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What’s next for health care reform?

After court ruling, focus turns to state plans for Medicaid

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Now that the Supreme Court has upheld the constitutionality of President Obama’s health care reform law, advocates are pushing for additional efforts to extend coverage of the law to LGBT people and people with HIV/AIDS to the fullest extent possible.

For the most part, the next step in the process involves looking to the states to determine whether they will adopt health policies afforded to them under the law — foremost among them is the Medicaid expansion to cover all people with incomes up to 133 percent of the federal poverty level.

Although the Supreme Court ruled the majority of the health care law is constitutional, it prevented the federal government from withholding all Medicaid funds from states if they decline to take part in the Medicaid expansion. As a result, states can decide whether or not to enter the expansion without fear of losing money.

Patrick Paschall, a policy advocate at the National Gay & Lesbian Task Force, said the Medicaid expansion is particularly important for LGBT people because they disproportionately live below the poverty level.

“The Medicaid expansions are going to end up being hugely important for LGBT people because it expands coverage to low-income people, and LGBT people are disproportionately low-income,” Paschall said. “We know this because of rampant employment discrimination and housing discrimination.”

A report on transgender people published earlier this year by the Task Force and the National Center for Transgender Equality, titled “Injustice at Every Turn: A Report of the National Transgender Discrimination Survey,” found that transgender people experience unemployment at rates twice that of the national population, and black transgender people experience it at a rate of four times as much.

Carl Schmid, deputy executive director of the AIDS Institute, said the Medicaid expansion is particularly important for people with HIV/AIDS because of 50 percent of those in care rely on that program for support and those numbers will “grow substantially” if states decide to participate.

“Those who are really poor, they’re going to be covered under Medicaid,” Schmid said. “The question is what are we expecting from the states.”

But a number of states may not take part. According to a report in The Hill newspaper, at least 15 governors have signaled they won’t participate in the Medicaid expansion now that the Supreme Court has enabled them to wiggle out of participation.

Florida Gov. Rick Scott, a Republican elected to office during the Tea Party wave in 2010, was among those saying his state wouldn’t take part in the Medicaid expansion — or other parts of the health care law that are optional to the states.

“We’re not going to implement Obamacare in Florida,” Scott said last week on Fox News. “We’re not going to expand Medicaid because we’re going to do the right thing. We’re not going to do the exchange.”

Under the health care reform law, the federal government will pay for the Medicaid expansion for the first few years. Expenses for states come up in 2017, when the federal government will pay 95 percent; That’s reduced to 94 percent in 2018 and in 2019 it goes down to 93 percent. Starting in 2010 and then on out, the federal government will pay 90 percent of the total amount.

Schmid said the bargain that was set up for states under the health care law makes the governors’ decision not to participate in the law questionable.

“Here their taxpayers are going to be paying their taxes to pay for this; this is federal funds,” Schmid said. “Their state is not going to take responsibility for covering. The hospitals? Don’t they want people to be covered? They’re going to have unconstituted care if they don’t.”

For the states that don’t participate in the Medicaid expansion, Schmid said people living there with HIV/AIDS will have to continue relying on the Ryan White Care Program, which provides funds for AIDS medications for low-income people with HIV. The program will be up for reauthorization in 2013.

As advocates push for states to adopt the Medicaid expansion, the law has several key components that already offer protections and benefits for LGBT people and people with HIV/AIDS. State and federal health insurance will be set up in the law starting in 2014.

For the first time, the law extends federal non-discrimination protection in the health care system on the basis of gender.

Paschall noted that provision is key as courts and agencies have determined that discrimination against transgender people amounts to gender discrimination.

“We know that federal agencies like the Equal Employment Opportunity Commission, the Department of Housing & Urban Development as well as federal courts have interpreted sex-based discrimination to include protections on the basis of gender identity and sex stereotypes,” PaschallĀ said. “What this means is that in the context of health care, LGBT people, especially transgender people have now for the first time protections in that setting, which is hugely important.”

Earlier this year, the Department of Health & Human Services issued rules saying that no program activity in an exchange, nor a health plan, can discriminate on the basis of sexual orientation and gender identity. The rule takes effect when exchanges open in 2014.

The administration has taken additional efforts to help the LGBT community when it comes to accessing health care.Ā Same-sex couples can now search for health plans that cover domestic partners through the health care finder tool at healthfinder.gov. HHS has also undertaken data collection efforts to include questions about sexual orientation and gender identity in surveys like theĀ National Health Interview Survey.

