A Message from David Ernesto Munar, President and CEO

Dear Community,

I am writing today to share an update on Howard Brown Health as it navigates a challenging time Across the country, LGBTQ+ and HIV-serving healthcare organizations like Howard Brown are navigating significant shifts in pharmacy revenue that now allow pharmaceutical companies to keep a greater share of federally negotiated savings through the 340B pharmacy revenue program.

A message from David Ernesto Munar, President and CEO of Howard Brown Health

Much like our sister organization Fenway Community Health Center in Boston, and other FQHCs across the country, we are feeling the pressure of changes with pharmacy revenues. Over the last ten years, this funding supported program expansion, personnel, and operations. With federal funding for COVID-related services ending, we are work toward lowering our operating expenses and enhancing our earned revenue.

Right now, we are facing a $12 million revenue shortfall which we are taking urgent measures to address.

Howard Brown’s leadership is exploring multiple mechanisms to help close the revenue gap, of which 75% is sought from non-personnel cost-cutting measures. This includes strategies to boost revenue generated from medical visits and other efficiencies such as the implementation of a new electronic medical record. Our urgent plan to close the revenue gap will not impact Howard Brown’s commitment to quality, culturally compassionate healthcare, and Howard Brown has no intention of eliminating services.

While a reduction in workforce is required to close the revenue gap, no positions will be let go until after Jan. 1, 2023. We are working collaboratively with leaders across the agency and our union to advance compassionate plans for departing employees and continuity plans to reset teams for success in meeting patient needs. In all cases where changes may impact union members, Howard Brown will bargain with the union first and in good faith.  

Howard Brown will continue to address financial challenges with integrity. We pledge to show our values in a plan that is thoughtful and respectful– keeping our patients and mission at the forefront.

While we face new challenges, our commitment to serving our patients and clients is unwavering. We are confident that we can emerge from this challenge stronger than before and in a way that ensures our communities will be able to count on us in the next 50 years and beyond.

In gratitude and respect,

David Ernesto Munar

President and CEO

For more information, see our previously published statements about the ongoing work to address the fiscal crisis:

Press statement – Saturday, December 3, 2022

Blog post – Wednesday, November 23, 2022

340B Information and Advocacy Blog Post – September 28, 2022

Howard Brown Health applauds the Passage of the Respect for Marriage Act by the U.S. Senate

Recently, the U.S. Senate voted to pass the Respect for Marriage Act! The legislation now moves back to the House of Representatives for approval, then onto the President’s desk. The Respect for Marriage Act passed the Senate with strong bipartisan support, mirroring strong support for same-sex marriage among the American public. According to Gallup data, 71% of Americans support legal same-sex marriage, a new all-time high.

The Respect for Marriage Act ensures federal recognition of same-sex and interracial marriages, and requires all states to give full faith and credit to all validly celebrated marriages. While limited, this is still a historic step forward in protecting the rights of all Americans, especially if the Supreme Court decides to overturn the 2015 Obergefell decision. Importantly, the Respect for Marriage Act would not mandate all states to allow same-sex marriage if Obergefell was overturned. In that case, the Respect for Marriage Act would require states that do prohibit same-sex marriage to still recognize all marriages conducted in other states where it is legal.  

The passage of the Respect for Marriage Act is a necessary defensive measure to ensure the Supreme Court does not roll back the right to marriage equality, and it is particularly crucial for those in states where same sex marriage would not be legal were it not for Obergefell. We applaud the US Senate for passing the Respect for Marriage Act and urge for the bill to be quickly signed into law. At the same time, more must be done to protect LGBTQ+ people more broadly. We have seen a dangerous surge in political attacks and acts of violence against LGBTQ+ communities, and we urge Congress to take strong action to protect LGBTQ+ people, and especially transgender and non-binary people, from these relentless attacks.

I completed the US Trans Survey and you should, too!

My name is Becs, and I am a policy associate at Howard Brown Health. I identify as trans-masculine and use they/them (and sometimes he/him) pronouns. I recently took the 2022 US Trans Survey (USTS), and wanted to share about why this survey is so important and what my experience was like responding. Don’t miss your chance to take the 2022 USTS! The deadline to take the 2022 USTS is TODAY, December 5, 2022 at 11:59 PM PST.

The USTS is the main source of data on the lived experiences of trans and non-binary (TNB) people in the US. As a member of the public policy and advocacy team at Howard Brown, I rely on data from the USTS frequently. I have used USTS data in issue briefs to better illustrate a need for gender-affirming interventions for TNB survivors of sexual harm, in emails urging legislators to support the modernization of Illinois’ name change laws, and in public comments in support of proposed Federal protections for LGBTQ+ students. Advocates around the country similarly use USTS data to advocate for TNB rights and develop tailored interventions to address health disparities. The last time the USTS was conducted was in 2015, so this incredibly vital data source is becoming outdated—especially with so many recent threats and attacks on the TNB community.

