The General Election is November 5! We want to ensure your Election Day runs as smoothly as possible. We have some resources to consider when planning your Election Day.
For our Trans and non-binary voters, Advocates for Trans Equality has a Voting Guide to help you prepare for Election Day. The ACLU Illinois also has a know-your-rights guide to help all voters in Illinois navigate the polls on election day and provide information on how to report any issues while voting.
There are several topics to consider when casting your ballot. To help prepare you for Election Day, we’ve assembled several blogs discussing important topics surrounding the Election, including a blog discussing what Project 2025 is and how Project 2025 could affect your healthcare. There are also blogs on the state of anti-LGBTQ+ legislation in 2024, access to housing, the dire need to increase funding for community health centers like Howard Brown, and the importance of school board elections.
Key Issues This Election
Tell Legislators to Support Reproductive Treatments for LGBTQ+ Families: On your ballot this November there will be a non-binding advisory question regarding insurance coverage for medically assisted reproductive treatments. While this question is not binding, it will serve as a way for Illinois legislators to better understand your needs and concerns around family planning. This is especially important for LGBTQ+ families as the cost associated with having a family can often be much higher for queer couples. It is critical for Illinois voters to understand what the assisted reproductive question is and how it connects to the expansion of family planning services for LGBTQ+ couples.
Decoding Project 2025: Fight Back Against this Anti-LGBTQ+ Agenda: Project 2025’s goal is for extreme conservative ideals to be enacted across multiple Federal agencies, to inform state legislation, and to train appointees in its conservative tenets through an online “education academy.” Project 2025 is comprised of numerous harmful policy proposals that would harm access to healthcare, economic security, and social services support, especially for already vulnerable and marginalized communities. Project 2025 specifically targets LGBTQ+ people and lays out a clear plan to erode or eliminate non-discrimination protections for LGBTQ+ people.
Decoding Project 2025: A Danger to Healthcare Access: Project 2025 is a comprehensive plan to enact extreme conservative policies that would reduce access to healthcare, economic security, and social services support. Project 2025’s goal is for conservative ideals to be enacted across every level of federal and state government. One of the primary goals of Project 2025 is to reduce access to necessary healthcare services specifically for LGBTQ+ people and other marginalized communities.
Safe Spaces: Combating Housing Disparities for LGBTQ+ Individuals: Homelessness and unstable housing in Chicago is one of the largest issues among LGBTQ+ and people living with HIV (PLWH). Social and economic barriers, including anti-LGBTQ+ housing discrimination, have long been a barrier to the safety and welfare of queer and trans people. There is a need for increased funding for affordable housing and cultural competency training for shelters, landlords, and housing providers to help eliminate the housing crisis among LGBTQ+ people.
Funding The Future of Healthcare: Community Health Centers (CHCs) are vital providers of healthcare in the United States, providing care to around 31 million people annually. CHCs provide affordable, high-quality, comprehensive primary care to medically underserved populations regardless of insurance status or ability to pay. Most CHC patients are people of color, and the vast majority are low-income. Learn more about CHC funding issues and how you can help support the critical work of CHCs
Beyond The Ballot: Vote For Chicago’s First Elected School Board:This November, Chicago will hold elections for the Chicago Board of Education (CBE) for the first time. Based on a law passed in 2021, the Chicago Board of Education will transition from a seven-member board appointed by the mayor to a 21-member elected board. This will eventually make the CBE the largest school board in any major city. The CBE oversees Chicago Public Schools (CPS), a large public school system that educates an average of 325,000 students annually. Learn more about this important and historical decision for voters this November.
Beyond the Ballot: Fueling Acceptance for LGBTQ+ Students in Our Schools: School boards are responsible for a wide range of academic, legal, and financial issues impacting our students’ quality of education. For example, boards often approve curricula, evaluate student achievement, and oversee the hiring of superintendents; all of the day-to-day things that impact our children’s lives. As such, their decisions have far-reaching consequences for students, families, and communities. Understand how school boards function and be as informed as possible on who should be on your community’s school boards when it comes time to vote.
Important Things to Keep in Mind
Get Ready to Vote: Rights to Accommodations: To help ensure that everyone is able to access voting in this upcoming election, below are some special circumstances and ways to prepare yourself or someone you know to vote in November.
Understand the State and Local Positions on your Ballot: With the variety of local, county, and state positions on our Midterm ballots, it is essential to understand and be informed about how these elected officials may impact your life!
Judges are on the Ballot: When it comes to advancing equitable and affordable healthcare for all, the idea of judges and court systems does not always immediately come to mind. However, the judicial system can have a profound impact on civil rights and access to healthcare, especially for marginalized populations like the LGBTQ+ community. Especially with the current surge of anti-LGBTQ+ political attacks, it is more important than ever to make your voice heard
To learn more about how Howard Brown Health contributes to vital advocacy work and has an impact on local, state, and federal policymaking, please visit our Advocacy webpage.
Celebrating 50 Years of Howard Brown Health
Following two years of service to the community beginning in 1974, Howard Brown Health was officially incorporated as a non-profit organization in the State of Illinois. In that document, our founders laid out our core purpose:
“To provide health care and related services without regard to affectional or sexual preference”
We’ve come a very long way in the decades since then, maturing from a tiny office above a market to a network of healthcare centers across Chicago. From the very beginning, our community members have turned to Howard Brown for compassionate, high-quality care when urgent health needs arise.
In good times and in bad, Howard Brown’s doors have always been open, ready to serve the unmet needs of our patients with our focused approach to medicine. As the needs of our community have grown and changed, so have we. We’ve grown to support our community by ensuring an inclusive, comforting healthcare experience for all. Howard Brown is turning 50, but our story is only just beginning.
After decades in the fight for our lives, we know what it’s like for the people we love to be lost too soon, and we don’t take growing old for granted. The concept of growing old was revolutionary when we helped develop the first hepatitis B vaccine. And during the AIDS epidemic, many of the youngest and most vibrant among us were not given the chance to reach old age.
Today, we continue to fight for the legacy of those we’ve lost, redefining what it means to live extensive, healthy lives, free to be ourselves and free from fear. We recognize that even today it is revolutionary to grow and age healthfully, especially for those most marginalized. Together, we stand by our commitment to grow older together – with our community, with our providers, and with our patients.
Whether your friends are your family, you’re newly married, or you’re putting kids through college, we all want to grow old alongside the people we love most. As we celebrate 50 years of liberated healthcare that empowers patients and ignites social justice from a place of wellness and health equity, Howard Brown keeps getting better with age — and you can, too. Let’s Grow Old Together.
As we begin our 50th Anniversary, we have a lot planned to celebrate our past, present, and future alongside our patients, staff, and broader community. This year, we will do just that by sharing our histories, highlighting community stories, and forging a path forward into the next 50 years of Howard Brown Health. We can’t wait for you to join us.
Tell Legislators to Support Reproductive Treatments for LGBTQ+ Families
On your ballot this November, there will be a non-binding advisory question regarding insurance coverage for medically assisted reproductive treatments. While this question is not binding, it will serve as a way for Illinois legislators to better understand your needs and concerns around family planning. This is especially important for LGBTQ+ families as the cost associated with having a family can often be much higher for queer couples. It is critical for Illinois voters to understand what the assisted reproductive question is and how it connects to the expansion of family planning services for LGBTQ+ couples.
An advisory question is a type of ballot measure that asks voters a non-binding question. The largest difference between an advisory vote and any other type of ballot measure is that the outcome of the ballot question is not legally binding and will not directly result in a new, changed, or rejected law or constitutional amendment. Rather, the advisory question allows voters to express their general opinion on important issues. The Assisted Reproductive Healthcare Advisory Question is asking voters to, “advise state officials on whether to provide for medically assisted reproductive treatments, including in vitro fertilization, to be covered by any health insurance plan in Illinois that provides full coverage to pregnancy benefits.” While Illinois does have some family planning insurance coverage protections for LGBTQ+ couples, this question is essentially asking if individual Illinois health plans should be required to fully cover all assisted reproductive treatments without any copays or limits. A “yes” vote would support advising state officials to provide for medically assisted reproductive treatments while a “no” vote opposes advising state officials to provide for medically assisted reproductive treatments.