Still, advocates are looking for additional efforts from the administration — in addition to the adoption of the Medicaid expansion by the states — to ensure LGBT people are included in health care reform to the greatest extent possible.

Paschall said the Task Force wants to see data collection efforts expanded beyond the federal surveys already designated by the administration.

“Generally speaking, we would like to see sexual orientation and gender identity questions added to all federal surveys where demographic data is collected,” he said. “Our priorities include a number of federal surveys, maybe most notably the American Community Survey, which is an annual survey that collects demographic data and is considered one of the largest annual data sources on the American population.”

Paschall continued, “We’re also working with them to ensure that those questions are developed and included in other federal health surveys across the board so that we can have more data in more areas identify where those disparities are.”

For people living with HIV/AIDS, Schmid said he is awaiting from the administrationĀ regulatory guidance in the next couple months on essential health benefits to cover people in the Medicaid program and federal exchanges.

“We’ll see if the coverage will be strong enough for medications and for all different other services,” Schmid said.

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U.S. Supreme Court

Supreme Court to hear Md. religious freedom case on Tuesday

Advocacy groups to rally outside during Mahmoud v. Taylor oral arguments

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U.S. Supreme Court (Washington Blade photo by Michael Key)

Activists on Tuesday will hold a rally in front of the U.S. Supreme Court as the justices hear oral arguments in a case that will determine whether schools are violating parents’ religious freedom by not letting them opt their children out of learning about LGBTQ-specific topics.

Mahmoud v. Taylor is a case out of Montgomery County about parents who wish to opt their children out of LGBTQ-themed lessons in public schools for religious reasons.Ā 

Montgomery County Public Schools, after initially allowing parents to opt their children out, changed the policy in March 2023.

The plaintiffs — Tamer Mahmoud, Enas Barakat, and other parents — argue ā€œthe storybooks were chosen to disrupt ā€˜cisnormativity’ and ā€˜either/or thinking’ among students.ā€ 

ā€œThe board’s own principals objected that the curriculum was ā€˜not appropriate for the intended age group,’ presented gender ideology as ā€˜fact,’ ā€˜sham[ed]’ students with contrary opinions, and was ā€˜dismissive of religious beliefs,ā€™ā€ according to the petition on the Supreme Court’s website. 

The petition goes further, saying the parents are ā€œnot challenging the curriculum, but arguing that compelling their elementary-age children to participate in instruction contrary to their parents’ religious convictions violated the Free Exercise Clause. Construing Wisconsin v. Yoder, the 4th Circuit found no free-exercise burden because no one was forced ā€˜to change their religious beliefs or conduct.ā€™ā€

The Coalition for Inclusive Schools and Communities, an organization that aims to bring together ā€œadvocates, educators, families, and organizations committed to inclusive, affirming, fact and science-based education,ā€ will participate in the ā€œRally for Inclusive Educationā€ rally outside the Supreme Court alongside Live In Your Truth and the Montgomery County Pride Family.

ā€œInclusive education isn’t just a value — it’s a necessity,ā€ said Phillip Alexander Downie, co-chair of the Coalition for Inclusive Schools and Communities and CEO of Montgomery County Pride Family. ā€œThe right of every child to learn in an environment where they see themselves reflected, affirmed, and respected is under attack. This rally is our moment to protect that right — and ensure future generations inherit classrooms rooted in truth, equity, equality, and justice.ā€

The Coalition for Inclusive Schools and Communities says the rally is a ā€œnonpartisan community gathering rooted in education, advocacy, and solidarity.ā€ 

ā€œThe focus of this event is to uplift the importance of inclusive learning environments, celebrate the power of diversity in our schools, and amplify the voices of those most impacted by exclusionary practices and rhetoric,ā€ it said.

The rally will feature speakers from across the country, including students, educators, civil rights leaders, and authors who will give their own testimonies as to why it is important to have inclusivity in primary education. Trans Maryland, the National Women’s Law Center, MoCoPride Center, and Authors Against Book Bans are among the LGBTQ groups sponsoring the event.

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National

EXCLUSIVE: Rodrigo Heng-Lehtinen to step down from Advocates for Trans Equality

A4TE formed last year when two transgender rights groups merged

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Rodrigo Heng-Lehtinen (Photo courtesy of Rodrigo Heng-Lehtinen)

Advocates for Trans Equality Executive Director Rodrigo Heng-Lehtinen on Monday announced he will step down on April 30.

