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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

D.C. Council gives first approval to amended PrEP insurance bill

Removes weakening language after concerns raised by AIDS group

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‘This is a win in the fight against HIV/AIDS,’ said Council member Zachary Parker. (File photo courtesy of Earline Budd)

The D.C. Council voted unanimously on Feb. 3 to approve a bill on its first of two required votes that requires health insurance companies to cover the costs of HIV prevention or PrEP drugs for D.C. residents at risk for HIV infection.

 The vote to approve the PrEP D.C. Amendment Act came immediately after the 13-member Council voted unanimously again to approve an amendment that removed language in the bill added last month by the Council’s Committee on Health that would require insurers to fully cover only one PrEP drug.

The amendment, introduced jointly by Council members Zachary Parker (D-Ward 5), who first introduced the bill in February 2025, and Christina Henderson (I-At-Large), who serves as chair of the Health Committee, requires insurers to cover all U.S. Food and Drug Administration approved PrEP drugs.  

Under its rules, the D.C. Council must vote twice to approve all legislation, which must be signed by the D.C. mayor and undergo a 30-day review by Congress before it takes effect as a D.C. law.

Given its unanimous “first reading” vote of approval on Feb. 3, Parker told the Washington Blade he was certain the Council would approve the bill on its second and final vote expected in about two weeks.

Among those who raised concerns about the earlier version of the bill was Carl Schmid, executive director of the D.C.-based HIV+Hepatitis Policy Institute, who sent messages to all 13 Council members urging them to remove the language added by the Committee on Health requiring insurers to cover just one PrEP drug.

The change made by the committee, Schmid told Council members, “would actually reduce PrEP options for D.C. residents that are required by current federal law, limit patient choice, and place D.C. behind states that have enacted HIV prevention policies designed to remain in effect regardless of any federal changes.”

Schmid told the Washington Blade that although coverage requirements for insurers are currently provided through coverage standards recommended in the U.S. Affordable Care Act, known as Obamacare, AIDS advocacy organizations have called on D.C. and states to pass their own legislation requiring insurance coverage of PrEP in the event that the federal policies are weakened or removed by the Trump administration, which has already reduced or ended federal funding for HIV/AIDS-related programs.

“The sticking point was the language in the markup that insurers only had to cover one regimen of PrEP,” Parker told the Blade in a phone interview the night before the Council vote. “And advocates thought that moved the needle back in terms of coverage access, and I agree with them,” he said.

In anticipation that the Council would vote to approve the amendment and the underlying bill, Parker, the Council’s only gay member, added, “I think this is a win for our community. And this is a win in the fight against HIV/AIDS.”

During the Feb. 3 Council session, Henderson called on her fellow Council members to approve both the amendment she and Parker had introduced and the bill itself. But she did not say why her committee approved the changes that advocates say weakened the bill and that her and Parker’s amendment would undo. Schmid speculated that pressure from insurance companies may have played a role in the committee change requiring coverage of only one PrEP drug. 

“My goal for advancing the ‘PrEP DC Amendment Act’ is to ensure that the District is building on the progress made in reducing new HIV infections every year,” Henderson said in a statement released after the Council vote. “On Friday, my office received concerns from advocates and community leaders about language regarding PrEP coverage,” she said.

“My team and I worked with Council member Parker, community leaders, including the HIV+Hepatitis Policy Institute and Whitman-Walker, and the Department of Insurance, Securities, and Banking, to craft a solution that clarifies our intent and provides greater access to these life-saving drugs for District residents by reducing consumer costs for any PrEP drug approved by the U.S. Food and Drug Administration,” her statement concludes.

In his own statement following the Council vote, Schmid thanked Henderson and Parker for initiating the amendment to improve the bill. “This will provide PrEP users with the opportunity to choose the best drug that meets their needs,” he said. “We look forward to the bill’s final reading and implementation.”

