As we celebrate Pride month, at least 20 million lesbian, gay, bisexual, transgender, queer, or intersex (LGBTQI+) American adults are facing threats to health care access. Amidst growing fears of violence and repression, Republicans across the country have launched a crusade against LGBTQI+ rights and affordable health care.
Trump-appointed MAGA judges are setting a dangerous precedent to pull vital medications off the market and eliminate no-cost preventive services that LGBTQI+ people count on to stay healthy — including PrEP, a medicine that is 99 percent effective at preventing the spread of HIV and can cost thousands of dollars annually. This threatens to exacerbate health disparities in queer Black and Hispanic/Latino communities. Republicans in 10 states continue to block Medicaid expansion, while the program provides critical health care access for LGBTQI+ people. Meanwhile, state-level Republicans are igniting a war on trans health care, with Florida Republicans banning upwards of 80 percent of all gender-affirming care in the state. Whether it’s barring no-cost screenings or preventive medicine, banning gender-affirming care, or attacking other fundamental LGBTQI+ rights, Republicans’ war on LGBTQI+ health care is only getting worse.
Republicans Are Pulling Medications They Don’t Like From The Market – Setting a Dangerous Precedent for LGBTQI+ Care
A Trump-Appointed Judge Is Working To Curb Access To Safe, Affordable Abortions. In April, another Trump-appointed judge ruled against the FDA in a case seeking to remove a popular medication used to induce abortion from the market. Medication abortions are the most common, least expensive, and most accessible method for people to terminate pregnancy, and the ruling impacts communities that already have difficulty accessing these key services.
Republicans Want to Pull Medications They Don’t Like Off The Shelves. The case could set a dangerous precedent for any federal judge to pull controversial medications off the market, regardless of the science behind approval decisions or the bureaucratic steps taken to prove safety and efficacy. As Lambda Legal has pointed out, “The trial court’s approach just as easily (or perhaps more easily) could be aimed at HIV-related medications and puberty blockers and hormone treatments, as well as medications for many other health conditions that are specially relevant for our communities.”
Republicans Are Taking Away No-Cost Preventive Care From LGBTQI+ People and Communities of Color
Republicans Are Curbing Access To No-Cost Preventive Services, Disproportionately Impacting LGBTQI+ People and Communities of Color. In March, a Trump-appointed judge decided against the federal government in Braidwood v. Becerra and struck down a major portion of the Affordable Care Act (ACA) requiring no-cost coverage of lifesaving preventive health care services recommended by the U.S. Preventive Services Task Force, including lung and breast cancer screenings, Hepatitis C screenings, HIV screenings, and PrEP medication. These changes have a disproportionate impact on historically marginalized populations like LGBTQI+ people and communities of color — curbing no-cost access to preventive services would create barriers to seeking needed care and exacerbate existing health disparities.
Republicans Are Targeting PrEP, A Key Prevention Strategy For HIV. The Trump-appointed judge’s ruling struck down a portion of the ACA guaranteeing access to pre-exposure prophylaxis (PrEP), a drug proven to substantially reduce the risk of contracting HIV. PrEP has been associated with a significant decrease in the number of new HIV diagnoses. PrEP is shown to lower the risk of infection from sex by more than 90 percent (more than 99 percent effective) and is widely viewed as a key prevention strategy for ending the HIV epidemic in the U.S. Thanks to ACA protections, the percentage of PrEP users has jumped from 3 percent of eligible patients in 2015 to 30 percent of eligible patients prescribed in 2021.
- Combating HIV Has Been Central To LGBTQI+ Public Health Efforts For Decades, Particularly For Gay and Bisexual Men. Efforts to combat the spread of HIV remain one of the largest public health concerns among LGBTQI+ populations. Gay and bisexual men, as well as Black and Hispanic/Latino Americans, remain disproportionately affected by HIV. The federal government’s 2022-2025 strategy to combat HIV recognized gay and bisexual men—particularly Black, Hispanic/Latino, and Native American men—Black women, and trans women as priority populations. Rural populations, especially gay and bisexual Native American men and Two-Spirit populations, have greater difficulty accessing preventive care for HIV.
- Ending ACA PrEP Protections Disproportionately Harms Black and Hispanic/Latino Gay and Bisexual Men. While 66 percent of eligible white people in America are prescribed PrEP, just 16 percent of eligible Hispanic/Latino Americans and 9 percent of eligible Black Americans are prescribed the lifesaving drug. Academic experts have concluded that Braidwood will disproportionately impact racial and ethnic sociodemographic groups at particularly high risk for HIV infection: “Even in our ‘best-case’ scenario, the predominant burden of new restrictions on access to PrEP will likely fall on Black and Latino gay and bisexual men, as well as transgender women, who already face significant barriers to HIV prevention and care.”
