Originally published on Advocate.com February 18 2012 10:43 AM ET
PHILADELPHIA — The White House rolled out its first campaign-season LGBT conference Thursday, one focused on health care issues facing the community and headlined by Secretary of Health and Human Services Kathleen Sebelius. The conference series was first announced by the White House last month.
Sebelius didn’t break big news on health care initiatives during a morning address at Philadelphia's Thomas Jefferson University. But the White House’s engagement on the issue, coupled with the HHS secretary’s attendance, brought national visibility to what Sebelius accurately described as a health care system that has been “especially broken for LGBT Americans,” who have lower rates of coverage and have been historically excluded from federal health surveys.
“Given the discrimination that often is faced in the workplace, LGBT Americans often have a harder time getting access to employment-based coverage,” Sebelius said at the conference, also attended by gay White House officials including Gautam Raghavan, the LGBT liaison in the Office of Public Engagement; and John Berry, director of the Office of Personnel Management.
But “all Americans, regardless of where they live, what age, sex, race, sexual orientation, or gender identity, have a basic right to get the health care they need here in the United States, and that’s a principle we are committed to fighting for in this administration,” Sebelius said.
The speech was similar in tone and structure to Sebelius’s address before the National Coalition for LGBT Health in October, where she enumerated the administration’s regulatory accomplishments over the past three years — most famously a hospital visitation mandate for same-sex couples — and touted health care reform as a major step toward improving health care access for the community. The U.S. Supreme Court will hear arguments on the law’s constitutionality in late March.
The lack of marriage rights can be a major barrier to care, as Sebelius discussed with The Advocate in an interview published last month. President Obama has endorsed legislation to repeal the Defense of Marriage Act, which prohibits federal recognition of same-sex marriages, though the White House has not budged in recent months beyond talking points of the president “evolving” on the issue of full marriage rights and opposing “divisive and discriminatory” measures against same-sex couples — this in reference to anti-gay marriage ballot measures in states such as North Carolina and Minnesota.
The issue-specific LGBT conferences, ranging from HIV/AIDS to aging-related and antibullying efforts, are slated to take place around the country over the next several months, ending in June. Invites have already been sent out for a March 9 event in Detroit focused on housing and homelessness.
At the Creating Change conference last month in nearby Baltimore, Shaun Donovan, the secretary of Housing and Urban Development, announced the agency had finalized a rule prohibiting antigay and antitransgender discrimination in housing programs that HUD oversees. The rule, Donovan said at the January conference, “says clearly and unequivocally that LGBT individuals and couples have the right to live where they choose.”
Donovan has stood out in pushing the envelope on LGBT rights in Obama’s cabinet, coming out ahead of the president in support of full marriage equality last November.
The Democratic Party has been urged to follow suit by supporting a pro-marriage equality platform with inclusive language on the issue, as proposed earlier this week by the group Freedom to Marry. A spokesman for Rep. Nancy Pelosi told Metro Weekly Tuesday that the House Democratic leader supports the proposed language (read the report here).
Another trending topic discussed Thursday was that of cultural competency standards for health care professionals treating LGBT patients. There are no uniform standards for doctors and medical staff on how (and how not) to treat LGBT individuals. Sebelius said in January that she does not necessarily believe codified regulation needs to be implemented, though the Office of Minority Health is working to add sexual orientation and gender identity into the language of its Culturally and Linguistically Appropriate Services in Health Care standards.
Liz Margolies, founder and director of the National LGBT Cancer Network, said mandatory training is essential for creating a health care environment where the specific needs of LGBT patients are thoroughly understood and addressed.
“Offering optional cultural competency is simply preaching to the choir,” said Margolies, who attended Thursday. “The people who don’t get it are the people who probably need it. So the only way to make a difference is to make sure every single person is trained.”
Such training should not be limited to medical school programs, she said: “Think of how many people you see and talk to during an emergency room visit before you are even seen by a doctor.”
Of the conference, Margolies said that face time with White House officials was highly important, though the campaign value of the event for the administration was also clearly evident. “There’s an amazing amount of talent in this room. It’s only with all of us screaming and pushing persistently that we’re going to make any difference.”
On Thursday, Secretary Sebelius also called for reinvigorating domestic HIV/AIDS prevention efforts, remarking that given the continued steady infection rate nationwide, “frankly, what we’ve been doing is not very good.” The president’s 2013 budget, released earlier this week, calls for modest increases in HIV prevention efforts for high-risk groups, including gay men and African-Americans.
“The most frustrating thing is that there’s now very good data about how prevention can work, about how to reduce partner-to-partner transmission, early identification and treatment,” Sebelius said in the January interview. “And yet we have 50,000 new infections popping up. It just doesn’t make any sense. So we’ve got to redouble our efforts on the education front and outreach front to really drill down into the communities most at risk.”
The Obama budget also calls for an additional $75 million for care and treatment through the Ryan White HIV/AIDS program.
