Last weekend, I joined the diverse crowd at San Francisco Airport to protest Trump’s ban on Muslim immigrants and refugees. One of the signs that brought tears to my eyes was a play on Martin Niemoller’s famous quote. (See page 6 to read the full quote.) The protest sign said: “First they came for the Muslims … And I said HELL NO!”
We are now forced, perhaps more than ever before, to stand up, with and for each other. The policies being put forth by Trump and the Republican Congress have at least given us the opportunity to see how hard we are willing to fight to support and protect each other. It won’t be easy, but let us take advantage of the opportunity to build community, find common ground, and work together to create a better world.
As a disabled person, a queer person, and a community organizer, I am terrified by the threats to decimate the U.S. health care system coming from Trump and Congress. I work with low-income seniors and people with disabilities, many of whom depend on Medicare and Medi-Cal (Medicaid) for basic health services, including prescription drugs and home care. Trump and Congress plan to repeal the Affordable Care Act (ACA), which would end Medicaid expansion and patient protections, and replace our existing Medicaid system with block grants. Block grants would provide a set amount of funding to each state to provide health care services, regardless of how many people need health care. Block grant funding would be woefully inadequate to address health care needs in each state, forcing states to limit eligibility and available services.
Health care cuts are of great concern to seniors and people with disabilities; cuts will also have a major impact on the LGBT community. We are, of course, not separate groups. According to the SF Human Services Agency study on LGBT Seniors in San Francisco, more than 12% of San Francisco seniors identify as LGBT, not including those who do not share this information publicly. Kaiser Family Foundation reports that LGBT people tend to have higher rates of chronic conditions and disability than the general population. For people with HIV, denial of health insurance or other discrimination based on medical conditions was once widespread; the Affordable Care Act finally outlawed discrimination based on pre-existing conditions, but is now under attack. Also threatened by politicians are ACA protections related to sexual orientation and gender identity. Our entire community then has a stake in the fight to protect health care programs like the Affordable Care Act.
One of the health programs at greatest risk is home care. Government-funded home care programs, like In Home Supportive Services (IHSS) in California, allow seniors and people with disabilities to live safely and independently in their homes, with a home attendant (or caregiver) to assist with daily activities. Our country has long had a bias towards nursing homes; it is much easier to get government funding to pay for a nursing home than for home care, even though nursing homes are much more expensive. Hiring an attendant privately can get very expensive, and so many people rely on Medi-Cal (which funds IHSS) to cover home care.
The LGBT community has a major stake in home care. Older LGBT people are more likely to live alone, are 3–4 times less likely to have children, and may be estranged from biological family, according to Services and Advocacy for Gay, Lesbian, Bisexual and Transgender Elders. As a result, they may be less likely to have informal caregiving from relatives, thereby needing to hire attendants to provide assistance in their homes. Nursing homes are often impersonal, unwelcome places, and LGBT seniors may face additional concerns about being out or feeling isolated.
Well-funded home care programs are critical to seniors, disabled people, and the LGBT community. The ACA includes the Community First Choice Option, which gives states an incentive to pay for home care rather than nursing homes. As Congress attacks health care, we all must fight to preserve Medicaid dollars, the Community First Choice Option, and all incentives for states to pay for home care to allow so many of us to stay in our own homes, with the people we love, and surrounded by the communities in which we feel comfortable.
What can we do to protect health care for seniors, people with disabilities, LGBT people, and all of us? We can call our legislators, join marches or donate financially as we are able, and encourage our friends, colleagues, families and neighbors to do the same. Today, and every day, call your legislators to urge them to speak up against block-granting Medicaid or defunding home care.
Medicaid and home care are not widely understood and will not get the same national attention as other issues, making it easy for Republicans to move quickly to destroy these programs. We must do our part to let Congress know we are watching. The website http://5calls.org is an easy way to prepare to call Congress. Senior and Disability Action and our allies are holding teach-ins about Medicaid and the ACA, to help people understand what the programs are and how to advocate for them. If you’d like to get involved, please email: firstname.lastname@example.org
This is a scary time. I find myself easily overwhelmed by the hatred and divisiveness that we are up against and by the sheer number of issues being thrown at us, and I know I’m not alone in that feeling. While I am saddened, and outraged by Trump’s executive orders and by Congress’s plans, I am inspired to see so many people taking action. It is especially heartening to see people standing up in solidarity with each other’s communities, recognizing that we are all in this together. Health care is simply one example of how LGBT issues are senior issues are immigrant issues are disability issues. By fighting with and for all of our communities, we can beat back the attacks on marginalized people, save lives, and strengthen connections with each other. As the protest chant goes, “When we fight, we win!”
Jessica Lehman is Executive Director of Senior and Disability Action, a non-profit organization that educates, organizes and mobilizes seniors and people with disabilities to fight for rights and social justice. She leads the national Organizer’s Forum, a project of the National Disability Leadership Alliance, and serves on the board of Hand in Hand: the Domestic Employers Network.
Dr. Marcy Adelman oversees the Aging in Community column.For her summary of current LGBT senior challenges and opportunities, please go to: sfbaytimes.com/challenges-and-opportunties