pride community and all the festivities that are associated with it. I was so proud to stand on the steps of the Wilson Building last year for WorldPride and announce what Washington, D.C. does and how we do it and why we’re so special as a city. And when it comes to supporting Pride this year, I’m going to be right there marching with everybody else and ensuring that the longstanding relationships with the LGBTQ community across the District of Columbia are shown and displayed as our nation’s capital sets the example of what it looks like to really protect the beautiful diversity that we have in our city.
Blade: People have been talking about the poll just released by the Washington Post showing you to be 11 points behind Janeese Lewis George in the race for mayor. Do you have any reaction to that?
McDuffie: Well, what the poll shows is that I have the broadest coalition of support across the District of Columbia. Because I continue to show up and meet residents where they are. That demonstrates whether you are a longtime resident or whether you are Black or white or a member of the LGBTQ+ community. My support in the District of Columbia is deep, and it is broad.
Because I will govern as mayor in the way I have led as a Council member, which is by building the broadest coalition possible, walking across differences and really coming out with solutions to address intractable issues. So, I know that Washington, D.C. has been a national leader when it comes to protecting civil rights and ensuring fairness and justice. And I’ve been one of the people who led on those issues, making our city more racially equitable, more socially just, and more economically inclusive.
Blade: As you know, some of your critics have been trying to link you to the Pepco electric rate increase and for being responsible for higher utility costs. Do you have a response to that?
McDuffie: They try to link me to a number of things that are a part of what is a widespread disinformation campaign much like what we’ve seen on a national level from Trump and other Republicans. I don’t accept it. I think the fact that I’ve been elected four times in the District of Columbia, I demonstrate my ability to work with residents across the District of Columbia to get things done.
When it comes to utilities, I’m going to fight to lower utilities costs for residents, ensuring that we expand renewables and alternative energy sources, recognizing that Janeese Lewis George was the only Council member who voted against expanding solar a couple of years ago. But I’m also going to make sure that we have automatic enrollment for individuals in the District of Columbia who are having trouble paying for the utilities. I will make sure we protect seniors who are feeling a squeeze when it comes to being able to pay for utilities …
And we’re going to make sure that everybody understands why their energy bill is going up and push back against disinformation, so that they understand that a lot of what we’re seeing in increased utility bills, which I also face with my wife, is driven by demand on the regional grid at PJM. It is the data centers that are driving up our costs and lowering supplies. I’m going to hold those data centers accountable to pay their fair share for how they are contributing to the increase in utility costs that residents across the District of Columbia and across the region are seeing on their Pepco bills.
Blade: Thank you for your time. Do you have anything else you may wish to say to conclude your remarks?
McDuffie: Just to be clear that the disinformation campaign that Janeese Lewis George and her supporters are waging is one of the lowest political tactics that we’ve seen in D.C. politics. But she is banking on voters who are not doing their research. And what I know is that D.C. voters are smart. They know me from my work on the Council. And they know I am better qualified on day one to stand up and fight back against Trump to protect home rule and to deliver a city that is safer, that is more affordable and deliver a government that is more accountable and works for residents across the District of Columbia.
District of Columbia
David Archuleta, Monroe Alise named D.C. Pride parade marshals
Honorees ‘live authentically’ and ‘power of sharing your story’
The Capital Pride Alliance has announced that David Archuleta and Monroe Alise will be the grand marshals for the Pride parade on June 20.
Ryan Bos, the Capital Pride Alliance’s president, said the two were chosen for the way that they exemplify the theme “Exist. Resist. Have the Audacity!”
Archuleta is the “American Idol” season 7 runner-up and a strong supporter of the LGBTQ community.
He grew up religious and has been clear about his struggle to reconcile his faith, identity, and self-expression. In 2021, he publicly came out and has since been a major voice for LGBTQ visibility and acceptance. This year, Archuleta published the memoir “Devout,” which details his lived experience as a closeted Mormon teenager.
Alise is a transgender advocate and a D.C. native.
She has appeared in the shows “P-Valley” and “The Chi.” She also grew a major online following through her social media series “I’m CLOCKABLE,” where she discusses topics such as dating, culture, and self-discovery from the perspective of a queer person.
“Together, they represent to live authentically and the power of sharing your story to create change,” Bos said in a statement.
As grand marshals, the two will kick off celebrations leading up to the parade and participate in it. Alise will join the Crack of Noon Parade Brunch from 12-3 p.m. at Viceroy Washington, alongside honorees such as D.C. Mayor Muriel Bowser.
The parade will kick off at 3 p.m. at the intersection of 14th and T Streets, N.W., before moving straight down 14th Street and ending at Pennsylvania Avenue at 7 p.m. The parade is free for anyone to watch at designated viewing areas.
More information about celebrations throughout Pride and the parade can be found at www.capitalpride.org.
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