OK, HIV community: Ready, set: exhale. WE DID IT.
Not just us, of course. But undoubtedly, many folks living with HIV and their allies were among those who not only voted, but got out the vote to hand the nation’s reins from Donald Trump and Mike Pence to Joe Biden and Kamala Harris. In doing so, we’ve vanquished the greatest threat this nation has seen since the Reagan-Bush era to people living with, or at risk for, HIV.
Yes, we can “thank” a few folks in the Trump administration for going along fairly well with Anthony Fauci’s national Ending the HIV Epidemic in America plan (otherwise known as EHE), which remains more or less on track. But that was overwhelmed by the assaults on health care access and the rights of LGBTQ (especially transgender) people, people of color, immigrants, and other vulnerable groups impacted by HIV.
And to think: We turned out to vote in record numbers in the middle of a raging pandemic that has crippled us both health-wise and economically. That’s truly extraordinary—a testament to the power of citizen participation in democracy.
Sadly, as much as we’d like to zone out to Netflix and cute cat videos for at least a year, we can’t. There’s simply too much still at stake.
Biden and Harris likely won’t be able to get us any significant COVID relief or health care expansion unless Democrats capture the Senate, whose majority will be decided on (or perhaps a bit after) Jan. 5, 2021, when two key races in Georgia go to runoff elections: Democrat John Ossoff will face Republican incumbent David Perdue, and Democrat Raphael Warnock will face Republican incumbent Kelly Loeffler.
Even if the ambitious goal of Ossoff and Warnock both winning their races is fulfilled, Dems will only hold the Senate with Harris’ tie-breaking vote as Vice President. That means any future victories on Dem priorities like beefing up Obamacare—in part by giving all Americans the option of buying into Medicare—will be far from locked up.
There’s also a very good chance that we could be facing at least two years (until the 2022 midterms) of the Dems not having the Senate. That would likely mean that anything good on health care (or other social equality programs, like affordable housing or police reform) would have to come solely out of Biden’s executive branch. And any of that can be challenged in court—all the way up to a Supreme Court with a newly expanded conservative majority.
Speaking of which: On Nov. 10, the Supreme Court heard arguments on whether they should kill the Affordable Care Act (ACA, also known as Obamacare), which currently ensures health coverage to tens of millions of Americans. In a good sign, it appears that during those arguments, Justices John Roberts and Brett Kavanaugh both suggested that the tax mandate part of ACA—which has already been rendered meaningless under Trump’s Congress—could go while leaving the rest of the plan intact.
But Jennifer Flynn Walker, a longtime HIV and health activist who now organizes for the Center for Popular Democracy, notes that the removal of the ACA tax mandate means that “there really is no future of funding the ACA,” even if the Supreme Court preserves it. (The Center for Popular Democracy organized mass protests in 2017 that played a big role in pushing Congress to just barely save the ACA.)
“An incredible amount of damage has been done in the past four years to a number of issues that are important to people [in the HIV world and beyond], mostly to health care,” Walker added.
In addition to taking whacks at health coverage, the Trump administration also took as many whacks as it could at Obama-era rules that required health providers to not discriminate against transgender people. Such whacks were primarily intended to satisfy the conservative evangelical wing of Trump’s base, but they thankfully have been struck down in courts.
“The administration would walk across its various agencies and ask, ‘What are you doing about promoting religious freedoms?’” says Matthew Rose, director of U.S. policy and advocacy for Health GAP. (The right-wing cause of “religious freedom” is widely seen as an excuse to let health and other service providers discriminate against LGBTQ people.)
“Leadership really does matter,” adds Rose, even if a presidential administration does not also have all of Congress on its side. “An administration decides what it’s going to incentivize across agencies and states.”
With Biden, Rose says, we will once again have an administration that incentivizes and pushes such priorities as LGBTQ protections and the expansion of Medicaid in the 12 states that have not yet done so, despite the offer baked into the ACA to almost entirely fund such expansions.