My experience taking the survey was incredibly informative, interesting, and empowering. As a research and data-loving person, I was excited to take the survey based entirely on the strong reputation of the survey and the incredible team that creates the survey. As a newly out trans person, this is the first time that I could take the survey, and it helped me feel empowered and affirmed. The survey is “smart,” meaning that depending on the selections a participant makes, they may be presented with different sets of questions with a focus on using inclusive and affirming language for all.

Nuanced discussion of lived experiences and barriers. Questions like, “How much time do you live in a gender different than the one assigned to you at birth?” are followed up with “What are the reasons you don’t live all of the time in your gender?” This offers unique insights into the fears and barriers that TNB people face. When combined with standard demographic data, this data provides a cultural temperature check to assess what regions of the U.S. or particular subgroups may be facing particularly harmful barriers and disparities.

Life satisfaction, resilience, and future hopes. These topics are frequently overlooked in other surveys and research with TNB communities. The USTS offers respondents the ability to discuss resilience, happiness, community, and coping with stress. For example, the USTS asks about happiness and satisfaction before and after gender-affirming care, feelings of belonging or isolation, and even family planning. Many negative assumptions are made about TNB people, which is why gathering data on perseverance, positive experiences, and future hopes is so important.

Health access and Covid-19 impacts. Questions focused on ability to access insurance, affirming healthcare, and necessary document changes provide vital data as TNB people continue to experience discrimination in healthcare and insurance coverage. The survey also asks about provider knowledge about TNB health and experiences navigating HRT. The survey assessed frequency of depressed feelings and even offered resources to helplines. This data will help advocates continue to push to ensure TNB people receive the care that they need and deserve. New for this year, the USTS asks if COVID-19 policy changes like telehealth were beneficial and something that the community would to continue. This data will be fantastic to see, as many LGBTQ+ community health centers have seen positive responses to telehealth/virtual care models.

USTS asks about your experiences with police and the criminal justice system. They ask important questions about experiences in jail or prison, including housing assignments, misgendering, and experiences of sexual harm or harassment. The USTS provides a valuable opportunity to uplift and amplify the voices of those who have experienced injustice with the carceral system and forge long overdue changes in policing and the criminal justice system.

The survey took me just under an hour to complete but it was so well-made and informative that the time seemed to pass quickly. At the end, I felt really good about hitting submit knowing that my story and my experiences mattered and would be part of something so useful for TNB people. We need as many trans and non-binary people to take the survey as possible! Take the survey TODAY to ensure that your voice and experiences are included!

The Rainbow Wave: A 2022 LGBTQ+ Midterm Round Up

The Midterm Elections presented Americans with crucial issues to decide on and important offices to fill. Many of these issues deeply impact LGBTQ+ people, and particularly trans and non-binary (TNB) youth. In weeks leading up to the Midterms, many campaigns prominently featured anti-LGBTQ+ rhetoric. For example, targeted ads from anti-LGBTQ+ groups claimed that candidates who support gender-affirming care are “pushing radical gender experiments on children.” While some well-known anti-LGBTQ+ political figures were re-elected, overall, Americans did not submit to the anti-LGBTQ+ fearmongering. Many prominent candidates running on anti-LGBTQ+ and anti-trans platforms failed to resonate with voters. This anti-LGBTQ+ rhetoric only encouraged an already resilient population to push harder to run for office in order to create the safe, affirming communities that all people deserve.

Representation matters: The midterms were a success for the LGBTQ+ candidates. According to Victory Fund, at least 678 openly LGBTQ+ candidates were on the ballot for November’s midterms, up from 574 in 2020. A record-breaking number of TNB candidates were elected, including Zooey Zephyr, the first openly trans person in the Montana’s House of Representatives who won with almost 80% of the votes. SJ Howell, who identifies as non-binary, also won their historic seat on Montana’s House of Representatives. Several LGBTQ+ candidates also had historic victories. In New Hampshire, James Roesener became the first out transgender man elected to a state legislature in U.S. history. Maura Healey of Massachusetts and Tina Kotek of Oregon became the first lesbian governors elected in the United States. In California, Robert Garcia was elected to U.S. Congress, making him the first out LGBTQ+ immigrant to hold the seat.

In Illinois, 35 LGBTQ+ candidates ran for election in 2022. Illinois now has more LGBTQ+ elected officials than ever before, from 50 in 2020 to 54 in 2022. Eric Sorensen won a seat in the U.S. Congress, making him the first LGBTQ+ member of Congress from Illinois. His presence means that the 118th U.S. Congress will have 13 out LGBTQ+ members, the most LGBTQ+ representation ever seen at this level of government. It is essential for the voices and experiences of LGBTQ+ people to be represented at all levels of government.

