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Will health reform make AIDS groups obsolete?

HIV clinics face new competition as clients obtain insurance by 2014

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‘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.”

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District of Columbia

To school to homeschool to school again

‘Pandemic took more than 2 years of school. It took 2 years of my childhood’

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Gloria Collazo Huamani studying at home during the COVID-19 pandemic (Photo courtesy of Gloria Collazo Huamani)

It wasn’t until I no longer had those 30 minutes of lunch and recess, when all the boys and girls would come together to trade bracelets, make up games, gossip about who we liked, play tag and sports, that I realized how much of my childhood happened during the parts of school that had nothing to do with schoolwork. 

I was in the third grade when the COVID-19 pandemic began. I remember my parents explaining that I couldn’t go back to school and wondering when I would see my friends again — or whether I wanted to go back at all. But after spending two years learning from home, cut off from the friends, teachers and routines I had known, I began to understand what I had lost. 

For many of my friends and classmates, going to school changed from a bus ride every morning to clicking a link and seeing their teachers and classmates through a screen. My experience was a little different. Instead of going to virtual school, I was homeschooled. My new routine was sitting at my kitchen table, with my mom teaching me how to write a paragraph or solve a math problem, surrounded by the same walls I saw every day. 

My family was not alone. Many families across the country turned to homeschooling after schools shut down. Homeschooling increased sharply during the pandemic, especially among Black families, rising from 3.3 percent in the spring of 2020 to 16.1 percent that fall, according to the U.S. Census Bureau’s Household Pulse Survey.  

It would be two years before I entered a classroom again.

At first, I loved homeschooling.

I didn’t have to wake up early or put on a uniform. I liked the comfort of my own room, surrounded by my stuffed animals and toys. I didn’t have to push my way through that horrible lunch line because my food was now waiting for me at the kitchen table. 

It felt like a fever dream where school was canceled and all day was fun. That was my view as a 9-year-old. 

But as days turned into weeks and weeks into months, that initial excitement wore off.

Every day became the same routine. There was no recess when I could play princess with all the other girls. There were no conversations in the lunch line and none of the small things that had broken up the school day before. I didn’t realize how much those moments mattered until I could no longer experience them. 

With less to look forward to, I started spending more time on the internet. 

I turned to platforms such as YouTube and TikTok to distract myself. Instead of seeing what the kids around me were doing every day, I could watch people online show off their clothes, makeup, dances, art and lives. 

Over time, I started comparing myself with what I saw. I thought the way I dressed was childish and wanted to be like the superstars I saw online. I followed what was trendy and admired the girls and boys who looked so confident on screen.

Before the pandemic, my friends and I didn’t need the internet to tell us what was popular. But during those years at home, I became much more aware of what other people thought was cool and what someone my age was supposedly supposed to like. I felt as though I was growing up without getting to experience all the steps in between. 

When I finally returned to school, I thought my classmates would be excited to see each other again after spending so much time apart. 

Instead, I realized how much we all changed. 

When I walked through those doors, I remembered vague memories of running down those halls and always seeing my peers with smiles on their faces. Now those same faces were tired, with eye bags. The lunchroom, which used to be full of life with happy kids eating to their hearts’ content, turned into a lunch where all the girls controlled what they ate and talked about the latest trend on TikTok.

Maybe some of that change would have happened anyway. Kids grow up. Interests change. Middle school has always been awkward.

But I didn’t get to watch my classmates gradually change or change alongside them. I left one social world and came back to another.

When I returned, I was expected to understand a social world that had changed while I was gone. I felt I missed so much that I would never get back, and without that day-to-day learning to help me adapt to these new norms, I struggled.

Those everyday interactions are an important part of how children learn to get along with others: A 2026 meta-analysis of 157 studies from 33 countries published in the academic journal Child Development found that children’s social and emotional skills declined during the pandemic, along with their overall well-being. The researchers noted that schools are not just places where children learn math and reading. They are also places where children learn how to make friends, work through disagreements, understand other people’s feelings and manage their own emotions.

Years later, many parents say some of those effects are still being felt. In a 2025 Gallup survey, 45 percent of parents with school-age children said the pandemic hurt their child’s social skills, and 22 percent said those problems were still ongoing. Forty-two percent said the pandemic negatively affected their child’s mental health. Parents were more likely to report problems with their children’s social skills and mental health than with their academics or physical health.

I saw some of those changes around me, too. Classmates who once seemed outgoing became quieter or more withdrawn. Starting conversations felt harder. Making new friends felt harder. Sometimes retreating into myself felt easier than trying to figure out where I belonged.

Now, the kids who were in elementary school when the pandemic began are moving through high school. We are older, but some of us are still figuring out what those missing years meant.