What the Biden Administration’s Top HIV Goals Need to Be
According to Jesse Milan, Jr., the openly HIV-positive head of the national advocacy group AIDS United, the few good things the Trump administration did for people living with HIV are overwhelmed by the bad things they did to the larger groups the HIV community is a part of, particularly LGBTQ people, Black and Brown people, and those who most need to rely on government healthcare.
"The HIV community always appreciates it when a president mentions HIV as a priority in the State of the Union address [which Trump did], and the administration will also certainly get credit for launching the Ending the Epidemic Initiative,” he says, even though the EHE plan had already largely been mapped out by the community advocates with the ACT NOW: END AIDS coalition.
"But EHE’s potential for success in this administration was sorely muted by the administration’s efforts to undermine healthcare, LGBTQ rights and civil rights and racial justice,” Milan adds. “That may well be the verdict of history about this administration.”
Now, says Milan, the Biden administration—with or without the help of Congress—must prioritize three things:
Shoring up the nation’s public health infrastructure in a time of pandemic, including support for state and local health departments, federally qualified health centers, and disease surveillance, such as COVID contact tracing.
Moving aggressively toward its stated goal of ending the domestic HIV epidemic by 2025 (five years earlier than the Trump administration called for).
Reinvigorating leadership within the administration that features people living with HIV, mainly by reopening the Office of National AIDS Policy (which Trump closed) and re-empowering the President’s Advisory Council on HIV/AIDS (PACHA) with new members who are actually living with HIV. Most of PACHA’s former members resigned in protest back in 2017; Trump then fired the rest of the council and did not reinstate a new one until 2019—and when he did, it appeared to be made up entirely of HIV-negative people, most of whom were health and pharma professionals instead of community advocates.
“I’ve been waiting to exhale for longer than I could actually believe,” says Milan. “But now I’m also ready to inhale and start forcefully collaborating with a new administration. Moving forward in a world facing COVID and economic constraints—and even [one that is] opposed to a more racially equitable world—will be hard work. But I’m so excited to be pursuing that, as opposed to the war we’ve been fighting the past four years.”
Another important agenda item: Funding for long-term health care, which Biden has committed to pushing. “That’s the one type of insurance that all of us are going to need at one point,” says Flynn Walker. “And it’s phenomenally expensive—usually more than $1,000 a month.”
Our Work Isn’t Over—And Our Voices Still Need to Be Heard
On the one hand, “I feel a tremendous weight has been lifted off my shoulders and the sky seems bluer than it has in four years,” says Jaron Benjamin, the vice president of community mobilization at the NYC HIV/AIDS powerhouse Housing Works.
On the other hand, he says this reminds him of the time, in Texas, he found a tarantula in his bedroom and ultimately killed it, but then lived in fear that more tarantulas awaited. “I went toe-to-toe with it and won, but I still live in a place where that kind of thing could happen.”
His message for people living with HIV and their allies is clear: “Just because we have someone now who is better prepared to be president doesn’t mean that our voices don’t matter anymore.”
Rose agrees, and urges anyone who cares about what happens next to join their state or local chapter of one of several powerful national advocacy groups that will be fighting hard for advances on health care regardless of who takes Congress:
Flynn Walker added that the Center for Popular Democracy and Healthcare for Heroes hold weekly Thursday night calls that lay out the ever-shifting battle plan for the health care agenda.
Regardless, there’s broad agreement that we simply can’t “Netflix and chill” now that Trump is on the way out—and we can’t rely on a Biden-Harris administration to work miracles on its own.
“Now is the time to stop pretending like the ACA was enough,” says Rose, adding that some of the health care advances we can fight for don’t even rely on Dems having the Senate. “The Centers for Medicare and Medicaid Services [CMS] can grant state waivers to fund innovative demonstration projects,” he notes. “You can restructure how grants are set up to compel [health providers] to [better] engage with communities. You can use existing authorities within federal agencies to grant latitude.”
“There is no way for one politician to hand you the health care you need,” says Flynn Walker. “You need to go find a lot of people and start organizing them.”
She adds: “The one nice thing about the Trump era is that it showed us that democracy is ours and we have to participate in it. We get as much back from it as we put in.”