So far, what we know right now about the resurrection of Trumpcare, or the Zombie American Health Care Act, which today received a thumbs up from the House Freedom Caucus, is that it still eliminates a higher Medicare tax for the wealthy, rolls back Medicaid coverage, allows states to waive essential health benefits and gives states a loophole around community-rating rules, which guarantees insurers charge the same for certain services regardless of gender or preexisting conditions.
Of course, the House Freedom Caucus blocked a vote on the AHCA in March, but with President Donald Trump quickly approaching his 100th day in office, many see this revised health care plan, which includes a GOP-favored approved amendment from New Jersey Representative Tom MacArthur, as nothing more than a last-ditch effort to hand the president a legislative win. Even though the “Zombiecare amendment” is impressing more moderate Republicans, it’s too early to know whether AHCA’s biggest detractors, like leaving 24 million more people uninsured over the next nine years, will sideline it once again.
Maligned by a sordid PowerPoint presentation for dummies by Speaker of the House of Representatives Paul Ryan, the AHCA is still battling a reputation of having been drafted by politicians with little to no knowledge of how health care works. Even in terms of affordability, the GOP seems to lack an understanding of how real people will be affected. Utah Representative Jason Chaffetz’s now-infamous quip about Americans having to choose between insurance and an iPhone illuminated just how little control the GOP has of its pro-AHCA talking points. Debates across the country—and across party lines—about just how severely the new plan will affect people who are uninsured, underinsured or have legitimate financial concerns related to health care are still hot. That’s because the Affordable Care Act has given 20 million previously uninsured Americans coverage.
One story has remained notably absent throughout many fiery deabtes, however: how the AHCA could affect LGBT people. “There has been a lot of talk about the very poor and the elderly,” says Christine Quinn, the first openly gay New York City Council Speaker. “But if you look at all the communities—for instance, women who are uninsured or underinsured or the LGBT community—they may actually just lose their coverage. This act will strip people of options and send us back in time,” she says.
The greatest oversight in limiting access to health care is that the most affected communities are also most susceptible to major health risks.
One of the greatest oversights in terms of limiting access to health care, whether by increasing premiums, rolling back Medicaid or discounting essential health benefits, is that the most affected communities are also most susceptible to major health risks. Statistically, LGBT people smoke more than they should. Many bisexual women don’t get pap smears as often as they should. LGBT people, and specifically transgender people, are more likely to suffer from depression. Gay men, along with people of color, are more likely to contract HIV, meaning they’re more likely to need HIV treatment. “Take away ACA and [those people] lose their support,” Quinn says.
Sean Cahill, director of Health Policy Research at The Fenway Institute in Boston, says that Obamacare cut the uninsured rate among LGBT people in half. According to Fenway Health, an LGBT health care advocacy group, only 17 percent of an estimated 1.2 million Americans living with HIV had private health insurance in 2013, before HealthCare.gov launched. The Centers for Disease Control and Prevention and the Kaiser Family Foundation estimate as many as 22 percent of people living with HIV were uninsured in 2012. By 2014, that rate had dropped to 15 percent following the implementation of Obamacare. But with proposed per-capita blocks on Medicaid, LGBT people could be facing major losses in coverage.
“Our LGBTQ and HIV-positive community stands to lose their health care in exchange for significant tax cuts for the wealthiest among us,” says William Hardy, president of Equitas Health, an Ohio-based not-for-profit healthcare system servicing the LGBTQ community. “What the final iteration of the Republican’s plan will look like is anyone’s guess, but what we do know is that the final version will have a significant impact on LGBTQ and HIV-positive people,” he says.
“Going from city to city, it became clear to me that Medicare disproportionately benefits the LGBTQ community and people with disabilities,” says Arizona doctor Matt Heinz, who previously served in the U.S. Department of Health and Human Services under President Barack Obama. “We currently have the lowest rates of uninsured in history. It’s nonsensical to think that a plan that removes Medicare expansion could go anywhere, but we have no reason to believe that a repeal-and-replace measure will proactively protect these rights.”
The good news is that there is at least one Republican in Congress who seems to be fighting to protect minorities’ access to Medicaid. In March, Ohio Senator Rob Portman, along with four other Republicans, sent a letter to Senate Majority Leader Mitch McConnell in favor of protecting Medicaid expansion programs. “We believe Medicaid needs to be reformed, but reform should not come at the cost of disruption in access to health care for our country’s most vulnerable and sickest individuals,” they wrote. “We will not support a plan that does not include stability for Medicaid expansion populations.”
“Portman is not an outspoken advocate for LGBTQ people,” says Hardy, “but leveraging the Senator’s opposition to the current repeal-and-replace plan, as well as his personal experience with a gay family member, could be an opportunity for action to protect the rights of LGBT people.” But with Trumpcare revised and seemingly hurdling toward a vote, many LGBT advocates fear the frantic effort will only set back marginalized communities further. “If we are to maintain the progress we have made on racial, ethnic and LGBT health disparities, we need to maintain Medicaid expansion and protection against insurance companies discriminating based on pre-existing conditions,” Cahill says.