Illinois has several pieces of legislation that already support LGBTQ+ couples and their family planning needs. HB 3709 expanded the definition of fertility to include a person’s inability to reproduce either as a single individual or with a partner without medical intervention. Previously, infertility was defined as a failure to establish a pregnancy or to carry a pregnancy to live birth after several months of regular, unprotected sexual intercourse. This automatically excluded same-sex couples and single individuals from insurance coverage for infertility treatments. For example, a woman from Illinois sued Blue Cross Blue Shield after learning her fertility treatments with her same-sex partner weren’t going to be covered because their IVF definitions only offered full coverage for IVF after couples failed to conceive after 12 months. This meant that many same-sex couples couldn’t receive insurance coverage or had reduced coverage for participating in many of the same procedures heterosexual and cisgender couples were accessing. In addition to HB 3709, Illinois also has the Reproductive Health Act (RHA) a law (Public Act 101-0013) Pritzker signed in 2019 and added to in 2023 (Public Act 102-1117) that helps protect access to in-vitro fertilization (IVF). Much of this legislation was enacted because accessing family planning like IVF for LGBTQ+ couples was difficult and costly.
The Assisted Reproductive Healthcare Advisory Question could be an important next step in letting legislators know there are still needs around access to IVF and other family planning services for LGBTQ+ families. This is becoming more important as attempts in Congress to codify the right to IVF access have failed. The cost of IVF is in the tens of thousands of dollars. A single IVF cycle – a period of about three weeks in which eggs are collected from an ovary, fertilized by sperm in a lab, and then transferred to a uterus – can cost upwards of $20,000, including medication. LGBTQ+ individuals statistically have higher rates of poverty and financial instability, so the high out-of-pocket costs can leave many queer families unable to access these services. These costs can increase even more as LGBTQ+ couples may have the added expenses of needing sperm donors, egg donors, surrogates, or gestational carriers. This advisory question is one way that voters can urge legislators to take another look at how the current IVF protections in Illinois can be more inclusive and less cost prohibitive. This may include requiring unlimited coverage for all IVF treatments or providing financial support for surrogacy. Let’s ensure we are supporting LGBTQ+ families across Illinois!
To learn more about how Howard Brown Health contributes to vital advocacy work and has an impact on local, state, and federal policymaking, please visit our Advocacy webpage.
How to Support LGBTQ+ Older Adults in Illinois
Nearly 2.9 million Illinoisians are now 60 or older, representing 22% of the population in Illinois. Far too many older adults experience abuse, neglect, poor care, isolation, and difficulty finding affirming and supportive spaces. For LGBTQ+ older adults, the barriers and discrimination they face when trying to access healthcare and social support are compounded due to anti-LGBTQ+ discrimination and lack of knowledge of LGBTQ+ health. As the population in Illinois continues to age, there needs to be a comprehensive plan to support the aging population. That is why we worked with Illinois Aging Together to advocate for the needs of LGBTQ+ older adults, leading to the Governor recently authorizing an executive order to establish a planning commission to develop and implement a multi-year Multi-Sector Plan for Aging (MPA). The MPA will serve as a 10-year blueprint to support healthy aging in Illinois and set clear, measurable objectives for evaluating public and private sector progress toward this goal. Learn more about how this plan will advance the health, mental, and social needs of LGBTQ+ older adults!
The Multi-Sector Plan for Aging (MPA)
LGBTQ+ older adults face unique challenges. Healthcare access, supportive and stable housing, and community support systems can look different for LGBTQ+ older adults compared to other older adults for a variety of reasons. For example, LGBTQ+ older adults are twice as likely to be single and live alone and four times less likely to have children. LGBTQ+ older adults are also far more likely than heterosexual peers to have faced discrimination, social stigma, and the effects of prejudice. This discrimination has far-reaching effects on health outcomes and financial stability: LGBTQ+ older adults are more likely to face poverty and homelessness, and more likely to have poor physical and mental health. One-third of LGBTQ+ older adults live at or below 200% of the federal poverty level, while LGBTQ+ older adults are more likely than non-LGBTQ+ to be told they have cancer at 29% and 23% respectively. Without intentional interventions focused on meeting the specific needs of LGBTQ+ older adults, LGBTQ+ older adults will continue to experience stark disparities in physical and mental health outcomes including higher rates of cardiovascular disease, frailty and mobility issues, depression, and substance and alcohol misuse.
Illinois Aging Together, a coalition of 188 organizations including Howard Brown Health, has been drafting and advocating for legislation for years that would create a commission to develop a multi-sector plan for aging. The Governor’s executive order creating the MPA was a huge advocacy achievement for Illinois Aging Together. The MPA will serve as another component to support older adults in every facet of their lives and serve as a blueprint to enact much-needed state legislation around aging. Stakeholders around the state will help draft the MPA in conjunction with an MPA planning commission, The Department of Aging, and other stakeholders. A final MPA will be delivered to the Governor and General Assembly by 2025, and an additional status report by 2026. The MPA is a comprehensive plan and has several focuses including:
Removing barriers to accessing healthcare: The plan aims to increase access and reduce the cost of primary care, behavioral, neurological, oral, and audiological healthcare, and prescriptions, across the state. It plans to institute geriatric and dementia education requirements for all healthcare providers. It will ensure that an older person’s right to self-determination is respected and upheld. Removing barriers to healthcare is incredibly important for LGBTQ+ older adults as well as older adults living with HIV. In Illinois, 47% of PLWH were 50+. As this population ages, we know that other health issues become a major concern. HIV may affect the biology of aging and as a result, older adults with HIV may suffer from aging-related illnesses such as dementia, arthritis, and certain cancers earlier and at higher rates than those without HIV. If we don’t eliminate LGBTQ+ older adults’ barriers to healthcare, social services, and other supports, the long-term physical, mental, and overall costs of treatment could lead to worsening health outcomes or even death.
Strengthen and improve service infrastructure for the quality, staffing, accessibility, and availability of long-term services and supports: Illinois nursing homes had the lowest staffing in the nation across the five years reviewed by USA TODAY. In 2022, 91% of nursing homes did not meet state and federal staffing guidelines. It is already difficult for LGBTQ+ older adults to access long-term services as they are more likely to face discrimination when seeking services, have lower incomes, and need more social services than some of their cisgender or straight counterparts. With a focus on infrastructure, staffing, and accessibility, this goal of the MPA will better enable older LGBTQ+ persons to remain in their homes and communities according to their wishes (to age-in-place), or to utilize nursing homes safely.
The Multi-Sector Plan for Aging is one way we can acknowledge and support the unique needs and experiences of LGBTQ+ older adults. This can be a guiding light for service providers, advocates, and aging networks as they look to pass legislation or understand how these issues impact the lives of LGBTQ+ older adults. You can learn more about this important Executive Order and the MPA by visiting here and here. You can visit Howard Brown’s website for more information on our policy priorities and state legislative agenda. You can also visit our Advocacy page to learn more about our work.
Celebrating Our 2024 Shapen Fellows
Each summer, Howard Brown Health welcomes a group of undergraduate students to our organization for The Gregory Shapen Public Health Fellowship. The Shapen Fellowship focuses on developing project management skills in the field of public health and community medicine. This summer, we were delighted to have six fellows join us, working with our Education, Advocacy, Diabetes Care, and Behavioral Health teams. Each student devised and developed their own project over the course of our ten week fellowship, working in partnership with a Howard Brown Health Mentor. We are proud to share summaries of their work with us this summer.
