Stand up for the ACA

With so much happening in our political system at the moment, it can be difficult to keep up with each new development. The fact is that under the new presidential administration, there are many reasons for LGBTQ Americans, and other marginalized communities, to be concerned. This week we’re looking at the Affordable Care Act, and what a repeal of this legislation would actually mean, both in the broader picture and specifically for LGBTQ Americans.

We believe that a repeal of the ACA would be disastrous for millions of Americans, including many of the populations that Mazzoni Center serves: LGBTQ people, women, low-income people and people living with HIV/AIDS and other chronic health conditions. 

Last week, the nonpartisan Congressional Budget Office issued a report that at least 18-million people could lose health insurance in the first year if Congress repeals the Affordable Care Act without replacing it. Members of the LGBTQ community would be overrepresented among these populations.

Researchers at the Urban Institute estimated that the percentage of uninsured lesbian, gay and bisexual adults fell from 28 to 11 percent between June 2013-March 2015. These findings reflect the trends we have seen in rates of insured versus uninsured patients at Mazzoni Center Family & Community Medicine in recent years.

With regard to nondiscrimination protections, Section 1557 of the ACA prohibits discrimination on the basis of “race, color, national origin, sex, age or disability” in any program that receives federal funding. The Obama administration had interpreted this clause to include gender-identity and sex stereotyping. This means that programs and providers cannot deny services to an individual on the basis of their trans identity and must provide treatment consistent with a person’s gender identity. A full repeal of the ACA would remove those protections. 

This week the U.S. Senate is holding confirmation hearings for Georgia Congressman Tom Price, whom Trump nominated to serve as Secretary of Health & Human Services. We have grave concerns about the suitability of Rep. Price for this critically important role, for several reasons.

Price has consistently and vehemently opposed the ACA and helped draft several bills to replace it. The replacement plans that Price has proposed in the past rely heavily on tax credits, which are not adjusted for income; they would favor the wealthy and offer little or no relief to Americans living in poverty or those with low incomes. 

In addition, a repeal of the ACA threatens coverage for services that help some of the one in five Americans with a mental-health condition.

We also have serious concerns about Price’s views on Medicaid, and his proposals to limit federal Medicaid spending by giving states a lump sum, or block grant, and more control over how they could use it. Many poor Americans would lose their coverage in this scenario.

Medicaid is the single largest source of health coverage for those who are living with HIV in the U.S., and the second-largest source of public financing for HIV care in the U.S., according to the Kaiser Institute. Prior to the ACA, accessing health care was extremely difficult for someone with HIV, and we cannot risk going back to that.

We’re certainly not alone in this view. Ezekiel J. Emanuel, MD, Ph.D., chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, has said that a repeal of the ACA without an immediate replacement “would create havoc and significant disruption in the American health-care system.” 

Emanuel explained that if Congress repeals the ACA and specifically repeals the individual mandate, including the subsidies that allow individuals to buy insurance in the marketplace, it would “totally disrupt” the individual insurance marketplace. Insurance companies would largely (if not entirely) stop selling to individuals, even those who do not receive subsidies, and the result would be millions more without health insurance.

If you’re among the majority of Americans who receives your health insurance through an employer-based program, or Medicare, it would be a mistake to think that a repeal of the ACA will not affect you. As more uninsured people are forced to access care through emergency rooms, hospital costs increase and those costs are passed along to those of us with employer-based programs in the form of higher premiums.

What can you do to ensure your voice is heard on this issue? If you live in Pennsylvania, contact Sen. Pat Toomey today at: 717-782-3951 and ask him to block the repeal of the Affordable Care Act. (If you live elsewhere, you can look up your senator at and do the same.)

If you get your insurance through the Affordable Care Act either through the Exchange or through Medicaid, our friends at Equality Pennsylvania would like to hear your story. Visit to find out more. You can also share your story online, on your own social-media pages and on Mazzoni Center’s Facebook or Twitter pages, and use the hashtag #MyCoverageStory.

We may not be able to stop the confirmation of Rep. Price to HHS, but it is imperative that we raise our voices in support of the Affordable Care Act and work to ensure access to affordable health care for all Americans. 

For our part, Mazzoni Center is committed to providing quality primary care to anyone who needs it, regardless of insurance status; we will continue to help patients access things like prescription-drug assistance and other forms of support, but for people who cannot access insurance, there are unfortunately limits to the assistance that we can provide. That’s why standing up for the ACA is so important. 

If past public statements and voting records of key people associated with the new administration are any indication, our communities have a battle ahead on many fronts. It is critical that we stand up and continue to advocate not just for our health care, but our civil rights, our environment and all the things that allow us to pursue healthy and meaningful lives. 

Elisabeth Flynn is senior communications manager at Mazzoni Center.