Off-the-record sessions for attendees during the Thursday conference focused on aging, LGBT youth, transgender health, cultural competency, and “engagement opportunities with the White House and HHS.”
Dr. Scout, a transgender health advocate with The Fenway Institute in Boston, said the conference "didn't have so much new information," though "its real value is in the fact that it exists."
"We can grumble about how much needs to be done on LGBT health at HHS, and we should, but today the Administration really showed up for us," said Dr. Scout, whose organization received a $250,000 grant last year from the Health Resources and Services Administration to create a national training center for improving LGBT health. "If more healthcare policymakers showed the commitment the people here did, LGBT health disparities could be practically eliminated. Our huge smoking disparity, our access to care problems, our mental health disparities, all of it could be virtually wiped out with smart policies like the ones we heard talked about today."
However, to his disappointment, Dr. Scout said that agencies with substantial power over LGBT health issues, such as the Centers for Disease Control and Prevention and the Agency for Healthcare Research and Quality, didn't have staff in attendance, "which frankly is what I expected considering their lackluster performance in this area. I really do love what was being said today, but we need to start noticing what's not being said too, and who didn't even show up."
Sebelius, who has been tapped by Obama campaign officials to speak at super-PAC events for the reelection effort, attended a Washington, D.C., fund-raiser last week with the president that drew a who’s who of major LGBT Democratic donors paying $35,800 each for a $1.4 million overall haul. Cohosts of the event included GeoCities founder David Bohnett, Gill Foundation founder Tim Gill, and Laura Ricketts, co-owner of the Chicago Cubs.
After the jump, the Secretary's full remarks to the conference as prepared for delivery.
February 16, 2012
HHS Secretary Kathleen Sebelius:
Good morning. It’s great to be here with you in Philadelphia for the first in a series of White House LGBT conferences we’ll be hosting around the country. The goal of these conferences is partly for us to talk about some of the work we’ve been doing that might be of interest to you. But it’s also an opportunity for you to share your knowledge and suggestions with us. And I hope you’ll do that as the day goes on.
Today, I want to talk about one of the core principles that guide this Administration: fairness.
As you heard the President say in his State of the Union, we believe America is at its best when everyone lives and works by the same set of rules and all Americans get a fair shot at success.
That idea is not new. It’s written into the Declaration of Independence. And it’s at the heart of the American dream: the belief that if you work hard, if you're responsible in your community, if you take care of your family, then that’s how you should be judged. Not by what you look like, not by how you worship, not by where you come from, and not by whom you love.
This belief means ensuring that LGBT Americans have the same protections and opportunities as their neighbors, colleagues, and family members. And over the last three years, this Administration has undertaken a broad agenda to do just that.
Since the President took office, we’ve ensured that Americans can serve and protect their country no matter whom they love. The Justice Department has stopped defending the constitutionality of the so-called ‘Defense of Marriage Act.’ We’ve fought for, and secured, the passage of the Matthew Shepard and James Byrd Junior Hate Crimes Act to make assaults based on sexual orientation or gender identity a federal hate crime.
And we’ve ended an outdated and misguided policy that banned individuals with HIV/AIDS from entering the U.S. – a policy that broke apart families, hurt our economy, and went against our fundamental values.
These are important achievements that many of you have spent years fighting for. But know that there are still many areas where we can do more to ensure equal opportunity for LGBT Americans. One of those areas is health care.
When this Administration took office, the health care system wasn’t working for a lot of Americans. But it was especially broken for LGBT Americans.
Given the discrimination they sometimes faced in the workplace, LGBT Americans often had a harder time getting access to employment-based coverage. And many childless LGBT adults with low incomes fell through the cracks in our health insurance market, unable to afford private insurance but unable to qualify for Medicaid either.
Even LGBT Americans who had insurance often struggled to get the best care in a health care system where some health care providers didn’t understand – or didn’t want to understand – their needs.
That wasn’t right. All Americans, regardless of where they live or their age, sex, race, sexual orientation, or gender identity, have a basic right to get the care they need.
That’s why we fought for the Affordable Care Act, a law that will ensure for the first time that all Americans have access to quality, affordable health insurance, and better care. The law makes a wide range of improvements. But today I want to tell you about five key new benefits that all LGBT Americans need to know about.
First, the law is protecting LGBT Americans from many of the worst abuses of the insurance industry. A year and half ago, insurers could cancel your coverage when you got sick just because you made a mistake on your application. Or put a lifetime limit on the amount of care they’d pay for, meaning your coverage often ran out when you needed it most.
Thanks to the new Patient’s Bill of Rights, these practices and other abuses have now been banned.
Second, the law is helping millions of LGBT Americans gain access to the care they need to get and stay healthy. Because of the law, most Americans with health insurance now have access to free preventive care including cancer screenings, vaccinations, blood pressure and cholesterol screenings, and HIV testing.