LGBTQ+ equality and protections for trans youth were a focal point for many candidates across the nation, as LGBTQ+ rights have been up for debate recently in many legislatures. In Illinois, Governor J.B. Pritzker won re-election. He shared in his victory speech his commitment to public health equity and human rights: “We reaffirm what we are fighting for access to healthcare that not only keeps you alive but keeps you healthy… A world where… AIDS can be eradicated… we will never surrender in the battle against hate, racism, sexism, homophobia, transphobia, xenophobia, and antisemitism.” In Maryland, Wes Moore was elected governor, making him the state’s first Black governor. He was an advocate for the newly passed Inclusive Schools Act and is a strong supporter of the proposed Trans Health Equity Act in Maryland. He has previously stated, “for anyone who wants to take away rights… (from) our LGBTQ+ community here in the state of Maryland, you’ll have to go through me first, because it is something that I will not tolerate nor condone.”

Reproductive freedom has been another issue concerning millions of LGBTQ+ people since the Supreme Court’s decision to overturn Roe v. Wade. States across the nation took action to protect reproductive freedom. In Illinois, Liz Rochford and Mary Kay O’Brien were elected to the state Supreme Court – making the Court a 5-2 majority supporting reproductive freedom and LGBTQ+ rights. Additionally, California, Vermont, and Michigan residents approved ballot measures codifying abortion rights in their state constitutions, while voters in Montana and Kentucky rejected measures that would have restricted access to reproductive care.

Protections in the workplace were voted into the Illinois constitution with the Worker’s Rights Amendment. Illinois is the first state to preemptively oppose “right to work” laws and the fourth state in the nation to enshrine workers collective bargaining rights in its constitution. This is especially beneficial for LGBTQ+ workers, as it will foster greater protections against workplace discrimination. 

Despite the recent successes, LGBTQ+ people are severely underrepresented in the American political landscape. The recent Rainbow Wave is proof that LGBTQ+ people are capable leaders, change agents, and critical representation to our youth. Yet, studies have shown that LGBTQ+ people feel they are not qualified to seek office which is not often the case. If you are interested in learning more about how you or someone you know can run for elected office, check out the LGBTQ Victory Fund for resources and support!

To check up on how your elected officials have voted on LGBTQ+ issues, check out 117th Congress Score Card by the Human Rights Campaign

Howard Brown Health Puts Patients and Staff First in Response to a Financial Challenge 

Howard Brown Health is being thoughtful and collaborative with our stakeholders as we work to close a $12 million (5.3%) fiscal-year gap in revenue. In all cases where changes may impact union members, we will bargain with the union first and in good faith. We recognize the difficulties these challenges will have on our employees and their families.

No layoffs will occur this calendar year and should they be needed, they will be the subject of bargaining with the union. Any cost saving options we pursue will align with the following goals:   

Across the country, LGBTQ+ and Ryan White HIV healthcare organizations like Howard Brown Health are navigating through significant changes in pharmacy revenue that now allow pharmaceutical companies to keep a greater share of federally negotiated savings through the 340B program.   

Like a similar Federally Qualified Health Center with LGBTQ+ healthcare expertise, Fenway Community Health Center in Boston, Howard Brown is feeling the pressures of a changing pharmacy landscape. In addition, federal COVID-19 relief funding that allowed Howard Brown to mobilize a robust, citywide response has ended. These changes are putting a strain on the agency’s finances, requiring a reduction in operating expenses.  

Howard Brown will provide continual updates as more information is available.

Howard Brown Health Opposes “Don’t Say Gay” Legislation

Due to the current surge of anti-LGBTQ+ legislation across the country, LGBTQ+ youth have increasingly become targets of harassment and discrimination. U.S. Rep. Mike Johnson (LA-R) recently introduced a national bill known as the Stop the Sexualization of Children Act (STSOCA). This new bill expands upon discriminatory and stigmatizing “Don’t Say Gay” (DSG) bills that have been introduced and passed in several states this year. Supporters of these bills claim that they will protect youth from exposure to “sexual imagery and radical gender ideology.” However, removing age-appropriate educational resources does not protect youth; on the contrary, it causes harm to LGBTQ+ youth, their families, and society as a whole.

Here is what you can do to help advocate for LGBTQ+ people!

State-Sponsored “Don’t Say Gay” Bills

Six states have passed laws banning school employees from discussing LGBTQ+ issues, and five states have passed laws requiring parental notification of LGBTQ-inclusive curriculum, allowing parents to opt their children out. One of the most prominent DSG bills was Florida’s HB 1557, Parental Rights Bill, which was signed into law by Governor DeSantis on March 28th, 2022. Florida’s law prohibits school staff from educating on topics “related to sexual orientation or gender identity,” citing that it is inappropriate material for children in grades kindergarten through 3rd grade. Inspired by Florida, other states drafted similar DSG legislation with additions of their own. Tennessee’s proposed HB 0800 includes a more expansive age range from kindergarten through 12th grade and would prohibit any materials that “promote, normalize, support, or address LGBTQ+ issues or lifestyles” in all public schools. Arizona’s proposed HB 2011, would mandate all public and charter schools to obtain written consent from a student’s parent or guardian to take part in any school group that relates to “sexuality, gender, or gender identity.” It would also grant parents access to all student records containing information on sexuality, gender, or gender identity. These state bills have paved the way for a national DSG bill.