Ifeyinwa Allanah, she/her/hers (Education and Behavioral Health)
Research Proposal: Effects of Menstrual Cycles and Hormonal Contraceptives on the Mental Health Quality of Life (MHQoL) of Cisgender Women (18-40 yr/o)
The menstrual cycle is an important aspect of reproductive health, influencing various physiological and psychological processes. Attention has increasingly turned towards understanding how these cycles, along with the use of hormonal contraceptives, impact the mental health quality of life (MHQoL) of individuals, particularly cisgender women aged 18-40. This observational study aims to explore the relationship between menstrual cycles, the use of different types of hormonal contraceptives, and MHQoL. By focusing on women who are either using combination hormonal contraceptives, progesterone-only contraceptives, or no hormonal contraceptives at all, this study seeks to uncover potential differences in the MHQoL across these groups, which could lead to more personalized and effective healthcare strategies for cis women experiencing menstrual-related mental health challenges.
Grace Courter, she/her/hers (Education)
Toolkit: Sapphics on Sex
Despite advances in LGBTQ+ health, significant gaps remain in research and services for sapphic individuals. This student-led project aims to create a comprehensive sapphic sexual health toolkit to address common misconceptions and provide accurate information about sexual health for sapphic people. The toolkit will empower individuals to make informed decisions and offer advocacy strategies for spreading awareness. Our goal is to reduce health disparities in the LGBTQ+ community, enhance sapphic sexual health knowledge, and promote inclusive sex education. We seek to ensure all sapphic individuals have access to accurate and comprehensive sexual health resources.
Sophia Hwang, she/her/hers (Diabetes Care)
NDPP Implementation Plan: Diabetes Prevention Program Implementation and Best Practices: Howard Brown Health
National Diabetes Prevention Program (NDPP), which we hope to offer at Howard Brown. In addition to researching how to successfully implement the NDPP, I investigated stress as a risk factor for chronic disease among LGBTQ+ populations, as well as potential strategies to address patients’ social needs that may be barriers to participation. This process involved reviewing literature, consulting other NDPP providers, and surveying patients, which provided valuable insight on how to tailor the NDPP to the specific needs of Howard Brown’s patient population.
Pietro Juvara, he/him/his (Policy and Advocacy)
Legal Guide: The Legal History of 340B
As part of the Advocacy team at Howard Brown this summer, I developed a guide to the legal history of the federal 340B Drug Pricing Program. 340B requires drug manufacturers to sell their products at a discounted rate to organizations like Howard Brown, which then get reimbursed by private insurance companies at market price, creating “340B savings” to help provide accessible healthcare. Since 2020, manufacturers have been slowly dismantling 340B in major lawsuits. Through studying landmark cases, I developed a guide to the legal defense of 340B for any health center to use, with findings on its current legal vulnerabilities, and recommendations for health organizations to apply in their own advocacy work and protect their 340B savings.
Naima McRoberts, she/her (Education and Behavioral Health)
Research Paper: Integrating Behavioral Healthcare into Primary Care for LGBTQ+ Adolescents with Chronic Pain
This summer, I conducted an independent research project reviewing the literature on primary care behavioral health integration and LGBTQ+ adolescent chronic pain disparities to argue for the benefits of integrating behavioral health care into primary care. My mentor, Dr. Kelly Ducheny was a leader in establishing integrated care at Howard Brown, so I was grateful to have her as a resource as I worked on this project. I also spent time shadowing therapist Dondee Gujilde and got to see integrated care in action. With my project, I hope to highlight the intersections of health disparities in minority communities and the urgent need for holistic and accessible health care.
Ari Zweibaum, she/they (Education)
Gender Affirming Care Guide: Guide to Transition Options in the Midwestern United States
Transgender and Gender Diverse (TGD) people often seek ways to change their existence in society to feel more comfortable in their own skin through a process called transition. However, this process can be very abstract and confusing to TGD people who are early on in their journey. The Guide to Transition Options in the Midwestern United States seeks to help remove information barriers by making it easier for TGD people to visualize their transition and work towards a life they want to lead. It explains in detail what goes into various forms of social, medical, and legal transitions to create a more welcoming environment for TGD people.
To learn more about the vital work done by the Education Department at Howard Brown Health, please visit our Education webpage.
Honoring the Legacy of the Lesbian Community Cancer Project at Howard Brown Health
At Howard Brown Health, we are proud to announce an upcoming tribute that will honor the legacy of the Lesbian Community Cancer Project (LCCP). In late Spring 2025, we will unveil a tribute wall on the third floor of our Halsted Clinic (3501 N Halsted), celebrating the incredible impact of LCCP and its contributions to our community.
Founded in 1990 by a group of passionate individuals, LCCP emerged as a vital resource for women with cancer and their families of choice. At a time when healthcare settings often lacked inclusive care, LCCP created a space for lesbians to find support, solidarity, and care. From direct services to peer groups, LCCP’s work not only provided care, but also created a community that lifted one another through grief, loss, and the triumphs of beating cancer. In 2007, LCCP merged with Howard Brown to expand the agency’s ability to serve LGBTQ+ women and their families.
The tribute wall will be a lasting memorial located in the waiting area of our Halsted Clinic. This will be a space for reflection and recognition of the individuals and families who shaped LCCP and contributed to its lasting impact on healthcare equity and community-building.
Tracy Baim, a Chicago-based LGBTQ+ journalist, editor, author, and filmmaker is leading the project. “LCCP was so important to us finding community together,” shares Baim. “When it started at the Cheetah Gym, LCCP was a space to support one another through grief and loss and celebrate when we beat cancer. It’s important that we remember and name the people who helped build that supportive community.”
In addition to memorializing those connected to LCCP, the tribute wall will be a reminder of the broader contributions lesbians have made to the health and well-being of the LGBTQ+ community. All donations up to $50,000 will be matched by an anonymous donor and all gifts will support access to care at Howard Brown.
“Honoring LCCP at Howard Brown Health Halsted gives us an opportunity to look back on some of the lesbians who helped our community age alongside one another,” said Katie Metos, Vice President of External Relations, “Lesbians have always been a backbone to the Queer community.”
We invite our community to participate in this tribute. For gifts of $500 or more, your name and the name of your honoree will be included on the donor wall. If your loved one wasn’t directly connected to LCCP, we offer other ways to honor them. All gifts, regardless of size, will ensure that you and your honoree are recognized in our annual report and on a dedicated webpage celebrating LCCP.
This tribute wall is a meaningful opportunity to reflect on the work that has been done, honor those who were part of it, and ensure that the spirit of LCCP continues to inspire future generations. We encourage everyone to be part of this lasting memorial.
Decoding Project 2025: A Danger to Healthcare Access
by Center for Education, Research, and Advocacy
Project 2025 is a comprehensive plan to enact extreme conservative policies that would reduce access to healthcare, economic security, and social services support. Project 2025’s goal is for conservative ideals to be enacted across every level of federal and state government. One of the primary goals of Project 2025 is to reduce access to necessary healthcare services specifically for LGBTQ+ people and other marginalized communities. We must take action now to stop the elimination of vital healthcare services and non-discrimination protections in healthcare!
Medicaid and Medicare Access
Project 2025 recommends that the Department of Health and Human Services (HHS) evaluate some of its programs for cuts or alterations to services. For example, Project 2025 calls to restructure the 340B Drug Pricing program. The Federal 340B drug discount program has required pharmaceutical manufacturers to sell drugs at a discount to covered entities, including safety net hospitals and FQHCs that care for uninsured and low-income patients. This allows FQHCs to pass along the discounts directly to uninsured patients to help them afford their medications. When we dispense medications to insured patients, we can generate 340B in savings or revenue—at no cost to the patient—that FQHCs use to provide and expand essential services and programs. For example, Howard Brown uses our 340B savings to help fund our HIV and PrEP navigation programs, our trans and non-binary health teams, our Broadway Youth Center, and other crucial services for our patients that are often poorly reimbursed and underfunded. Project 2025 would restructure this program restricting the amount of revenue FQHCs could generate. This would result in fewer affordable medications for underinsured or uninsured patients and a critical funding loss for community health centers.
