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The National Coalition for LGBT Health’s “VOTE for LGBTQ Health!” campaign provides education on LGBTQ health issues to encourage voter registration and LGBTQ voter turnout for the November 3, 2020 general election. 

LGBTQ persons aren’t a homogenous voting bloc; however, candidates who focus on our issues and work to meet our ongoing, unmet needs will benefit at the polls. Yet nearly 1 in 5 of us aren’t registered to vote. The data from this year’s presidential primaries and recent 2018 mid-terms show that the LGBTQ community is showing up in force; and that our voice and our vote matters—especially when it comes to our health.

We hope the LGBT Health Issues Guide will help inform your vote.

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The Patient Protection and Affordable Care Act (more commonly known as the ACA) was passed in 2010. It is a law that established new rules and guidelines on the offering, administration, and acceptance of health care coverage in the U.S. It has expanded basic health insurance and Medicaid access to millions of people who were previously un- or under-insured. The ACA, in its current iteration, requires that insurance plans cover people with pre-existing health conditions—including pregnancy—without charging more for their basic essential health care coverage. It also provides free preventive care and greater access to vaccine care. Young adults also have expanded access to insurance coverage in both individual and employer plans—all the way up to the age of 26. And it ended the lifetime and annual caps on coverage of essential health benefits.

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The Patient Protection and Affordable Care Act (more commonly known as the ACA) was passed in 2010. It is a law that established new rules and guidelines on the offering, administration, and acceptance of health care coverage in the U.S. It has expanded basic health insurance and Medicaid access to millions of people who were previously un- or under-insured. The ACA, in its current iteration, requires that insurance plans cover people with pre-existing health conditions—including pregnancy—without charging more for their basic essential health care coverage. It also provides free preventive care and greater access to vaccine care. Young adults also have expanded access to insurance coverage in both individual and employer plans—all the way up to the age of 26. And it ended the lifetime and annual caps on coverage of essential health benefits.

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Vice President Joe Biden advocates to not only protect the ACA, but also build upon its basics, by expanding health care coverage options (giving Americans a public health insurance option, like Medicare); reducing health care costs (like increasing the value of tax credits to lower premiums and stopping “surprise medical billing” by health plans); and making the health care system easier to navigate (partnering with health care workers to accelerate COVID-19 testing and better deploying innovative treatment and care solutions in all disease states). Vice President Joe Biden will guarantee the ACA’s non-discrimination protections for the LGBTQ community, whereas before the ACA, insurance companies could increase premiums simply based on someone’s gender, sexual orientation, or gender identity—or worse, deny coverage altogether due to someone’s HIV or cancer status. He believes that health care is a right, not a privilege. And he will restore federal funding for Planned Parenthood, a primary and critical link in our health care system that provides quality health care to poor and underserved communities—including reproductive health services, cancer screenings, HIV testing, hormone therapies, and general medical care.

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President Donald Trump opposes the ACA and seeks to overturn it. He advocates for replacing it with an alternative health care plan, though no plan has been outlined. During his term, President Donald Trump worked to repeal the ACA’s individual mandate, which requires all U.S. residents to have health insurance. The Trump administration has also recently issued a rule that would undermine the ACA’s LGBTQ non-discrimination provisions. The rule would allow providers and insurers to deny care to LGBTQ individuals. For example, it includes denying coverage of transition-related procedures and denying coverage of that care when it does not correspond to a person’s sex assignment at birth. The Trump administration has also worked to eliminate Title X funding to Planned Parenthood and is currently asking local Planned Parenthood affiliates around the U.S. to return millions of dollars in loans received through the federal government’s coronavirus relief CARES package.

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Passing the ACA was a huge step forward in expanding access to affordable, quality health care—especially for LGBTQ individuals. But, LGBTQ people are more than twice as likely to be uninsured as non-LGBTQ people. In fact, 15% of LGBTQ are uninsured, compared to 7 % of non-LGBTQ people. And, that’s even higher among Transgender individuals, in particular—with an estimated 25% uninsured compared to just 8% of those who are Cisgender (or persons whose sense of personal identity and gender corresponds with their birth sex). Among our Bisexual community, over 19% are uninsured versus 6% of Gay men. Lesbian women are 4% more likely to be uninsured.

