By Toni G. Atkins
As our community prepares to celebrate LGBTQ Pride in San Diego, we reflect on equality and justice — both in terms of the civil-rights victories we have won and the battles we’re still fighting.
Marriage equality becoming the law of the land two years ago was a watershed moment that we’ll celebrate long into the future, and we’re currently rallying around issues affecting transgender rights.
For example, my bill Senate Bill 179, the Gender Recognition Act, will create a new, non-binary gender marker on state-issued identification documents for people who identify as neither male nor female and will also make it easier for transgender, non-binary and intersex people to obtain IDs that accurately reflect their gender.
But we must also be watchful of how the largest issues facing our country affect our LGBTQ community, such as access to healthcare.
The Affordable Care Act (ACA) has reduced the number of uninsured Americans by more than 20 million, either through the health care exchanges created by the ACA or through the Medicaid expansion that was made possible by the ACA. In California, roughly 5 million more people have insurance, thanks to the ACA. In San Diego County, that number is approximately 350,000. In our state, the ACA is a success story.
The U.S. House of Representatives has passed a bill that would repeal the ACA and replace it with a plan, the American Health Care Act (AHCA), that the Congressional Budget Office (CBO) concluded would result in 23 million people losing coverage by 2026. The U.S. Senate is considering a bill, the Better Care Reconciliation Act (BCRA), that the CBO says would cause 22 million people to lose access to care during the same timeframe.
Clearly, the stakes are high for tens of millions of Americans, and that includes members of the LGBTQ community who stand to lose access to quality health care. According to the Center for American Progress, LGBT people are more likely than non-LGBT people to be living in poverty and to be uninsured. A recent study by The Fenway Institute concluded that the rate of uninsured LGBT people dropped from 22 percent to 11 percent between 2013 and 2015.
These trends are due in large part to the expansion of Medicaid under the ACA. Under the U.S. Senate bill, Medicaid would be cut by $772 billion by 2026, a 26 percent decrease.
Prior to Medicaid expansion, many people with HIV didn’t qualify for coverage until they were disabled — meaning until their condition reached AIDS. In states that expanded the program under the ACA, that barrier was removed, allowing people to receive treatment for HIV. Cutting Medicaid would undermine that progress for the LGBTQ community.
So would dropping the provisions of the ACA that require insurers to cover “essential health benefits,” as is proposed in the Senate bill, and cover people with preexisting conditions.
Specifically, transgender Americans have much to lose. Before the ACA, for example, being transgender was considered a preexisting condition and many health plans refused to cover transition-related care and services. Essentially, the pre-Obama system allowed insurers to discriminate against the transgender community. The ACA changed that — one provision of the law barred discrimination on the basis of sex, which has been interpreted to include gender identity.
Repealing and replacing the ACA will also greatly affect the women in our LGBTQ community. In May, the Kaiser Family Foundation published an exhaustive rundown of how women would be affected, including the impacts of cuts to Medicaid (and repeal of the requirement to provide preventative services under Medicaid, like breast- and cervical-cancer screenings and osteoporosis screenings), defunding Planned Parenthood and allowing states to waive the requirement to cover essential health benefits. Essential benefits include those that are specific to women, such as maternity and new-born care, and those that are more frequently accessed by women, like prescription drugs and mental-health services.
Meanwhile, the stalled progress of national HIV/AIDS policy in America recently caused five members of the Presidential Advisory Council on HIV/AIDS (PACHA) to resign — they realized that they could be more effective by pushing from the outside than by working within the system, which is incredibly disheartening.
With access to care in such peril at the national level, I am fighting for universal healthcare in California. We will not go back.
The theme of San Diego Pride this year is “Allied in Action, United in Justice.” For our community, rolling back access to healthcare is unjust, and we are committed to action.
—Toni G. Atkins (D-San Diego) represents the 39th District in the California Senate and was the first lesbian and the first San Diegan elected as Speaker of the state Assembly. Follow her on Twitter @SenToniAtkins.