Project 2025 also calls for stark reductions in funding to state Medicaid programs. Currently, the federal government guarantees to match payments made by the states for services provided to Medicaid patients with no pre-set limits. In states with lower per capita incomes, the federal government pays a larger share of Medicaid funding. Project 2025 proposes a “balanced or blended match rate,” which would provide a flat funding rate to all states. This would eliminate a substantial amount of federal funding for state Medicaid programs, ultimately resulting in reductions in the medical workforce and services for low-income Americans. Project 2025 also calls for more stringent and burdensome eligibility requirements for Medicaid coverage, including work requirements. Work requirements for Medicaid coverage have been shown to be ineffective in helping Medicaid recipients attain employment, and instead just result in many low-income patients losing their Medicaid coverage. For example, when Arkansas briefly implemented work requirements in Medicaid, 1 in 4 participants lost their health coverage. Project 2025 also recommends applying lifetime coverage caps for Medicaid. This would mean that once a person has been on Medicaid for a set amount of time, they can no longer access Medicaid benefits. People who have been on Medicaid for a certain number of months or years could immediately lose eligibility for Medicaid coverage. Project 2025’s eligibility requirements would result in around 18.5 million people at risk of losing their coverage.
Medication Affordability
Project 2025 also proposes the repeal of the Inflation Reduction Act (IRA). The IRA greatly helped reduce the out-of-pocket drug costs for more than 1.5 million Medicare Part D enrollees. Importantly, it capped out-of-pocket costs at $2,000. Medicaid Part D recipients are some of the most vulnerable patients with significant health needs, and repealing the IRA would see Part D enrollees lose upwards of $7.4 billion in out-of-pocket savings next year. This would be especially harmful to people living with HIV (PLWH). When it comes to the costs of HIV treatment including doctor visits, labs, mental health access, and ART medication, about 60% of these costs come from the high cost of medications alone. The costs of HIV medications are estimated to run between $500-$4500 each month during a person’s lifetime. Increasing the costs of HIV treatment or having HIV treatments be mostly, if not fully out-of-pocket, will lead to less PLWH being able to afford their life-saving medications.
Abortion and Reproductive Healthcare
Since the Dobbs v. Jackson Women’s Health Organization decision eliminated the constitutional right to an abortion, Project 2025 now aims to enact policies that would amount to a nationwide abortion ban. These attempts to erode or eliminate access to abortion access will lead to providers denying care due to fear of being prosecuted and ultimately result in increased health disparities and poorer health outcomes. States that currently have abortion restrictions report fewer reproductive health providers. There is a 32% lower ratio of obstetricians to births and a 59% lower ratio of certified nurse midwives to births. States with abortion restrictions experience 62% higher maternal death rates than states with full abortion access. States with abortion bans also see higher rates of mental health conditions, including suicide and substance use disorder overdoses, as the most frequently reported causes of preventable pregnancy-related deaths. According to the Center for American Progress, if a nationwide abortion ban is enacted, the overall number of maternal deaths would rise by 24%. Maternal deaths for Black women would rise by 39%. Abortion access is also an important healthcare issue for LGBTQ+ people. A survey by the Guttmacher indicates that LGBTQ+ people make up as many as 16% of U.S. abortion patients.
Project 2025 also focuses on eliminating access to abortion pills via the mail. Project 2025 would try to weaponize the long-dormant Comstock Act to try and make the delivery of medication abortion by mail illegal. Without a mailing option for medication abortion, the steep logistical and financial burdens of travel will put abortion care out of reach for many patients. Project 2025 also calls to eliminate access to free no-cost emergency contraception that millions of people rely on. This could result in over 47 million reproductive-age women losing access to no-cost contraception.
LGBTQ+ Non-discrimination Protections
Project 2025 aims to eliminate non-discrimination protections for LGBTQ+ patients by reverting Section 1557 of the ACA to the 2020 version enacted under the Trump Administration. This would mean eliminating the general prohibition on discrimination based on gender identity and sex stereotyping and adopting blanket religious freedom exemptions for health care providers making it easier for LGBTQ+ patients to be denied care based on a provider’s religious beliefs. The Trump Section 1557 rule also removed sexual orientation and gender identity nondiscrimination protections in several Centers for Medicare & Medicaid Services (CMS) programs. This was especially heinous as many of the impacted CMS programs disproportionately benefit LGBTQ+ individuals.
LGBTQ+ people have long experienced discrimination and barriers when seeking healthcare. Based on a 2022 survey by the Center for American Progress (CAP), 15% of LGBQ respondents—and 23% of LGBQ people of color—experienced care refusal by a provider in the past year. For trans and non-binary (TNB) individuals, 32% reported that they experienced care refusal by a healthcare provider in the past year. Rates of discrimination were even higher for TNB people of color, with 46% reporting care refusal. The CAP survey also showed that 55% of intersex respondents reported a healthcare provider refused to see them because of their sex characteristics or intersex variation. For TNB patients, having their insurance cover necessary and affirming medical care has become an ever-increasing obstacle. In the past year, 30% of TNB patients, including 47% of TNB patients of color, reported at least one form of denial by a health insurance company, including denials for necessary gender-affirming hormone therapy or gender-affirming surgery. Delaying or avoiding healthcare due to discrimination contributes to poorer health outcomes for LGBTQ+ individuals, including higher rates of chronic diseases like heart disease, certain cancers, asthma, and strokes. Discrimination also takes a toll on mental health, with LGBTQ+ patients having higher rates of mental health distress and suicidality. With the increasing number of anti-LGBTQ+ legislation, including gender-affirming care bans, the elimination of anti-discrimination polices for LGBTQ+ patients will result in increased poor health disparities.
Conclusion
Project 2025 will infiltrate many levels of healthcare access and patients’ ability to afford their treatments. Creating barriers to accessing Medicaid, enacting harsh abortion restrictions, and eliminating non-discrimination protections would be detrimental to the health of all Americans.
With the Presidential election coming up in November, it is important to vote for candidates that support the civil rights and equity of everyone. Be sure you are registered to vote. To register to vote, receive information on voting by mail, find a polling location, or get updates on the upcoming election you can visit your local election boards for more information.
For all residents, regardless of where in Illinois you reside, you can go the Illinois State Board of Elections at www.elections.il.gov.
To learn more about how Howard Brown Health contributes to vital advocacy work and has an impact on local, state, and federal policymaking, please visit our Advocacy webpage.
Decoding Project 2025: Fight Back Against this Anti-LGBTQ+ Agenda
by Center for Education, Research, and Advocacy
This election year there has been much discussion around Project 2025, a political transition plan being pushed by a coalition of conservative extremists. Project 2025 is comprised of numerous harmful policy proposals that would harm access to healthcare, economic security, and social services support, especially for already vulnerable and marginalized communities. Project 2025’s goal is for extreme conservative ideals to be enacted across multiple Federal agencies, to inform state legislation, and to train appointees in its conservative tenets through an online “education academy.” Project 2025 specifically targets LGBTQ+ people and lays out a clear plan to erode or eliminate non-discrimination protections for LGBTQ+ people. It is imperative to understand what Project 2025 is so that we can take action to prevent this threat from taking hold!
What is Project 2025?
Project 2025 is a 900-page document published by the Heritage Foundation that is meant to serve as a road map for a conservative extremist federal government. Project 2025 contains a 180-day playbook of regulations and executive orders that could be signed and implemented by the next conservative president upon taking office. It also includes a database of potential presidential appointees and information on the kinds of bills conservatives in Congress and state legislatures should attempt to enact. Project 2025 contains plans for enacting long-standing extreme conservative idealsthat impact all aspects of everyday life, including reducing federal spending on social services for low-income people, eliminating efforts to fight climate change, increasing military spending, and impeding reproductive and sexual healthcare access, to name a few.
Project 2025 was created by the Heritage Foundation. Founded in 1973, the Heritage Foundation is a conservative think tank whose mission is “to formulate and promote public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values, and a strong national defense.” As part of furthering their mission, the Heritage Foundation has a long history of anti-LGBTQ+ advocacy. For example, the Heritage Foundation has fought against out LGBTQ+ military service, LGBTQ+ Boy Scouts and leaders, marriage equality, protections against discrimination for LGBTQ+ workers, rights of LGBTQ+ parents, bans on conversion therapy, evidence-based healthcare for trans youth, and LGBTQ+ inclusive curricula. The Heritage Foundation took a leading role in the conservative movement in the 1980s during the presidency of Ronald Reagan, whose policies were informed by the Heritage Foundation’s Mandate for Leadership. The Mandate for Leadership would continue to be released every Presidential election year as a way for the Heritage Foundation to instill conservative and traditional ideals into the federal government. Project 2025 is the name for this year’s iteration of the Mandate for Leadership.