The National “Don’t Say Gay” Bill

STSOCA includes features of previous state-sponsored DSG bills, but it is especially concerning as it extends beyond the classroom. The proposed bill would make it illegal for federal funds to be used to support any “sexually-oriented” program, event, or literature for children under the age of 10. The bill is broad and could affect an array of federally funded organizations, including universities, libraries, museums, health centers, and social service non-profits. STSOCA defines “sexually-oriented material” as “any depiction, description, or simulation of sexual activity, any lewd or lascivious depiction or description of human genitals, or any topic involving gender identity, gender dysphoria, transgenderism, sexual orientation, or related subjects.” As such, it equates age-appropriate education about sexual orientation and gender identity with sexually explicit content, further stigmatizing LGBTQ+ identities. Additionally, the bill would give parents and guardians the right to bring legal action against public officials, non-profit organizations, and private businesses if their student is “exposed” to such sexually-oriented materials. The bill’s language specifically mentions Drag Queen story hours as a specific example of sexually-oriented exposure.

Harms of DSG Bills

Proponents of DSG bills are spreading hateful anti-LGBTQ+ rhetoric, including the false narrative of “grooming” that suggests that queerness is dangerous and can lead to child abuse. They insist that schools and other organizations that provide LGBTQ+ inclusive resources are using these materials to recruit, indoctrinate, and sexualize children. Yet, age-appropriate education on relationships and identities has always been provided to students without concern; these resources have just always been framed on cisgender, heterosexual human experiences. Allowing youth to learn about the full diversity of human identities will foster a more compassionate and understanding society, and there is nothing inherently sexual or inappropriate about such education.

Unfortunately, the fearmongering around grooming has resulted in increased attacks on the LGBTQ+ community over the last year especially. Legislators who support such homophobic and transphobic rhetoric act as validation to others who wish to terrorize LGBTQ+ people. A study by the Human Rights Campaign found that hateful, anti-LGBTQ+ discourse on social media grew by 406% in the month following the passing of Florida’s DSG bill. What starts as fear and intimidation online can lead to real world consequences, as 20% of all hate crimes are anti-LGBTQ+ motivated. For example, earlier this summer, staff at the Uprising Bakery and Café in the Chicago suburbs received threats and the establishment was vandalized because they planned to host a family friendly drag event. Upon recently re-opening, Uprising Bakery’s owners were met with anti-LGBTQ+ protestors. Other similar anti-LGBTQ+ attacks have been on the rise all across the country. Police stopped 31 white supremacists on their way to disrupt an LGBTQ+ pride event in Idaho, and a group of right-wing extremists interrupted a family-appropriate drag event by shouting anti-LGBTQ+ slurs at parents and children in California.

Of course, DSG bills also have a tremendous impact on school environments. After Florida passed its DSG bill, LGBTQ+ students and their allies in schools across the state were taunted with threats from other students like, “Kill ‘em all.” LGBTQ+ students already struggle to find affirming educational environments and in turn face higher risk for depression and suicidality. According to the Trevor Project’s 2021 Mental Health Survey, 42% of LGBTQ+ youth seriously considered attempting suicide in the past year, including more than half of transgender and nonbinary youth. More specifically, over 60% of LGBTQ+ youth said their mental health has declined due to recent legislative efforts to ban gender-affirming care. Often, students who may not have accepting parents at home rely on the support of an affirming teacher or supportive school club. According to GLSEN’s 2019 National School Climate Survey, supportive teachers positively influenced students’ academics, absenteeism, emotional well-being, and safety. However, with the presence of DSG bills, staff are cautious to express any support for LGBTQ+ students and schools are going to tremendous lengths to remove LGBTQ+ resources. In Florida, teachers were advised to not wear rainbow clothing items, to remove Safe Space stickers from their classrooms, and to omit LGBTQ+ historical figures in lesson plans.

Whether the National DSG Bill passes Congress or not, its presence is still causing harm. Here is what you can do to help advocate for LGBTQ+ people!

Understand the State and Local Positions on your Ballot!

Midterm elections have an incredible impact on our day-to-day life, but voter turnout for Midterms often lags behind Presidential elections. Even for voters who do vote in Midterm elections, much of the attention is focused on national races. It’s critical to remember that Midterm elections are also an opportunity to vote on positions and ballot initiatives at the state and local level. 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!