Ending ACA Cost-Sharing Protections Could Increase HIV Transmission By At Least 17 Percent In The First Year Alone. According to academic experts, ending the prohibition of cost sharing for PrEP will increase HIV transmission among men who have sex with men by at least 17 percent in the first year alone. Researchers at Yale have already determined that the Braidwood ruling could see coverage for PrEP drop from 28 percent to only 10 percent, mainly due to the fact that 80 percent of PrEP users are on commercial plans that would now have the ability to refuse to cover PrEP.
- Without ACA Protections, PrEP Could Cost Nearly $4,200 A Year On Average In Addition To Lab Costs and Office Visits. Out-of-pocket costs may be prohibitively high without ACA protections against cost-sharing. A recent study found that PrEP medication costs nearly $350 for a 30-day supply on average. Outside of the cost of obtaining medication, PrEP users incur additional required charges as part of the care regimen like clinical visits and lab costs that can add up to thousands of dollars annually.
- The Trump-Appointed Judge Who Ruled In Braidwood v. Becerra Has Long Been Hostile To LGBTQI+ Populations. The Texas judge who decided Braidwood has referred to PrEP as a drug that would “facilitate and encourage homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use.” In the past, he has also said that Obergefell v. Hodges (2015) and Lawrence v. Texas, the 2003 ruling that invalidated all remaining state anti-sodomy laws, “are judicial concoctions, and there is no other source of law that can be invoked to salvage their existence.”
Republicans Are Pushing An Anti-Trans Agenda
10 Republican-Led States Continue To Block Medicaid Expansion, Which Serves Millions Of LGBTQI+ Patients. Republicans in 10 states continue to block Medicaid expansion, while the program provides critical health care access for an estimated 1.2 million LGBTQI+ adults, disproportionately trans and non-binary Black, Hispanic/Latino, Pacific Islander, and Native American people. LGB individuals are more likely to qualify for Medicaid based on income, and Medicaid covers about 21 percent of trans and non-binary people in the U.S.
Republicans Are Waging War On Trans People and Their Health Care. Across the country, Republicans have escalated their war on trans people and health. As of May 2023, 16 Republican-led states have enacted new anti-trans health care laws and 22 states have passed anti-trans health care bills in at least one Republican-held legislative chamber. Republicans have re-centered their culture wars around trans people, with new legislation prohibiting drag shows from public property alongside bans on gender-affirming care. Anti-trans laws contribute to negative health impacts, including an increased risk of suicidality and substance use among trans and non-binary youths. Equitable access to health care services has always been a challenge for LGBTQI+ people. A 2018 survey found that 75 percent of people seeking gender-identity-based care have had negative experiences during physician visits. The fight to get insurers to cover basic care for trans patients—let alone gender-affirming care—has been a grueling, decades-long process even with ACA protections and federal and state-level enforcement. New bans threaten to undo decades of work to provide trans people with access to affordable, gender-affirming care.
Florida Republicans Have Effectively Banned 80 Percent of All Trans Health Care Providers In The State. In the past year alone, Florida Republicans have passed a slate of anti-trans laws banning health care for minors and adults alike. In April 2022, the Florida GOP passed legislation that requires trans adults seeking gender-affirming care to receive approval from the Florida Board of Medicine at least 24 hours in advance and has banned insurance providers from covering gender-affirming care for young adults. Just a few weeks ago, Florida Governor Ron DeSantis signed yet another law that bars up to 80 percent of all gender-affirming care providers in the state from practicing, including all nurse practitioners, physician assistants, and telehealth visits, drastically reducing the number of providers available for trans adults seeking care.
Republicans’ Anti-Trans Efforts Are Prompting “Mass Migration” Of LGBTQI+ People. In addition to direct attacks on trans health care, Republicans have ramped up their efforts to make LGBTQI+ social integration part of the broader culture wars. For example, Florida Republicans, led by Governor Ron DeSantis, have also enacted a ban on all topics surrounding gender identity and sexual orientation—including sex education and LGBTQI+ health—prompting many Florida-based Pride groups to cancel Pride celebrations amid a “mass migration” of LGBTQI+ people out of the state. In March, Tennessee Republicans adopted a strict ban on gender-affirming health care, while Texas Republicans have ordered state agencies to start investigating parents seeking gender-affirming care for their trans kids for criminal penalties.