And as of last fall, insurers can no longer deny coverage to children because of pre-existing health conditions – a protection that will extend to every single American in 2014. Similarly, insurers will no longer be able to turn someone away just because he or she is lesbian, gay, bisexual, or transgender.
The third thing the law is doing is bringing competition and transparency to the health insurance market. Under the law, we created a new consumer website healthcare.gov where, for the first time, you can compare all the insurance plans in your market and find the one that works best for you.
And earlier this year, we added a tool to make sure LGBT families can specifically search for plans that cover same-sex domestic partners. When we first launched the site, this was one of the first suggestions we received from LGBT stakeholders, and we made sure it happened.
In two years, LGBT Americans will have even better access to care when a new competitive insurance marketplace made up of state based Affordable Insurance Exchanges is created. This will mean that whether you lose your job, or change jobs, or retire early, or start a business, you’ll have somewhere to go to get affordable coverage.
The fourth key point to remember about this law is that it makes historic investments in our health care workforce in the communities where it’s needed most. With new resources from the law, we’re adding new community health centers and helping existing health centers expand their hours and add new services.
We’re also placing thousands of primary care providers in underserved communities. And through our Health Resources and Services Administration, we continue to train these providers in culturally competent care for LGBT patients.
Finally, the law helps us better understand the specific health challenges LGBT Americans face. Last year, our department released a plan to integrate sexual orientation- and gender identity-specific questions into our national surveys, allowing us, for the first time, to gather the data we need to strengthen our efforts to improve LGBT health.
For all these reasons, the Affordable Care Act is a huge step forward in closing LGBT health disparities.
But, when it comes to fighting for the equal rights of LGBT Americans, this Administration hasn’t waited for Congress to act. What we’ve found is that we can make a huge difference by simply using the administrative power we already have, and over the last three years, we’ve put it work.
I’m sure that many people in this room know the story of Janice Langbehn and her partner Lisa Pond.
While on a family vacation, Lisa experienced a brain aneurysm and was rushed to a local hospital. When Janice arrived with the couple’s children they were denied access to Lisa. Janice was Lisa’s partner of 18 years. They were raising three beautiful children together. But in the opinion of that hospital, they were not a family.
Over the next few hours, Lisa Pond died alone as her partner and children desperately tried to get to her side.
As a daughter, a wife, and a mother, it pains me to think of the anguish that Janice and her family went through in the hours, days, and weeks that followed Lisa’s death. And in 2010, under a memorandum issued by the President, HHS used our authority to make sure this never happens again by establishing full visitation rights for LGBT patients.
And our efforts haven’t stopped there. When confronted with the tragic suicides of LGBT teens around the country who had been bullied, this Administration launched a historic effort to stop bullying of LGBT children and youth in their homes, schools, and communities.
For the first time, we put a national spotlight on this issue when President Obama held the first ever White House Conference on Bullying Prevention. And that same day, we launched a new website called StopBullying.gov, a one-stop shop where kids, teens, parents, and educators can go online to learn about preventing or stopping bullying.
Our department also continues to support organizations around the country that are finding innovative ways to improve the health of LGBT Americans. Last year, for example, we awarded nearly $250,000 to the Fenway Institute in Boston to create a National Training and Technical Assistance Center that will help community health centers and their providers learn the best ways to provide culturally competent care to LGBT patients.
And we’ve committed to turning the tide in our nation’s fight against HIV and AIDS, a disease that has taken far too many of our LGBT brothers and sisters. When this Administration came into office, our domestic HIV/AIDS strategy was basically to keep doing what we were doing. We weren’t adapting fast enough. Agencies and programs weren’t working together well enough. We had lost some of the urgency we had in the 90s.
And yet 50,000 Americans continued to become infected with HIV each year –more than half of them were gay men. In some large cities, half of the African-American gay men were HIV positive.
Under President Obama’s leadership, we adopted a national strategy that has breathed new life into the fight against HIV and AIDS by focusing our resources on the populations that are most affected. The result is more momentum behind our domestic HIV/AIDS efforts today than we’ve had for nearly a decade.
We can’t make up for years of neglect with one policy or one grant. But collectively, these efforts are putting us on a path to ensuring all LGBT Americans get the care they deserve.
And this is just one department. Throughout the Administration, every department is looking for these same opportunities to erase disparities for LGBT Americans. These efforts may not make the headlines. But added together, these administrative changes can make a huge impact.
We know there is work left to do. Around the country, there are still too many places where fairness is not the rule.
But I am confident that the progress of the last three years will continue because ultimately, the goal we are working towards is the goal that’s at the heart of what this country stands for: the idea that every American, no matter who they are or where they come from, should have the same chance to reach their full potential.
In the last three years, we have begun to push open doors that seemed like they would remain shut forever. And in the months to come, I look forward to continuing to work with all of you to open even more doors and bring our nation closer to its highest ideals.