The main difference between Project 2025 and past Mandate for Leadership editions is the massive coalition of conservative and far-right groups that have contributed to Project 2025, uniting under this singular vision. Some high-profile organizations that have contributed to Project 2025 alongside the Heritage Foundation include the Family Research Council (FRC), Alliance Defending Freedom (ADF), and the American Legislative Exchange Council (ALEC). All these organizations have a long history of being powerful lobbyists on behalf of conservative causes. Many of these organizations are designated hate groups by the Southern Poverty Law Center due to their goals and activities being based on a shared antipathy towards people based on race, religion, ethnicity/nationalities/national origin, gender and/or sexual identity. The goal of many of these groups is to reduce or eliminate LGBTQ+ rights using legislative advocacy. Project 2025 is a consolidation of these groups’ decades-long campaigns to erode or eliminate many non-discrimination protections for the LGBTQ+ community.
How does Project 2025 affect the LGBTQ+ community?
Given the anti-LGBTQ+ work of many of the groups behind Project 2025, it is not surprising that one of Project 2025’s main goals is to drastically roll back rights for the LGBTQ+ community to promote “life and strengthening the family.” Many of these policy changes would be enacted by the President through executive orders and presidential appointments. Just a few of these actions would include:
Department of Justice (DOJ): Project 2025 would encourage the DOJ to pursue litigation that is consistent with the agenda of the President. This means litigators with the DOJ would be encouraged to prosecute someone performing abortion care or providing gender-affirming care (GAC) to someone traveling from another state where that care is banned, or where the language on how and when these procedures can be given is vague. This would cause providers of services like abortion and GAC to refuse to provide these services out of fear of prosecution. This would put the physical and mental health of LGBTQ+ patients at risk.
Department of Health and Human Services (HHS): Project 2025 recommends that the future HHS secretary reverse focus on LGBTQ+ equity, and instead enact policies that encourage “marriage, work, motherhood, fatherhood, and nuclear families.” Project 2025 urges for policies that protect adoption and foster agencies that refuse to work with LGBTQ+ couples, as well as bans on in-vitro fertilization (IVF)—preventing many LGBTQ+ people from becoming parents. Project 2025 also would eliminate free birth control access and enact a national abortion ban.
Medicaid: Project 2025 calls for imposing targeted time limits or lifetime caps on Medicaid benefits. Similar policies have previously been introduced, including a proposal to impose a 36-month lifetime maximum for Medicaid coverage. It also proposes introducing a work requirement to be eligible for Medicaid coverage, even though work requirements for Medicaid have been shown to reduce insurance coverage for patients while not increasing employment. These proposals would greatly limit and restrict access to Medicaid, and this would disproportionately impact LGBTQ+ communities. LGBTQ+ people utilize Medicaid at higher rates than non-LGBTQ+ with around 21% of LGBTQ+ adults in the U.S. accessing Medicaid every year. This would put millions of LGBTQ+ patients at risk of losing their healthcare coverage immediately as Project 2025 may retroactively impose these limits.
Supreme Court: Project 2025 calls for not only limiting the application of the Supreme Court’s ruling in Bostock v. Clayton County,which held that Title VII’s sex discrimination protections applied to LGBTQ+ Americans, but also threatens to prevent the ruling from extending to other sexual and gender minority communities, such as two-spirit, intersex, an asexual Americans.
Department of Defense: Project 2025 threatens to reverse policies allowing trans individuals to serve in the military.
Department of Education (DOE): Project 2025 calls for eliminating the DOE. This would eliminate most of the mechanisms to enforce non-discrimination protections for LGBTQ+ students and put their lives and well-being at risk.
How can we fight back against Project 2025?
Project 2025 is just the beginning of a long-term plan to eliminate protections for LGBTQ+ and other marginalized people. First, it’s important that you learn more about what Project 2025 is. You can read more info about what Project 2025 is and how extensive Project 2025 goals are. You can also read our blog on the state of anti-LGBTQ+ legislation.
With the Presidential election coming up in November, it is important to vote for candidates that support the civil rights and equity of everyone. Be sure you are registered to vote. To register to vote, receive information on voting by mail, find a polling location, or get updates on the upcoming election you can visit your local election boards for more information.
For all residents, regardless of where in Illinois you reside, you can go the Illinois State Board of Elections at www.elections.il.gov.
To learn more about how Howard Brown Health contributes to vital advocacy work and has an impact on local, state, and federal policymaking, please visit our Advocacy webpage.
Roundup of the 2024 Illinois Legislative Session
Every year, Howard Brown Health (HBH) supports several state legislative priorities to advance healthcare for LGBTQ+ patients. There were some important LGBTQ+ health equity and healthcare funding bills that Howard Brown and our community advocated for and passed during the 2024 Illinois General Assembly Legislative Session!
State Budget
The FY 2025 State budget and recently passed Medicaid omnibus bill includes a few vital funding provisions that will help health centers in Illinois. Legislators included an increase of funding for the HBIA/HBIS or Healthy Illinois for All programs for ages 42 and older in the state’s FY25 budget. This will provide $440 million from the General Revenue Funds and $189 million from other sources for a total of $629 million. This will help further close coverage gasps as it provides Medicaid-like coverage for low-income residents regardless of immigration status. This funding is necessary with the influx of immigration into Chicago from Central and Latin America. This additional funding will positively impact Howard Brown’s patients to gain better access to healthcare coverage. On average 30% of Howard Brown patients utilize Medicaid, and 21% are uninsured or qualify for a sliding scale.
An additional $40 million above the initial proposed appropriation was given to implement the HOME Illinois plan to prevent and end homelessness. This funding will primarily be focused on rental assistance, homeless prevention, and funding to address youth homelessness. 28% of LGBTQ youth report experiencing homelessness or housing instability at some point in their lives. Howard Brown’s Broadway Youth Center provides support for LGBTQ+ youth experiencing homelessness or unstable housing and this funding will go a long way in helping LGBTQ+ youth find the safe and stable housing they deserve.
There are some important additions to the 2025 Medicaid omnibus bill around psychiatric care and medication access. SB3668 will lift unnecessary prior authorization (PA) requirements for certain psychiatric medications so patients can get vital medications as soon as they need them. This budget will also increase Medicaid psychiatry reimbursement rates (SB3668) and increase rates for psychiatric evaluations and substance use disorder treatment, as well as medication monitoring performed by community mental health centers (HB4664). The cost of psychiatric care can be high for patients and Medicaid reimbursement rates in Illinois are historically low compared to neighboring states. Increasing these reimbursement rates will make psychiatric care more affordable for low-income residents. This will allow places like Howard Brown where a large population of our patients use Medicaid for their healthcare coverage to affordably treat more patients.
Diversity, Equity, and Inclusion
In this session, we were able to see the passage of the Nonprofit Board Diversity Reporting Bill (SB2930). Illinois will now require non-profits that provide $1,000,000 or more in grants each year to release aggregated demographic information of its board of directors and officers. This includes race, ethnicity, gender, disability status, veteran status, sexual orientation, and gender identity. This is to ensure non-profit boards and leadership are reflective of the populations they serve. We want to applaud our partners at Equality Illinois for their leadership in the passage of this bill!
The other bill, the Support Trans Candidates Running for Chicago’s Elected School Board Act (HB4924) would update the Illinois School Code to ensure trans individuals who are candidates for Chicago’s elected school board don’t have to publish their deadnames on their nominating petitions. This requirement is harmful to trans and gender-diverse individuals who would be forced to release a deadname or inadvertently out themselves as these names would become public record. While these bills did not pass this session, we will continue to advocate for these important bills.