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People living with HIV often face HIV-related or AIDS-related stigma, which presents a barrier to preventing HIV care and prevention utilization services and adherence, and is dramatically linked to low testing rates. 

HIV Statistics

  • Men-Who-Have-Sex-With-Men (MSM) accounted for 69% of all new HIV diagnoses in the U.S.
  • Black/African American MSM accounted for 25% and 38% of diagnoses among all MSM.
  • Hispanic/Latino MSM made up 20% of diagnoses among all MSM.
  • 27% of diagnoses of HIV infection was for Transgender Male-to-Female (MTF) adults and Adolescents aged 25–29 years, followed by the 25% for Transgender MTF adults and adolescents aged 20– 24 years.
  • HIV diagnoses increased among People who Inject Drugs (PWID), with notable increases occurring among white PWID.
  • Nearly 51% of all PLWH were over the age of 50; and 1 in 6 were recently newly diagnosed.
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Vice President Joe Biden has fought for decades to enhance access to care, prevention, and treatment services for Persons living with HIV/AIDS—as well as secure major funding and innovation research funds for HIV/AIDS. He helped pass and expand the Global AIDS program (PEPFAR) and supports Pre-and Post-exposure HIV programs. And he seeks to expand viral Hepatitis testing and treatment. As president, he will re-commit to ending the HIV/AIDS epidemic by 2025. Vice President Joe Biden will update and implement the nation’s comprehensive HIV/AIDS strategy, first launched by the Obama-Biden Administration. This strategy will aggressively reduce new HIV cases, while increasing access to treatment and eliminating inequitable access to services and supports. Vice President Joe Biden also will fully fund the Ryan White HIV/AIDS Program and support increased funding for the Housing Opportunities for Persons with AIDS program. Finally, he has promised to reverse Department of Defense policies that perpetuate stigmatization of and discrimination against people living with HIV. He supports the Repeal HIV Discrimination Act, which promotes best, scientific practices on HIV exposure laws in states. He also will remove the Trump administration’s “Deploy or Get Out” policy, which is used to forcibly discharge

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While President Donald Trump and his administration have made major investments in access to and utilization of HIV care and prevention resources with 2019’s State of the Union announcement on Ending the HIV Epidemic: A Plan for America (EHE) by 2030, 18 of the 48 hotspot counties identified in the EHE plan have still not expanded Medicaid—including some of the most high-occurrence states, such as Mississippi, Alabama, and South Carolina. Under the EHE plan, agencies across the Department of Health and Human Services have worked to pursue this common goal.

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More than 1.2 million people in the U.S. live with HIV. An estimated 36,400 new HIV infections occurred in the United States in 2018, with rates highest in the South and among communities of color. In fact, HIV incidence has remained very stable in 2018 as compared to 2014. Yet, the U.S. government spends $20 billion in annual direct health expenditures for HIV prevention and care. Medicaid is the single biggest source of coverage for Persons Living with HIV (PLH), covering roughly 42% of all Persons Living with HIV in care. A 2017 National Association of State Budget Officers fiscal survey found that two-thirds of those states that reported Medicaid expansion had significant savings in uncompensated care expenses—a 55% drop vs an 18% in non-expansion sates. The Ryan White Program further provides a comprehensive system of HIV primary medical care, essential support services, and medications for low-income people living with HIV who are uninsured and underserved.

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The Equality Act (CR H3931-3934) is a bill that would provide consistent federal non-discrimination protections for LGBTQ individuals in key areas such as: employment, housing, credit, education, public spaces and services, federally funded programs, and jury service. It prohibits discrimination on the basis of sex, gender identity, and sexual orientation.

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Vice President Joe Biden supports the Equality Act. If it were to pass through the Senate, Vice President Joe Biden will direct his Cabinet to ensure immediate and full enforcement of the Act across all federal departments and agencies within the first 100 days. 