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Maryland

4th Circuit dismisses lawsuit against Montgomery County schools’ pronoun policy

Substitute teacher Kimberly Polk challenged regulation in 2024

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(Photo by Sergei Gnatuk via Bigstock)

A federal appeals court has ruled Montgomery County Public Schools did not violate a substitute teacher’s constitutional rights when it required her to use students’ preferred pronouns in the classroom.

The 4th U.S. Circuit Court of Appeals in a 2-1 decision it released on Jan. 28 ruled against Kimberly Polk.

The policy states that “all students have the right to be referred to by their identified name and/or pronoun.”

“School staff members should address students by the name and pronoun corresponding to the gender identity that is consistently asserted at school,” it reads. “Students are not required to change their permanent student records as described in the next section (e.g., obtain a court-ordered name and/or new birth certificate) as a prerequisite to being addressed by the name and pronoun that corresponds to their identified name. To the extent possible, and consistent with these guidelines, school personnel will make efforts to maintain the confidentiality of the student’s transgender status.”

The Washington Post reported Polk, who became a substitute teacher in Montgomery County in 2021, in November 2022 requested a “religious accommodation, claiming that the policy went against her ‘sincerely held religious beliefs,’ which are ‘based on her understanding of her Christian religion and the Holy Bible.’”

U.S. District Judge Deborah Boardman in January 2025 dismissed Polk’s lawsuit that she filed in federal court in Beltsville. Polk appealed the decision to the 4th Circuit.

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District of Columbia

Norton hailed as champion of LGBTQ rights

D.C. congressional delegate to retire after 36 years in U.S. House

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Del. Eleanor Holmes Norton announced she will not seek re-election; her term ends January 2027. (Washington Blade file photo by Drew Brown)

LGBTQ rights advocates reflected on D.C. Congressional Del. Eleanor Holmes Norton’s longstanding advocacy and support for LGBTQ rights in Congress following her decision last month not to run for re-election this year. 

Upon completing her current term in office in January 2027, Norton, a Democrat, will have served 18 two-year terms and 36 years in her role as the city’s non-voting delegate to the U.S. House.

LGBTQ advocates have joined city officials and community leaders in describing Norton as a highly effective advocate for D.C. under the city’s limited representation in Congress where she could not vote on the House floor but stood out in her work on House committees and moving, powerful speeches on the House floor.

 “During her more than three decades in Congress, Eleanor Holmes Norton has been a champion for the District of Columbia and the LGBTQ+ community,” said David Stacy, vice president of government affairs for the Human Rights Campaign, the D.C.-based national LGBTQ advocacy organization.

“When Congress blocked implementation of D.C.’s domestic partnership registry, Norton led the fight to allow it to go into effect,” Stacey said. “When President Bush tried to ban marriage equality in every state and the District, Norton again stood up in opposition. And when Congress blocked HIV prevention efforts, Norton worked to end that interference in local control,” he said.

Del. Eleanor Holmes Norton (D-D.C.) (Washington Blade photo by Jeff Surprenant)

In reflecting the sentiment of many local and national LGBTQ advocates familiar with Norton’s work, Stacy added, “We have been lucky to have such an incredible champion. As her time in Congress comes to an end, we honor her extraordinary impact in the nation’s capital and beyond by standing together in pride and gratitude.”

Norton has been among the lead co-sponsors and outspoken supporters of LGBTQ rights legislation introduced in Congress since first taking office, including the currently pending Equality Act, which would ban employment discrimination based on sexual orientation and gender identity. 

Activists familiar with Norton’s work also point out that she has played a lead role in opposing and helping to defeat anti-LGBTQ legislation. In 2018, Norton helped lead an effort to defeat a bill called the First Amendment Defense Act introduced by U.S. Sen. Mike Lee (R-Utah), which Norton said included language that could “gut” D.C.’s Human Rights Act’s provisions banning LGBTQ discrimination.