Elected Administrative Positions Provide Needed Services

There are many positions that help manage the administrative needs of state and local government agencies, such as your city and county housing authorities, public transportation, school districts, and departments of public health. In each county in Illinois there is a County Clerk responsible for maintaining all records of transactions with government bodies. The County Clerk is where you go to get a copy of a birth or marriage certificate, or to receive a permit of business license. For LGBTQ+ voters, the County Clerk can help you obtain an updated copy of a birth certificate after a name change or updating a gender marker. Your County Board President is responsible for overseeing the operations of all county departments and plays a key role in presenting funding budgets and annual reports for the needs of the county. As such, the County Board President can decide if issues like healthcare or affordable housing become important agenda items and funding priorities for your county.

State/County Financiers can Influence Funding for Much Needed Public Services

At the state level, we elect a State Treasurer who keeps track of state budgets, manages state investments, and receives and deposits state monies in approved financial institutions. The State Comptroller audits financial claims and provides fiscal guidance to local governments. The State Treasurer and the State Comptroller play a pivotal role in funding critical public services. For example, the State Treasurer and Comptroller can influence funding for underserved schools, increase resources to community-based health clinics, and expand transportation access across the state. They can audit, adjust, and recommend how funding to these services should be allocated.  On a local level, we elect a County Treasurer to safekeep public funds and distribute the public funds of the county. One of the main jobs of County Treasurer is to collect and distribute property taxes to a multitude of agencies including school districts, villages, cities, townships, park and forest preserve systems, libraries, public health and safety agencies, election authorities, economic-development agencies and bonds to pay for public-works projects. Who we elect to watch state and local budgets is important in the management of public services we use everyday.

Elected Judicial and Law Enforcement can set Precedents

We elect several District and Circuit Court Judges who are responsible for overseeing a majority of criminal and civil cases in the state. There are also elected State Appellate Court Judges and State Supreme Court judges responsible for hearing cases filed from the lower circuit courts. These judges hold immense power to set legal precedents and influence access to healthcare and civil rights. An important elected law enforcement position is County Sheriff. County Sheriffs are elected in each county and are considered the chief law enforcement official responsible for ensuring that county and state laws are followed. The culture and ecosystem of our court systems and law enforcement bodies are dependent on what judges and law enforcement on our ballots we elect.

What else is on the ballot?

In Chicago, there are elections for the Metropolitan Water Reclamation District (MWRD). The MWRD is responsible for protecting the health of Lake Michigan and all area waterways. It is also responsible for treating wastewater and storm water management for Chicago-area residents and businesses. You can find more information on the MWRD here and on the MWRD candidates here. Alongside these important elected officials, voters will sometimes be asked to vote on ballot measures. A ballot measure is an issue or question that appears on a statewide or local ballot for voters of the jurisdiction to decide. In this upcoming Midterm election, there is a statewide ballot measure regarding a provision being added to the Illinois State Constitution regarding worker’s rights and collective bargaining rights. You can find more information on that ballot measure here

Engaging in Midterm elections provide many opportunities for voters to elect officials who align with their needs. Being an informed voter on these positions can help us all better understand how these elected officials will serve us and our communities. For more information on the officials up for election on your ballot (state or county), you can visit here. You can visit Howard Brown to get more info on the Midterms, judges’ races and special circumstances when voting.

October is Breast/Chest Cancer Awareness Month!  

Breast/chest cancer is the most common diagnosed cancer in the U.S. with an expected 290,560 new cases in 2022. While there is limited data on overall rates of breast/chest cancer screenings, diagnosis, and health outcomes among LGBTQ+ individuals, a growing body of research shows that sexual minority women may be at increased risk of breast cancer due to higher prevalence of well-known risk factors—including cigarette smoking, alcohol use, obesity, and nulliparity. Additionally, research shows that lesbian women report lower rates of preventative healthcare, including mammography, compared to their heterosexual counterparts. While there is even more limited data on transgender and non-binary (TNB) individuals, some recent studies have shown that transgender patients are less likely receive breast/chest cancer screening compared to the cisgender population.

For LGBTQ+ patients, there are many barriers to accessing breast/chest cancer screenings. For example, socioeconomic factors like lack of insurance coverage and economic instability disproportionately impact LGBTQ+ patients and also make it more difficult to access all types of healthcare, including cancer screenings. Another barrier to LGBTQ+ individuals seeking breast/chest cancer screenings is the lack of affirming and inclusive breast/chest cancer awareness campaigns. Breast/chest cancer campaigns typically use terminology and visuals that are geared towards heterosexual and cisgender women without any acknowledgement of queer and TNB individuals. This can lead to many LGBTQ+, and TNB individuals especially, to not feel seen or represented and potentially not identify with the necessity for breast cancer screenings.