The Transgender Legal Defense and Education Fund and the National Center for Transgender Equality formed Advocates for Trans Equality last year when they merged. Heng-Lehtinen was previously NCTE’s executive director.

ā€œNow that we’ve made it through the merger, and A4TE is established as a new, prominent institution fighting hard for trans equality, it’s time for me to take my next step,ā€ said Heng-Lehtinen in a press release that Advocates for Trans Equality sent exclusively to the Washington Blade. ā€œWhen Andy (Hong Marra) and I began envisioning the merger, I committed to seeing it through. I’m proud that now our vision has been realized. A4TE has not just launched, but is fully up and running, delivering results for trans people around the country. With A4TE gaining momentum, I’m now ready to move on to my next chapter.ā€  

Heng-Lehtinen, whose mother is former Florida Congresswoman Ileana Ros-Lehtinen, in the press release stressed he “will be focusing on changing hearts and minds.”

“With my background in persuasion and messaging, it’s where I can make the biggest difference, and what I feel called to return to in this era of anti-trans backlash,” said Heng-Lehtinen. “I will still be fighting shoulder-to-shoulder with everyone (in) the trans movement, simply in a different capacity.”

Marra, who is Advocates for Trans Equality’s CEO, praised Heng-Lehtinen and said the organization’s work will continue.

ā€œWe thank Rodrigo for his years of dedicated leadership and service,ā€ said Marra. ā€œA4TE will continue to deliver on our promise to advocate for the lives of trans people who need us now more than ever. We remain undaunted by our endeavor to ensure trans people and our families are no less than free and equal and treated with dignity and respect.ā€Ā 

Louisiana Trans Advocates Executive Director Peyton Rose Michelle also praised Heng-Lehtinen.

“Rodrigo has been a steady hand and a bright light in this work,” she said. “He’s someone who shows up with integrity, kindness, and a deep commitment to meeting this political moment with courage. I’ve always felt deeply supported and heard by him, which is something I value deeply.ā€

ā€œI fully support him as he steps into this new chapter, and I know his clarity of vision and heart-forward leadership will keep shifting this landscape back toward justice for trans people, and therefore, all people,” added Michelle. 

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U.S. Federal Courts

Federal judge blocks Trump passport executive order

State Department can no longer issue travel documents with ‘X’ gender markers

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(Bigstock photo)

A federal judge on Friday ruled in favor of a group of transgender and nonbinary people who have filed a lawsuit against President Donald Trump’s executive order that bans the State Department from issuing passports with “X” gender markers.

The Associated Press notes U.S. District Judge Julia Kobick in Boston issued a preliminary injunction against the directive. The American Civil Liberties Union, which represents the plaintiffs, in a press release notes Kobick concluded Trump’s executive order “is likely unconstitutional and in violation of the law.”

“The preliminary injunction requires the State Department to allow six transgender and nonbinary people to obtain passports with sex designations consistent with their gender identity while the lawsuit proceeds,” notes the ACLU. “Though today’s court order applies only to six of the plaintiffs in the case, the plaintiffs plan to quickly file a motion asking the court to certify a class of people affected by the State Department policy and to extend the preliminary injunction to that entire class.”

Former Secretary of State Antony Blinken in June 2021 announced the State Department would begin to issue gender-neutral passports and documents for American citizens who were born overseas.

Dana Zzyym, an intersex U.S. Navy veteran who identifies as nonbinary, in 2015 filed a federal lawsuit against the State Department after it denied their application for a passport with an ā€œXā€ gender marker. Zzyym in October 2021 received the first gender-neutral American passport.

The State Department policy took effect on April 11, 2022. Trump signed his executive order shortly after he took office in January.

Germany, Denmark, Finland, and the Netherlands are among the countries that have issued travel advisories for trans and nonbinary people who plan to visit the U.S.

ā€œThis ruling affirms the inherent dignity of our clients, acknowledging the immediate and profound negative impact that the Trump administration’s passport policy would have on their ability to travel for work, school, and family,ā€ said ACLU of Massachusetts Legal Director Jessie Rossman after Kobick issued her ruling.

ā€œBy forcing people to carry documents that directly contradict their identities, the Trump administration is attacking the very foundations of our right to privacy and the freedom to be ourselves,” added Rossman. “We will continue to fight to rescind this unlawful policy for everyone so that no one is placed in this untenable and unsafe position.ā€

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