340B
Even with the wins this legislative session, there is still further advocacy work to be done. One major bill that unfortunately didn’t pass this session was the Illinois Patient Access to 340B Pharmacy Protection Act (SB3727). This bill would prohibit pharmaceutical manufacturers from prohibiting, restricting, or interfering with a local pharmacy that contracts with a 340B covered entity, including community health centers like Howard Brown, to dispense medications acquired through the 340B program. This legislation will help to ensure that the medications needed by patients are available at their local pharmacies and safeguard critical 340B savings that we invest in expanding services and programs our patients rely on. We can still do lots of advocacy to ensure the 340B program is protected. Congress recently introduced the 340B ACCESS Act (HR 8574) aimed to ensure 340B’s long-term viability as a critical resource for Community Health Centers and their patients. You can show your support for the 340B Access Act by contacting your Representatives and telling them we need Congress to take action and reform the 340B Program to ensure we can continue to serve our nation’s most vulnerable patients.
Insurance Coverage and Prior Authorization
We strongly advocated for The Prior Authorization Reform Act (HB5051) which would prohibit health insurance providers from requiring prior authorization for a prescription drug prescribed to a patient by a healthcare professional for 6 or more consecutive months. Many of our patients have experienced denials of coverage for necessary and life-saving medications due to burdensome and unnecessary prior authorization requirements from insurers. This bill would also prohibit prior authorization requirements for certain specific FDA-approved prescription drugs, including insulin, human immunodeficiency virus prevention medication such as PrEP and PEP; human immunodeficiency virus treatment medication; viral hepatitis medication; and hormonal therapy drugs used for gender-affirming care. We are continuing to push for this legislation as it will provide immediate and life-saving medications for our patients.
The Illinois legislature passed a SB3203 that would cap patient costs for prescription inhalers at $25 a month. The bill’s passage follows years of outcry from patients with asthma and other lung conditions over the cost of inhalers. The annual per person medical cost for asthma prescriptions was $1,830. The passage of this bill will relieve the high financial burden of rising inhaler costs.
The passage of the Healthcare Protection Act (HB5395) will ban PAs for admission for inpatient psychiatric services for the first 72 hours on an inpatient stay. These will help make access to psychiatric medications and inpatient care more available. When needed it also bans step therapy, an insurance practice that requires a patient to try a lower-cost drug or therapy first. This will ensure that patients have access to the medications that best suits their needs.
Education and Training
There were a couple of bills focused on education introduced in this session that HBH strongly supported. The Supporting Implementation of the Keeping Youth Safe and Healthy Act (SB3384) requested an appropriation of $20 million in the FY25 State Budget as a grantmaking program to support those public school districts that want to teach comprehensive sex education that is vital to the health and safety of Illinois students. This would have helped eliminate barriers to teaching comprehensive sex education by funding much needed training and curriculum development.
We also sought to pass the LGBTQ+ and HIV Cultural Competency for Legal Professionals (HR582) that urged the Illinois Supreme Court to adopt a continuing education mandate for LGBTQ+ and HIV cultural competency education for attorneys, judges, and courtroom staff. LGBTQ+ and people living with HIV (PLWH are disproportionately incarcerated and have negative experiences when trying to access legal services due to their identities and HIV status. While the cultural competency for legal professionals resolution was adopted by the house, it failed to advance. We are committed to fully pushing this bill through in the upcoming legislative sessions.
HIV Treatment and Prevention
There are a couple of HIV-related budget appropriations HBH advocated for that would ease the burden of individuals getting tested for HIV and connected to healthcare quickly. However, for the first time in the last four fiscal years, state legislators did not include any new HIV-related funding in the state’s Fiscal Year 2025 budget. There are several HIV-related budget items that will operate with level funding for the FY 2025 budget.
Getting to Zero (GTZ) Illinois Omnibus budget which is a state-wide initiative to end the HIV epidemic in the state by 2030 ($5.5 million).
HIV treatment and prevention services, also known as the HIV Lump Sum ($25.5 million).
The African American HIV/AIDS Response Act (AAHARA) funds grants to Black-led community-based organizations and HIV services meant to address the disproportionate impact of HIV/AIDS on African Americans and other communities of color ($15 million).
Grants and administrative expenses for the distribution of PrEP medication access ($2 million).
The Quality-of-Life Endowment Fund for grants related to HIV/AIDS prevention and education ($1 million).
Administrative expenses associated with STI testing, treatment, and prevention. ($500,000).
We would like to thank our partners at AIDS Foundation of Chicago for all their hard work and leadership on securing this important funding.
The Strengthening & Protecting Illinois HIV Funding Infrastructure (SPIHFI): (HB5667) bill would have provided an $2 million increase in state funding for HIV education, prevention, testing, and treatment. This would include $2.5 million in new funding to launch eight Rapid Start for HIV Treatment pilot sites that establish HIV treatment standards that would connect people with treatment within 7 days of initial diagnosis or 7 days of referral to HIV medical care. While this bill didn’t pass, we will fight to increase access to HIV testing and treatment in Illinois. We would like to thank our partners at AIDS Foundation of Chicago for all their hard work and leadership on this bill.
the Connection to HIV Testing and Linkage to Care (LTC) Act (HB5417) would enact reforms to ease HIV-testing and connection to treatment by mandating at-home HIV and/or sexually transmitted infections (STIs) testing kits be covered by insurers and Medicaid without cost-sharing; create 8 rapid start pilot sites that would connect people with treatment within 7 days of initial diagnosis or within 7 days of referral to HIV medical care; and ensures that all county jails provide HIV/AIDS education to people who are incarcerated and visitors, as well as link them to HIV testing as mandated by Illinois’ County Jail Act. It is vital that people newly diagnosed with HIV gain access to treatment and other wrap-around services as soon as possible. HB5417 passed the Illinois House with a bipartisan, unanimous vote, but the bill was unable to advance through both chambers. We will continue to fight for people to gain immediate access to the healthcare they need. We would like to thank our partners at AIDS Foundation of Chicago for all their hard work and leadership on this bill.
To learn more about how Howard Brown Health contributes to vital advocacy work and has an impact on local, state, and federal policymaking, please visit our Advocacy webpage.
The Fight Against Anti-LGBTQ+ Legislation
Over the past few years, we have seen a record-breaking onslaught of anti-LGBTQ+ legislation across the country. So far in 2024, 515 anti-LGBTQ+ bills have already been introduced in states all across the United States. Of these bills, 336 specifically targeted trans and non-binary people. This is nearly three times the number of such bills introduced in 2022. These bills target all aspects of LGBTQ+ people’s lives, including healthcare, education, and even using the restroom. This legislation is a direct response in recent years to the increasing protection of LGBTQ+ people against discrimination in healthcare, the workplace, housing, marriage, education, and public accommodations. Increasingly, conservative extremists are using anti-LGBTQ+ legislation as a prominent part of their political platforms to rally support from their voter base. In honor of Pride month, this blog will take a brief look at the history of anti-LGBTQ+ bills and examine the current-day anti-LGBTQ+ bills we are fighting against. With the upcoming election in November, we all have the opportunity to act and push back against this harmful legislation!
History of Anti-LGBTQ+ Legislation
While we have seen a historic amount of anti-LGBTQ+ legislation over the past few years, this new wave of anti-LGBTQ+ legislation is part of a historically sustained campaign to erode or eliminate LGBTQ+ rights. Since its founding in 1974, Howard Brown Health has been serving LGBTQ+ communities and helping queer communities fight against legislative attacks on their rights. In the 1970s, there was a notable increase in anti-LGBTQ+ legislation stemming from supposed “moral” panic in response to the increased support for LGBTQ+ rights. For example, Anita Bryant and the Save Our Children campaign was one of the first very high-profile examples of targeted anti-LGBTQ+ legislation. This campaign produced the original “Don’t Say Gay” bill, which resulted in the repeal of an ordinance in Dade County, Florida that protected gay and lesbian teachers from being fired because of their sexuality. This spawned lookalike bills against gay and lesbian teachers in Oklahoma and Nebraska. At this time, states also started to pass statutes restricting marriage to heterosexual couples, as well as sodomy laws targeting queer people. This pattern of successful anti-LGBTQ+ legislation spawning a surge of lookalike and new legislation across the country would continue to repeat itself, especially as opposition to LGBTQ+ rights has become a more prominent political issue. From same-sex marriage bans, to anti-trans bathroom bills, to religious exemption bills, to this current surge of anti-LGBTQ+ legislation, Howard Brown and the LGBTQ+ community continue to push back against these attacks.