Lack of affirming and knowledgeable healthcare spaces is also a huge contributor to disparities in breast/chest cancer screening and outcomes. Research shows that 15% of LGBTQ+ Americans, and 30% of transgender people, postpone or avoid medical treatment—including cancer screening—due to discrimination. TNB individuals also may have specific concerns or needs around breast/chest cancer screening that are often overlooked. For trans men who experience gender dysphoria around their chest, being misgendered and having their mammary tissue referred to as “breasts” can be very distressing. For those on feminizing hormone therapy, as well as those who have had gender affirming top surgery, there may be questions about breast/chest cancer risk and screening protocol. Unfortunately, there is confusion and lack of knowledge among providers regarding breast/chest cancer screening guidance for TNB patients.

It is critical for providers to create more affirming spaces for LGBTQ+ patients to receive breast/chest cancer preventative care, treatment, and resources. Using more inclusive terminology, such as “chest” instead of “breast” or “mammary tissue” rather than “breast tissue,” may help make mammograms a bit more comfortable for TNB patients. Providers should always use terminology that patients are comfortable with and use for themselves. Additionally, providers can also help to ensure that breast cancer patient education materials depict a wide range of people, and that mammograms are not specifically labeled as women’s healthcare. Overall, it is critical that national cancer data registries collect sexual orientation and gender identity data to better understand breast/chest cancer concerns, needs, and disparities affecting LGBTQ+ communities.

The importance of getting screened for breast/chest cancer cannot be overstated. Early detection for breast/chest cancer can be lifesaving. For more information on breast/chest cancer among LGBTQ+, including resources on cancer screening for transfeminine and transmasculine individuals, you can visit the National LGBT Cancer Network here. You can also visit Howard Brown Health to get more information or speak to a provider about breast exams.

Midterm Elections: 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 by voting for local and state judges in the Midterm Elections!

Recently there have been several cases that highlight just how important the courts are when it comes to healthcare access. For example, in August, a federal judge in Texas ruled that mandating employers to provide PrEP coverage in the employee insurance plans violated the employer’s religious freedom. Despite the proven efficacy of PrEP in preventing HIV transmission, there remain significant barriers to PrEP access for many communities disproportionately burdened by HIV, including BIPOC and transgender populations. Cost is one of the most significant barriers, and this court decision in Texas only undermines efforts to make PrEP more affordable, making it even more difficult for the most vulnerable individuals to access life-saving medication.

In contrast, courts have also been vital in protecting access to care. We have seen a recent onslaught of anti-trans healthcare legislation across the nation. However, some courts have pushed back against anti-trans legislation. For example, a federal court of appeals recently ruled that Arkansas cannot enforce its new law banning gender-affirming healthcare for trans youth. Another federal court ruled that excluding medically necessary gender-affirming care in North Carolina healthcare plans for state employees is discriminatory. There is still much more that can be done to protect LGBTQ+ individuals as they seek and receive healthcare, and it is increasingly clear that courts across the country have a vital role to play.

Despite the critical impact that judges have on healthcare access, judicial races are often overlooked during elections. Approximately 25% of voters who go to the polls do not cast votes for any judges at all. Part of the issue stems from lack of knowledge about the importance of state courts compared to federal courts. Approximately 90% of all cases heard in the American judicial system are heard at the state level. In contrast, of the more than 7000 cases submitted to the U.S. Supreme Court each year, it only accepts 100-150, with most of those cases originating in state courts before being submitted to the Supreme Court. Additionally, cases at the state level help to set legal precedents, establishing an understanding of the law that becomes the standard interpretation used in rulings made by other courts, including federal courts and the U.S. Supreme Court. One of the most important distinctions between state and federal courts is that many state court judges can be elected by the public, as opposed to federal judges who are appointed by the president. This means voters have a direct impact on the judges who are responsible for hearing the vast majority of cases in the country and setting important legal precedents! Voting in state judges who are committed to health equity and upholding civil rights is even more critical now given that many federal court vacancies over the last few years have been appointed to conservative judges who oppose LGBTQ+ equality.

Now more than ever, being informed about the judges we elect is critical for advancing LGBTQ+ health equity. Across the country, there are a total of 385 state appellate court seats up for election in 2022, including 84 state supreme court seats and 301 state intermediate appellate court seats. In Illinois, there are two state supreme court seats and 61 judge seats in Cook County up for election in 2022. Many judicial races will depend on where you live. You can get more information on the judicial races in Cook County through Injustice Watch, and to find out what judges are on your ballot for all of Illinois you can visit Illinois Voter Guide. The upcoming 2022 Midterm election can have decades-long repercussions in the continued fight for affirming, affordable and equitable healthcare—so make sure you make your voice heard by voting!