Norton pointed to a provision in the bill not immediately noticed by LGBTQ rights organizations that would define D.C.’s local government as a federal government entity and allow potential discrimination against LGBTQ people based on a “sincerely held religious belief.”

“This bill is the latest outrageous Republican attack on the District, focusing particularly on our LGBT community and the District’s right to self-government,” Norton said shortly after the bill was introduced. “We will not allow Republicans to discriminate against the LGBT community under the guise of religious liberty,” she said. Records show supporters have not secured the votes to pass it in several congressional sessions.

In 2011, Norton was credited with lining up sufficient opposition to plans by some Republican lawmakers to attempt to overturn D.C.’s same-sex marriage law, that the Council passed and the mayor signed in 2010.   

In 2015, Norton also played a lead role opposing attempts by GOP members of  Congress to overturn another D.C. law protecting LGBTQ students at religious schools, including the city’s Catholic University, from discrimination such as the denial of providing meeting space for an LGBTQ organization.

More recently, in 2024 Norton again led efforts to defeat an attempt by Republican House members to amend the D.C. budget bill that Congress must pass to eliminate funding for the Mayor’s Office of LGBTQ Affairs and to prohibit the city from using its funds to enforce the D.C. Human Rights Act in cases of discrimination against transgender people.

“The Republican amendment that would prohibit funds from being used to enforce anti-LGBTQ+ discrimination regulations and the amendment to defund the Mayor’s Office of LGBTQ+ Affairs are disgraceful attempts, in themselves, to discriminate against D.C.’s LGBTQ+ community while denying D.C. residents the limited governance over their local affairs to which they are entitled,” Norton told the Washington Blade.

In addition to pushing for LGBTQ supportive laws and opposing anti-LGBTQ measures Norton has spoken out against anti-LGBTQ hate crimes and called on the office of the U.S. Attorney for D.C. in 2020 to more aggressively prosecute anti-LGBTQ hate crimes.

Del. Eleanor Holmes Norton marches in the 1995 AIDS Walk. (Washington Blade archive photo by Clint Steib)

“There is so much to be thankful for Eleanor Holmes Norton’s many years of service to all the citizens and residents of the District of Columbia,” said John Klenert, a member of the board of the LGBTQ Victory Fund. “Whether it was supporting its LGBTQ+ people for equal rights, HIV health issues, home rule protection, statehood for all 700,000 people, we could depend on her,” he said.

Ryan Bos, executive director of Capital Pride Alliance, the group that organizes D.C.’s annual LGBTQ Pride events, called Norton a “staunch” LGBTQ community ally and champion for LGBTQ supportive legislation in Congress.

“For decades, Congresswoman Norton has marched in the annual Capital Pride Parade, showing her pride and using her platform to bring voice and visibility in our fight to advance civil rights, end discrimination, and affirm the dignity of all LGBTQ+ people” Bos said. “We will be forever grateful for her ongoing advocacy and contributions to the LGBTQ+ movement.”

Howard Garrett, president of D.C.’s Capital Stonewall Democrats, called Norton a “consistent and principled advocate” for equality throughout her career. “She supported LGBTQ rights long before it was politically popular, advancing nondiscrimination protections and equal protection under the law,” he said.

“Eleanor was smart, tough, and did not suffer fools gladly,” said Rick Rosendall, former president of the D.C. Gay and Lesbian Activists Alliance. “But unlike many Democratic politicians a few decades ago who were not reliable on LGBTQ issues, she was always right there with us,” he said. “We didn’t have to explain our cause to her.”

Longtime D.C. gay Democratic activist Peter Rosenstein said he first met Norton when she served as chair of the New York City Human Rights Commission. “She got her start in the civil rights movement and has always been a brilliant advocate for equality,” Rosenstein said.

“She fought for women and for the LGBTQ community,” he said. “She always stood strong with us in all the battles the LGBTQ community had to fight in Congress. I have been honored to know her, thank her for her lifetime of service, and wish her only the best in a hard-earned retirement.”

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