Two more Supreme Court wins for equality.
By John Wright
Photo by Victoria Pickering
As they eagerly awaited the U.S. Supreme Court’s ruling on same-sex marriage last month, LGBT and HIV/AIDS advocates were celebrating favorable decisions in two other cases.
On June 25, the high court ruled that insurance subsidies are available under the Affordable Care Act (ACA, or Obamacare) to people in states that haven’t set up their own health insurance exchanges, including Texas.
If the high court had decided the subsidies were illegal, it would have effectively gutted the ACA, and 800,000 low- and middle-income Texans, as well as millions of people from other states, would have lost coverage.
Katy Caldwell, executive director of Legacy Community Health in Houston, said the ACA decision is particularly important for people living with HIV/AIDS. Caldwell said Legacy has 8,000 clients who receive subsidized health insurance through the ACA, including 2,000 with HIV. “If they weren’t subsidized, the majority of those people could not afford the health insurance—especially the people living with HIV, because of the medication expense,” Caldwell said. “The coverage they get is so much more comprehensive than trying to piece together healthcare between Ryan White [the federal HIV/AIDS program] and other types of charitable care.”
Caldwell said the ACA has also helped many LGBT people access pre-exposure prophylaxis, or PrEP, which helps them to prevent HIV infection by taking a pill every day. And she said it has allowed many transgender people to access hormone therapy, which is otherwise “incredibly expensive.” Studies show transgender people are more likely to have extremely low incomes, compared to both the general population and the LGBT population.
Scott Schoettes, HIV project director for Lambda Legal, called the court’s 6–3 decision in King v. Burwell “great news” and said it will especially benefit low-income African-Americans living with HIV in the South. “No one should be put at greater risk to the ravages of HIV simply because they live in one of the 34 states choosing not to set up its own health insurance exchange,” Schoettes said.
Lambda Legal joined nine national HIV/AIDS advocacy organizations in filing a friend-of-the-court brief in the case. Lambda Legal counsel Greg Nevins said that when the ACA was enacted, only 17 percent of people living with HIV had private insurance, noting the reduced likelihood of transmission when people have access to consistent care. “Today, the court acted to preserve a key component in the battle against HIV/AIDS—improved access to affordable, reliable, and comprehensive healthcare, an especially critical need for vulnerable communities of color,” Nevins said.
Meanwhile, the court also ruled 5–4 on June 25—in Texas Department of Housing and Community Affairs v. The Inclusive Communities Project—that the Fair Housing Act allows for lawsuits based on whether a law or policy has a discriminatory effect, even though the discrimination may not have been purposeful. “Disparate impact claims under the Fair Housing Act are key to addressing systemic housing discrimination and segregation in the United States, including against LGBT people,” said Sarah Warbelow, legal director for the Human Rights Campaign. “As the LGBT community seeks to gain explicit protections from discrimination based on sexual orientation and gender identity in housing, this decision from the court is welcome news and reinforces this important tool for addressing housing discrimination.”
HRC said that although the Fair Housing Act doesn’t explicitly include sexual orientation or gender identity, many LGBT people who experience discrimination may still be covered under its sex- or disability-discrimination provisions.
Kate Kendall, executive director of the National Center for Lesbian Rights, said that she was “elated” with the decisions. “These two rulings reaffirm the most basic principles of equality, access, and fair dealing,” Kendall said.
In another big win at the federal level last month, the U.S. Office of Personnel Management (OPM) announced on June 23 that starting in January 2016, insurance plans for federal workers can no longer include blanket exclusions of transition-related care. “Until now, the federal government has been providing discriminatory healthcare plans to its trans employees,” said Mara Keisling, executive director of the National Center for Transgender Equality. “With today’s announcement, transgender federal employees can now access healthcare that is so fundamental to their well-being and, in the long term, will make transgender employees happier and more productive workers.”
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