340B is Under Attack

The 340B program, a critical lifeline for the nation’s public health safety net, is under attack 

Federally Qualified Health Centers (FQHCs), like Howard Brown, serve as an essential safety-net provider of primary care, behavioral health, dental, social, and wraparound services. The federal 340B program requires pharmaceutical manufacturers who participate in the Medicaid Drug Rebate Program to provide discounted pricing to FQHCs and other 340B covered entities. This allows FQHCs to pass along the discounts directly to uninsured patients to help them afford their medications.  Dispensed medications to insured FQHC patients can generate savings or revenue—at no cost to the patient—that FQHCs use to help afford free or discounted medical care and other essential services. The 340B program was designed to allow safety net providers “to stretch scarce federal resources as far as possible” – all at no cost to patients or taxpayers.  

Unfortunately, this critical program is under attack by pharmaceutical manufacturers, threatening to undermine the nation’s public health safety net. Without swift and meaningful action by federal authorities, manufacturers will continue to decrease prescription affordability and access to the most vulnerable patients at Howard Brown and across the country. If these attacks on the 340B program continue, Howard Brown and many other safety-net providers will have no other choice but to reduce services offered to help patients access basic subsidized healthcare and social services.  

Help save this crucial funding for patient care! Contact your state and federal representatives to tell them to take action to protect 340B. Contact your representatives today. 

340B and the Public Health Safety Net 

The 340B program plays a vital role in sustaining the healthcare safety net across the United States. By law, FQHC’s are mandated to provide care to every patient that comes through our doors, regardless of insurance status or ability to pay. Virtually every FQHC, Ryan White CARE Act HIV medical provider, and STI clinic in the country relies at least in part on 340B program savings in order to provide sliding scale and free care to patients with financial barriers. Nearly 25% of Howard Brown patients are uninsured and rely on 340B discounted drugs to treat chronic conditions including HIV, diabetes, respiratory disease, and hypertension.  

Manufacturer Attacks on 340B 

Despite the critical role of the 340B program in sustaining the nation’s safety net, pharmaceutical manufacturers have continuously attacked the program.  

Since 2020, 18 pharmaceutical manufacturers—including Eli Lilly, Merck, and Gilead—have restricted or eliminated access to 340B priced drugs through contract pharmacy partners, with 8 manufacturers specifically targeting FQHC contract pharmacies. This reduced pharmacy access is harmful to the patient populations that FQHCs primarily serve – with many living in pharmacy deserts, without transportation to travel to more distant pharmacies. A network of strategically selected contract pharmacies is essential to ensure Howard Brown patients have convenient access to affordably priced medications no matter where they live.  

In July, Bausch Health, a manufacturer of life-saving diabetes medication, became the 18th drugmaker to impose restrictions on the sale of 340B to entities that contract with commercial pharmacies.  For many patients, the broad network of commercial pharmacies increases convenience and availability, helping them adhere to their treatments. 

These restrictions allow pharmaceutical companies to keep for themselves the 340B savings that should be going to safety net providers. The resulting loss in 340B savings for FQHCs like Howard Brown significantly undermines our ability to continue to provide the continuum of care necessary to maximize patient access and health outcomes. Funding for critical positions that support traditional medical care teams, including case management, behavioral health services, and patient services, are also supported through 340B savings. All these programs and positions, and the patients who rely on them, are under threat by these manufacturer actions.  

Defend 340B Before It’s Too Late 

There is still time to protect the 340B program! We continue to engage our local, state, and federal government representatives around drug costs, pharmacy access, and 340B, and so can you! FQHC patients, staff, and community members alike are encouraged to engage with their state and federal representatives to tell them to take action to protect 340B. Contact your representatives today. 

Learn more about how health centers across the country use 340B savings to improve access to care and how recent attacks have impacted the public health safety net: https://www.nachc.org/wp-content/uploads/2022/06/NACHC-340B-Health-Center-Report_-June-2022-.pdf 

Howard Brown Health Condemns Texas Court’s Discriminatory PrEP Ruling

Today, a U.S. District judge in Texas ruled that the ACA’s mandate requiring health insurance companies to cover PrEP violates the plaintiff’s religious rights.

Pre-exposure prophylaxis, or PrEP, is a vital tool in the fight against HIV. We cannot get to zero new HIV infections without it, and creating a barrier to access the medication goes against all evidence-based practices and public health recommendations. The ruling is clearly targeting marginalized groups and will further restrict their access to healthcare and bodily autonomy. An employer’s religious beliefs do not give the employer a license to discriminate against their workforce, and the ruling further stigmatizes HIV as something that only impacts men who have sex with men.

PrEP is healthcare. Employers who provide health insurance cannot choose the type of healthcare their employees need. Howard Brown will continue to work with local lawmakers to ensure anyone who can benefit from PrEP has access to it.

Get Ready to Vote: Rights to Accommodations

Whose Seats? Your Seats!