The New Wave of Anti-LGBTQ+ Legislation
In 2023 we saw an expansion and proliferation of anti-LGBTQ+ bills that has continued into 2024.
Gender-affirming care bans – These bills deny access to medically necessary gender-affirming care that many trans and nonbinary people rely on. They are still the most popular version of anti-LGBTQ+ bills. Many of these bills were aimed at trans and non-binary youths attempting to access GAC.
185 anti-trans GAC bills were introduced in 2023. 137 GAC bans have been introduced in 2024 so far.
“Don’t Say Gay” curriculum restriction bills – “Don’t Say Gay” bills prohibit teaching about sexual orientation or gender identity in the classroom. These bills can also often include bans on use of pronouns and censoring of books and other educational resources with LGBTQ+ characters or themes.
Last year, 314 education-related bills were introduced in 2023. Around 203 bills have been introduced in 2024 related to education and curriculum restrictions.
Trans bathroom and sports bans – Sports bans prevent trans youth from participating in school sports aligned with their gender identity. Bathroom bans ban trans individuals from using public facilities, particularly bathrooms, that correspond to their gender identity.
73 sports and 29 bathroom bans were introduced in 2023. 48 sports and 36 bathroom bans have been introduced in 2024 so far.
Drag ban bills – Drag bans generally prohibit drag performances and gender non-conforming expression in public places and/or in the presence of minors.
15 drag bills were considered in 2023 with two states, Montana and Tennessee passing these bans. However, these bans have been deemed law restricting drag performances is currently unenforceable due to a federal court order. 21 drag-related bills have been considered in 12 states in 2024, but a number of them are carried over from 2023 legislative sessions.
Unfortunately, 2024 is poised to be another challenging year in fighting against anti-LGBTQ+ legislation, and there are some new and growing trends in the types of legislation or aspects of legislation that advocates should be aware of. One emerging trend is the increasing number of forced outing policies often included in “Don’t Say Gay” bills. These policies typically require school staff to notify parents about changes in the name or pronoun used for a student at school. Eight states have forced outing polices in place with Idaho, South Carolina, and Tennessee passing bills with forced outing provisions in 2024. This puts students in incredibly vulnerable positions as their homes may not be a safe space. A 2022 survey by the Trevor Project shows that 51% of trans youth considered school a safe space, in stark contrast to the 32% who felt the same about their homes. School may present as one if not the only safe space for queer students. According to the Journal of Adolescent Health, students who couldn’t use their preferred name and pronouns were 29% more likely to consider suicide and 56% more likely to exhibit suicidal behavior.
There is also a growing introduction of bills that redefine the legal meaning of “sex.” These bills attempt to exclude trans and non-binary people from protection under the law by codifying definitions of sex and gender that are completely binary and solely about reproductive capacity or physical genital categorization. This will prevent trans and non-binary individuals from being able to legally change their gender marker on their IDs, access GAC, or be protected under certain discrimination protections, especially in healthcare. 41 of these bills have been introduced in 2024.
There is also an uptick in anti-LGBTQ+ bills being introduced at the national level in the United States Congress. In 2023, an unprecedented 37 anti-LGBTQ+ bills were introduced at the federal level impacting LGBTQ+ rights in healthcare, student athletics, the military, incarceration, and education. As of May 2024, we have already outpaced 2023 with 45 anti-LGBTQ+ bills being introduced into the U.S. Congress. This includes the newly introduced Protection of Women in Olympic and Amateur Sports Act that would require all national governing bodies for amateur sports to bar trans girls and women from participating in athletic events for females. This would affect Olympic teams, national championships, and more.
How to push back against Anti-LGBTQ+ legislation
With the historical number of anti-LGBTQ+ bills we have seen this year, we have seen some recent wins against this hateful legislation. Recently the Biden Administration released an updated rule implementing Section 1557 of the Affordable Care Act (ACA). The new Section 1557 rule reinstates explicit prohibitions on discrimination based on gender identity, and it introduces new provisions that prohibit discrimination based sexual orientation or sex characteristics, including intersex traits. The new Section 1557 rule applies to all federal health programs and activities, including health insurance issuers. The Biden Administration also released an undated Title IX rule that adds explicit protections for LGBTQ+ students and expands the definition of sexual harassment to include sexual orientation and gender Identity.
Even with these wins, we need an unprecedented amount of support to push back against these bills and uphold LGBTQ+ rights! It is vital to vote and support candidates who support LGBTQ+ rights and push back against these harmful bills. The Human Rights Campaign has a Congressional Scorecard so you can track how your legislators in Congress are voting regarding important LGBTQ+ issues. You can also look at past year’s scorecards to better understand your legislators’ voting record. You can visit the GLESN Action Center to learn more about how to support important legislation that will improve LGBTQ+ students’ lives and make schools safer and more affirming. You can support Gender Cool’s Play It Out Campaign which supports trans kids’ participation in sports without discrimination. You can also tell your Members of Congress to protect LGBTQ+ people from discrimination in healthcare! You can read more about some of the legislation discussed by reading our Don’t Say Gay, Drag Bans, and support trans athletes blogs. You can also visit our Advocacy page to learn more about our work.
Safe Spaces: Combating Housing Disparities for LGBTQ+ Individuals
This past March in Chicago, voters were asked to vote on the Bring Chicago Home initiative. This initiative would have restructured the Real Estate Transfer Tax (RETT), a one-time tax on properties when they are sold to create a substantial and legally dedicated revenue stream to provide permanent affordable housing for people experiencing homelessness. Homelessness and unstable housing in Chicago is one of the largest issues among LGBTQ+ and people living with HIV (PLWH). Social and economic barriers, including anti-LGBTQ+ housing discrimination, have long been a barrier to the safety and welfare of queer and trans people. Voters ultimately voted down this initiative, but not before putting a local and national spotlight on the reality of homelessness in Chicago. There is a need for increased funding for affordable housing and cultural competency training for shelters, landlords, and housing providers to help eliminate the housing crisis among LGBTQ+ people.
LGBTQ+ Discrimination in Housing
LGBTQ+ people continue to face significant bias based on sexual orientation and gender identity (SOGI) in housing. Affordable housing needs are especially important to LGBTQ+ people as they are more likely to be low-income and unhoused. LGBTQ+ adults have higherrates of being poor compared to their cisgender counterparts and LGBTQ+ people, especially trans people, people of color, and youth, experience higherrates of poverty compared to their cisgender, heterosexual counterparts. Discrimination consistently exasperates queer people from accessing shelter and housing. LGBTQ people face widespread harassment and discrimination by housing providers. For example, studies have shown housing providers are less likely to respond to rental inquiries from same-sex couples and are more likely to quote male same-sex couples higher rents than comparable different-sex couples. LGBTQ+ people face similar discrimination when attempting to own a home. Same-sex couples face system-wide discrimination by mortgage lenders. One study found that same-sex borrowers experienced a 3% to 8% lower approval rate and higher interest rates on loans than their non-LGBTQ+ counterparts. LGBTQ+ youth and adults also face challenges in accessing homeless shelters and services. 28% of LGBTQ+ youth reported experiencing homelessness or housing instability at some point in their lives. LGBTQ+ youth report experiencing harassment and violence, staff who are not equipped to appropriately serve LGBTQ+ people, and sex-segregated facilities in which trans people are housed according to their sex assigned at birth. This leads many trans youths to go unsheltered instead. For LGBTQ+ older adults, many are at risk of being turned away from or charged higher rents at independent or assisted living centers as well as harassed, treated poorly, or forced to go back in the closet once moved to protect the housing they have secured.
