Gutting the Affordable Care Act Will Devastate the LGBT Community

There is a myth out there known as Gay Affluence — a myth that LGBT people are wealthier or more affluent than the population at large. This myth, while common in marketing campaigns, has no actual basis in fact. LGBT people have higher rates of poverty across all populations, including among transgender people, who are four times more likely than non-transgender people to have an annual income of less than $10,000. LGBT people, and particularly LGBT young people, suffer from higher rates of homelessness. LGBT people are less likely to have family support, which means seniors are more at-risk for falling into isolation and suffering illnesses like dementia.

And, prior to the Affordable Care Act, LGBT people were less likely than the population as a whole to have health insurance. There were a number of reasons why this was the case, including pre-existing condition exclusions that prevented people living with HIV from accessing health coverage and the obscenely high unemployment rate in the transgender community.

With the passage of the Affordable Care Act, we began to see a change in these statistics. For example, we saw Medicaid coverage of people living with HIV increase significantly nationwide. LGBT people, in general, benefited tremendously from the ACA.

Donald Trump and Congress are now pursuing the demolition of the Affordable Care Act, and their proposal is estimated to throw tens of millions of people off their healthcare insurance. Just as the LGBT community has benefited significantly from the Affordable Care Act, we will be disproportionately impacted if Trump and company are successful in this endeavor. While each and every one of the projected 24 million people to be thrown off healthcare represents a tragedy, the LGBT community will be dramatically impacted by the gutting of the ACA.

(Video: My remarks on the Senate floor about health impacts on the LGBT community of gutting the Affordable Care Act)

People living with HIV will be devastated by a loss of access to medication. With improvements in treatment, HIV is no longer the death sentence it once was in the 1980s and 1990s. But, people living with HIV are often seniors and lower-income people who cannot afford their medication without insurance. If these people lose their insurance, they will lose access to medication, and they will get sick. HIV death rates will, tragically, start to increase again.

We will also see more people contract HIV. Right now, people who are living with HIV can use medication to reduce the likelihood that they will transmit HIV by suppressing their viral load. Indeed, an HIV-positive person on medication can become essentially non-infectious due to viral suppression. By eliminating access to this medication, the Trump demolition of the ACA will lead to an increase in HIV infections as people living with HIV become more infectious.

HIV infections will also rise due to reduced access to pre-exposure prophylaxis or “PrEP,” a once-daily pill that reduces risk of HIV infection by about 99%. PrEP is not cheap, and as someone who is on PrEP, I know how important insurance is to be able afford this powerful HIV-preventative. By reducing the number of people who have insurance, we will see fewer people being able to afford PrEP and increased rates of HIV infection.

It doesn’t end with HIV. Under the Affordable Care Act, transgender people, who have historically faced discrimination from the insurance industry, are guaranteed equal treatment by insurers. Many will lose that coverage. Lesbians, who have been found to suffer from higher rates of breast cancer, will lose access to treatment and prevention. LGBT seniors, who often don’t have children to take care of them, will have reduced access to healthcare, since seniors will be most impacted by the ACA repeal. LGBT young people who are living on the streets or marginally housed will struggle to access the care they need.

The Trump/Congress plan to gut the Affordable Care Act will harm many millions of Americans. LGBT people will be particularly harmed. We must stop this train wreck before it happens.

CA State Senator. Urbanist. Environmentalist. Advocate for transit, housing, clean energy, criminal justice reform, health, ending poverty. Democrat. 🏳️‍🌈

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