The Midterm Elections are coming up fast, on November 8, 2022! As we begin to prepare for the upcoming election, there are millions of Americans who face extra barriers to voting. There are many factors that can make it difficult for people to register to vote or to vote at all.  1 in 4 Americans live with a disability and in 2016 the Government Accountability Office (GAO) found that 60 percent of polling places were inaccessible to disabled voters. When it comes to those experiencing homelessness, according to 2008 data roughly 60% of the homeless population were U.S. citizens over age 18, but only 1 in 3 were registered to vote. Add in the intersectionality of LGBTQ+ status or race and this can increase barriers to participation in elections. In the 2018 Midterm elections, the trend of stricter voting laws harmed BIPOC voters the most with 80 percent of Black voters in Georgia either being unable to vote, experiencing great difficulty voting, or being removed from voter rolls.  

This year’s Midterm Elections are your opportunity to have a say so on issues ranging from healthcare, LGBTQ+ rights, gun control, education and transportation, just to name a few. It is critical that all people have the ability to vote. 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.

ADA (American with Disabilities Act) Voting/ Assisted Voter/ Challenged Voter/ Curbside Voting

For voters with a physical disability, the American with Disabilities Act (ADA) provides support for any voter that needs physical support, including having polling places that are ADA and wheelchair accessible. They will also provide any supplemental ballot assistance such as a magnifying glass, assistance from another person, touchscreens that present large print or the ability to vote curbside with notice. For more information on voting with a disability, you can visit disabilityvoteil.org.

Hospitalized or Assisted Living Voter

If you are admitted to a hospital, assisted living facility, or rehabilitation center within 14 days before Election Day and are unable to physically make it to a polling place, you may quality to have a ballot delivered to you by a family or friend subject to certain conditions. To find out more information on the parameters, you can visit cookcountyclerkil.gov.

Military/Overseas Voter

The Uniformed and Overseas Citizens Absentee Voting Act (UOCAVA) allows the opportunity to vote to all active U.S. military, Merchant Marines, other uniformed services, eligible family members, and U.S. citizens overseas (with some provisions). There are some registration requirements and any ballots requests need to be requested within 10 days of the election. To get more information on overseas voters, please visit cookcountyclerkil.gov.

Provisional Voter

Provisional voters are voters who might be missing important information necessary to vote. A few examples of situations where someone may be marked as a provisional voter include: your registration cannot be found and you are unable to provide required documentation or witness; you are challenged by a poll-watcher in the voting site and you cannot provide required documentation or a witness; or you insist on voting at the incorrect Election Day voting site.

A person is given a provisional ballot to fill out and will have a certain amount of days to send the ballot back to the Illinois Election Board information with the information requested such as State ID, in order for the provisional ballot to be counted. For more information on provisional voters and ballots you can visit cookcountyclerkil.gov and elections.il.gov.

Survivors of Domestic Violence

The Illinois Address Confidentiality Program (ACP) aids survivors of domestic violence by providing a substitute address to use as their home and work addresses. This will also ensure their home and work addresses are kept private on voter rolls so no one can identify their actual information. For more information on voting privacy or to apply for ACP protections, you can visit illinoisattorneygeneral.gov.

Voting with a Criminal Record

In the state of Illinois, anyone who is not actively incarcerated and serving out a sentence is allowed to vote. For example, if you are on parole, you are not actively serving a prison sentence and are therefore allowed to vote. You are not allowed to vote in Illinois if you are still actively serving out a sentence, and this includes participating in a furlough program. For more information on voting with a criminal record, please visit illinois.gov.

Persons Experiencing Homelessness

State and federal law protects the right to vote for people experiencing homelessness. If a person is not already registered they can register in person or online. There are multiple forms of ID the state of Illinois will recognize when registering to vote, including mail postmarked to the applicant; Illinois driver’s license or state ID card; a municipal ID card (for example, the Chicago CityKey); an employee or student ID; Social Security card; birth certificate; credit card; valid U.S. passport; lease or rental contract. People experiencing homelessness can provide a letter from a drop-in center, shelter, or the person in whose home they are living doubled-up that approves the center or residence to be used for the purpose registering to vote. There is also a Illinois ID program where those who are experiencing homelessness can receive help getting an ID recognized by the State of Illinois. You can find out more information on voting while experiencing homelessness at chicagohomeless.org. You can get more information other alternative Illinois ID at outreachchicago.us.

To get more information including registering to vote, receiving information on voting by mail, finding a polling location, or get updates on the midterm election you can visit your local election boards for more information

For residents of Chicago, you can get more information at chicagoelections.gov

For residents of all of Cook County, including Suburban Cook County, you can go to cookcountyclerkil.gov/elections

For all residents, regardless of where in Illinois you reside, you can go the Illinois State Board of Elections at elections.il.gov.

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