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President Donald Trump opposed the Equality Act and has a proven track record of rolling back LBGTQ+ discrimination protections. Under President Donald Trump, the Department of Justice filed a court brief in the Western District of Kentucky, arguing that anti-LGBTQ discrimination is not “a sufficient government interest” to overcome the objections of private businesses who want to deny “expressive” services (such as wedding photography to LGBTQ individuals), and that these businesses must be allowed to opt-out of complying with local non-discrimination laws. Under President Donald Trump, the Department of Health and Human Services announced it would no longer enforce (and planned to repeal) regulations prohibiting discrimination based on: gender identity, sexual orientation, and religion in all HHS grant programs. These include programs to address the HIV, opioid, and youth homelessness epidemics—as well reduce or eliminant hundreds of billions of dollars in other related HHS programs.

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LGBTQ adults reported that they experienced discrimination in the past year. The Equality Act would reduce discrimination by ensuring consistent federal protections. The Act has passed through the House of Representatives but has not been voted on in the Senate. Should the bill pass, its enforcement will be largely dependent upon the executive branch.

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Vice President Joe Biden has promised to appoint a diverse selection of judges to match the diversity of America. He will select judges who are “committed to the rule of law; who understand the importance of individual civil rights and civil liberties in a democratic society; and who respect foundational precedents like Brown vs. Board of Education and Roe v. Wade.”

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President Donald Trump has appointed several anti-LGBTQ judges with alarming regularity during his term. Those with anti-LGBTQ equality records include: Supreme Court Justices Gorsuch and Kavanaugh, and most recently Supreme Court nominee Amy Coney Barrett.

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Amy Coney Barrett has been paid for speeches delivered to the Alliance Defending Freedom group. The Southern Poverty Law Center called the Alliance Defending Freedom organization an ‘anti-LGBTQ hate group’, which supports re-criminalization of homosexuality and works on legislation to allow Gay and Lesbian individuals to be denied goods and services on the basis of religion. Barrett is also opposed to a Woman’s Right to Choose and would undermine or overturn Roe vs. Wade.

The Department of Justice (DOJ) upended previous Obama-era DOJ interpretations of the Civil Rights Act that protects Transgender and non-binary workers from employment discrimination and ceased enforcing non-discrimination protections as well as taking a hostile stance to LGBTQ workers in court.

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Vice President Joe Biden promises to reverse the Trump administration policy that bans Transgender individuals from serving in the military. He will support Transgender and non-binary individuals in the workforce by funding training programs and resources, as well as incentivizing states and local governments to adopt programs preparing Transgender and non-binary people for the workforce. Vice President Joe Biden will also reverse the Trump administration’s proposed rule that would allow homeless shelters to place Transgender individuals based on their sex at birth. 

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President Donald Trump’s campaign does not have an official statement on Transgender rights. During his term, President Donald Trump has rolled back various transgender protections. These include protections for Transgender students and the Obama administration’s policy allowing Transgender individuals to serve in the military. The Trump administration has also issued new rules that undermine Transgender rights, such as a rule requiring Transgender inmates to be housed based on their sex at birth, and a newly proposed rule that would allow federally funded homeless shelters to place Transgender individuals based on their sex at birth.

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The Transgender community faces a disproportionately high amount of discrimination. For example, the majority of LGBTQ homicide victims are Transgender women. The Transgender unemployment rate is double the general population rate, and 90% of Transgender people report experiencing harassment, mistreatment or discrimination on the job. 53% of Transgender people also report being harassed or disrespected in a place of public accommodation. Federal policies that protect Transgender rights are thus crucial for preventing discrimination. Who takes office for the next four years will have a profound impact on the creation and enforcement of such policies.

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Vice President Joe Biden supports the proposed Violence Against Women Reauthorization Act of 2019, which contains additional protections for LGBTQ people, including incarcerated Transgender individuals.

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President Donald Trump’s Secretary of Education, Betsy DeVos, has rescinded Title IX rules related to schools’ obligations to address sexual harassment, impacting LGBTQ communities especially. 

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In the landmark case Bostock vs. Clayton County (June 2020), the Supreme Court ruled that under Title VII of the Civil Rights Act, sexual orientation and gender identity discrimination are prohibited.

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Vice President Joe Biden will reaffirm that the Civil Rights Act prohibits employment discrimination based on sexual orientation and gender identity.

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President Donald Trump’s campaign has not mentioned the Civil Rights Act or the Bostock vs. Clayton County.

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