For PLWH, access to housing can save their lives. Homelessness and housing instability are associated with increased vulnerability to new HIV infection and poorer health outcomes for those living with HIV. In 2020 alone, 17% of PLWH were unhoused or experiencing unstable housing. People with unstable or temporary housing have lower levels of viral suppression than those with stable housing (77.3% versus 90.8%). Stable housing is such a vital piece in reducing new HIV infection rates, that organizations like the AIDS Foundation of Chicago have made it an integral part of the Getting to Zero Illinois statewide initiative to end the HIV epidemic in the state by 2030. Housing discrimination against PLWH is illegal, but many still face housing providers and shelter systems that lack adequate cultural competency around HIV.
How To Support Affordable, Affirming, and Safe Housing
Initiatives like Bring Home Chicago highlight some of the much-needed funding for affordable housing programs and housing service providers. There are also steps that must be taken to ensure LGBTQ+ and PLWH and not discriminated and intimidated away from meeting their housing needs.
Expansion of housing and shelter options for LGBTQ+ youth and adults so that they are sheltered safely and appropriately.
Mandated training for all staff at agencies providing housing, child welfare, homelessness, and other relevant services to the LGBTQ+ and PLWH population, to ensure that staff become and remain equipped to serve this population in an affirming manner.
Evaluation of the extent to which LGBTQ+ people face barriers to accessing programs and services to increase housing affordability and reduce housing instability—such as Section 8 and homebuying programs of the Federal Housing Administration—and execution of corrective actions as necessary.
Ensuring comprehensive federal and state protections against sexual orientation and gender identity discrimination in housing, lending, and government-funded programs and activities, among other settings are being adopted and enforced. This includes advocating for $85 million in new funding in the Illinois Fiscal Year 2025 budget—spearheaded by the AIDS Foundation of Chicago (AFC) — for homeless prevention, emergency shelter, homeless youth programs, supportive housing, and other priorities—to keep making progress on the HOME Illinois plan to prevent and end homelessness
Housing is an essential right. Housing is also an essential part of healthcare, The discrimination, and social and economic barriers LGBTQ+ and PLWH face when trying to secure shelter will lead to poorer health outcomes. Housing needs to be a top priority for everyone. You can visit the Bring Home Chicago website to learn more about their initiative and visit Getting to Zero Illinois to learn more about how housing can support ending the HIV epidemic in Illinois.
To learn more about how Howard Brown Health contributes to vital advocacy work and has an impact on local, state, and federal policymaking, please visit our Advocacy webpage.
Beyond The Ballot – Know Your Right To Treatment!
The U.S. Department of Health and Human Services (HHS) recently issued a final rule under Section 1557 of the Affordable Care Act (ACA) that outlines strengthened protections for LGBTQ+ people in health care. Section 1557 specifically prohibits discrimination based on race, color, national origin, sex, age, or disability in health programs or activities that receive federal funding. Over the last decade, this provision has undergone several alterations by prior Administrations, which has led to confusion and fear from LGBTQ+ patients trying to seek health care. With the historical surge of anti-LGBTQ+ healthcare legislation being introduced over the past couple of years, this new rule is a much-needed step in protecting LGBTQ+ people as they seek care.
History Of The Rule Under The Obama And Trump Administrations
LGBTQ+ people have long experienced discrimination and barriers when seeking healthcare. Based on a 2022 survey by the Center for American Progress (CAP), 15% of LGBQ respondents—and 23% of LGBQ people of color—experienced care refusal by a provider in the past year. For trans and non-binary (TNB) individuals, 32% reported that they experienced care refusal by a healthcare provider in the past year. Rates of discrimination were even higher for TNB people of color, with 46% reporting care refusal. The CAP survey also showed that 55% of intersex respondents reported a healthcare provider refused to see them because of their sex characteristics or intersex variation. For TNB patients, having their insurance cover necessary and affirming medical care has become an ever-increasing obstacle. In the past year, 30% of TNB patients, including 47% of TNB patients of color, reported at least one form of denial by a health insurance company, including denials for necessary gender-affirming hormone therapy or gender-affirming surgery. Delaying or avoiding healthcare due to discrimination contributes to poorer health outcomes for LGBTQ+ individuals, including higher rates of chronic diseases like heart disease, certain cancers, asthma, and strokes. Discrimination also takes a toll on mental health, with LGBTQ+ patients having higher rates of mental health distress and suicidality. With the numerous healthcare barriers that LGBTQ+ patients face, Section 1557 became one avenue to provide better protection in healthcare for LGBTQ+ patients.
Section 1557 is the non-discrimination provision of the Affordable Care Act (ACA), introduced in 2010, that made it unlawful for health care providers to refuse to treat—or to otherwise discriminate against—an individual based on their race, color, national origin, sex, age, or disability. While Section 1557 and the ACA provided certain protections for LGBTQ+ patients, there was still the need to clearly and explicitly implement protections for LGBTQ+ people, especially TNB individuals. So, under the Obama Administration, HHS released a new Section 1557 rule in 2016 that expanded the definition of sex discrimination to include discrimination related to gender identity, thereby prohibiting anti-trans discrimination in insurance coverage and in health care settings.The sex discrimination definition was also updated to prohibit discrimination based on sex stereotypes. These stereotypes are usually based on heteronormative and binary views and result in prevalent forms of anti-LGBTQ+ discrimination in our health care system. This new rule provided historic protections for LGBTQ+ patients.
Unfortunately, in 2020, the Trump Administration released its new Section 1557 rule as part of a systematic erosion of LGBTQ+ protections. This new rule eliminated the general prohibition on discrimination based on gender identity and sex stereotyping. The 2020 rule only worsened anti-LGBTQ+ and particularly anti-trans discrimination in healthcare. For example, the rule would have allowed denying a trans man a medically necessary hysterectomy for gender-affirming care, even though this procedure would have been provided for a cisgender woman without issue. The 2020 rule also adopted blanket religious freedom exemptions for health care providers making it easier for LGBTQ+ patients to be denied care based on a provider’s religious beliefs. The Trump Section 1557 rule also removed sexual orientation and gender identity nondiscrimination protections in several Centers for Medicare & Medicaid Services (CMS) programs. This was especially heinous as many of the impacted CMS programs disproportionately benefit LGBTQ+ individuals.
Just a few days after the release of the 2020 rule, The Supreme Court issued a ruling in Bostock v Clayton County, Georgia. The Court found that discrimination based on sex encompasses sexual orientation and gender identity in the context of employment. This would provide legal challenges to the Trump Administration’s new 1557 rule and an injunction would prevent healthcare providers and insurers from having to abide by it. Even with the hope of the Bostock v Clayton ruling, there was already confusion and fear on the part of LGBTQ+ patients as they were unsure if they would be discriminated against or denied care.
The 2024 Section 1557 Rule
After the Biden Administration sought public comments from stakeholders on how to best strengthen Section 1557, the Administration released the new Section 1557 rule in 2024. This updated Section 1557 reinstates explicit prohibitions on discrimination based on gender identity and it introduces new applications that prohibit discrimination based sexual orientation or sex characteristics, including intersex traits. Section 1557 will apply to all federal health programs and activities, including health insurance issuers, and for the first time in six years, Medicare Part B providers. The new rule makes sure to clarify the broad intended scope of the rule to cover all health programs and activities and health insurers receiving federal funds. This new rule comes at a crucial time as LGBTQ+ patients have been fending off attacks against the care they need. Over 300 anti-trans laws have already been introduced in 2024, and most have been directed at banning access to gender-affirming care. The new Section 1557 rule not only reinstated necessary protections for LGBTQ+ patients, but it will also provide more protections for LGBTQ+ patients to seek care safely. With this new rule in place, if you believe that you or someone else has been subject to discrimination in health care or health coverage, you may file a complaint with the HHS Office for Civil Rights (OCR) under Section 1557.
The history of Section 1557 is not just about protecting LGBTQ+ patients, it’s reflective of elected official’s support for those protections. It’s important to have elected officials who will fight for the right to healthcare for everyone. You can visit HHS to read more about the new Section 1557 rule and you can visit our Advocacy page to read our public comment to the Biden Administration on Section 1557.
You can also visit our Advocacy page to learn more about our work.
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