Before the pandemic, I thought lunch and recess were simply breaks from learning. Now I understand that we were learning during those 30 minutes, too. We were learning how to make friends, how to disagree and make up, how to be embarrassed and recover from it, what we liked and what we didn’t, and slowly who we wanted to become.

I can’t know exactly who I would be if I had spent those years inside a classroom instead of at home. Maybe middle school still would have been awkward. Maybe I still would have worried about fitting in.

But I know I missed something I didn’t understand was important until it was gone: the ordinary, sometimes boring, sometimes ridiculous parts of growing up alongside other kids.

You can make up schoolwork. You can return to the classroom. But there are some parts of childhood you don’t get to repeat.

Gloria Collazo Huamani is a sophomore at Benjamin Banneker Academic High School in D.C., one of Youthcast Media Group’s journalism class partners. Gloria worked with James Jarvis, a YMG mentor-editor and reporter for Inside Health Policy, on this story.

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Virginia

Gay Va. couple hopeful voters will enshrine marriage equality in state constitution

Early voting has already begun in the state

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Virginia flag flies over the state Capitol. Voters this year will consider a proposed amendment that would enshrine marriage equality in the state's constitution. (Washington Blade photo by Michael Key)

A referendum on whether to enshrine marriage equality in Virginia’s constitutional amendment is on the ballot this year.

If voters approve Question 2, it will codify the U.S. Supreme Court’s Obergefell ruling in 2015 that extended marriage rights to same-sex couples across the country — gays and lesbians have been able to legally marry in Virginia since Oct. 6, 2014.

Ron Bookbinder and James Fisher are a married couple who live in Arlington.

They have been together for 38 years — Bookbinder and Fisher married in 2014.

“We think this is a critical vote to remove this discriminatory language from the constitution and to ensure that going forward, no matter what happens, the state of Virginia will ensure marriage equality,” Fisher told the Washington Blade. “It is it is really difficult and upsetting to think that our current state constitution would prohibit same-sex marriage, even though the federal government overrides that now. There’s no saying what may happen in the future.” 

Bookbinder said it was important for him and Fisher to get married “to gain social equality.”

“I was surprised how good it felt, how important it was to begin to say, ‘my husband rather than my partner,'” Bookbinder said.

Bookbinder then explained why it feels good to be married.

“Is it a legal partner, a business partner, a tennis partner, you know, or a romantic partner? But when you say my husband James, everyone knows exactly what you mean and confers an equal status with everyone else who’s married, and we were both surprised at how good it felt and how equal it felt to suddenly be married and be able to state that you were married and discuss your husband rather than your partner, and I would hate to lose that,” he said. 

Bookbinder and Fisher said they are hopeful that voters will approve the amendment, noting Virginia has become more progressive over the years.

“I think people have, with the Supreme Court decision, people have seen that a same-sex marriage is just a marriage,” stated Fisher. “It’s just two people who love each other, and I think more and more people have attended a same-sex marriage, someone in their family or a friend, and the experience of what this is, firsthand experience, is so important in shaping people’s opinions, and I think the period of time that we’ve had since the Obergefell decision has given a lot of voters that experience, which I think is really important and powerful.” 

The couple also said the push to enshrine marriage equality in Virginia’s constitution is in response to the Trump-Vance administration.

“And I think due to President Trump doing all the horrible things he’s done to so many groups, including LGBTQ, especially trans people, that Virginians are kind of pushed to be even more progressive to protect those who need protection, which would include the LGBTQ community in terms of marriage equality, so I’m confident it will pass,” said Bookbinder. 

Narissa Rahaman, executive director of Equality Virginia, sent the Blade a statement about early voting on Question 2 that has already begun.

“With early voting now underway, our focus is making sure every Virginian knows Question 2 is on their ballot,” said Rahaman. “The outdated ban on same-sex marriage still in Virginia’s state constitution leaves a gap in protections for the thousands of same-sex couples that call this state home, but after 20 years we have the chance to fix it.” 

Log onto www.mobilize.us/vaformarriage to find out more about the campaign in support of Question 2.

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Baltimore

Baltimore’s oldest gay bar to reopen this week

Leon’s owner Ron Singer died in July

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Leon’s, the oldest gay bar in Mount Vernon, will reopen Wednesday. (Photo by Kaitlin Newman for the Baltimore Banner)

By JOHN-JOHN WILLIAMS IV | Those legendary heavy-handed pours, spirited karaoke and trivia nights, and groan-worthy wall-to-wall patrons on packed nights are back!

Leon’s will live to see another day.

Baltimore’s oldest gay bar, which opened in the 1950s, closed in July following the death of its owner, Ron Singer.

The rest of this article can be read on the Baltimore Banner’s website.

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