When I first joined the LGBT aging movement in early 2010, overseeing SAGE's national advocacy efforts, the federal landscape was brimming with promise.
I joined SAGE–Advocacy & Services for LGBT Elders months after the U.S. Department of Health and Human Services (HHS) had seeded funding to establish the country’s first resource center focused on LGBT aging, the National Resource Center on LGBT Aging. The Center would over time evolve its training approach into SAGECare and reach more than 95,000 long-term care providers with LGBT competency training.
Under President Barack Obama, those years were flush with positive change: advocates in our LGBT and aging fields held regular meetings and briefings with federal officials on critical issues. We produced seminal policy reports and consistently crafted legal guidance that would translate into scores of new rules and regulations for LGBT older people, significantly expanding their protections and supports across departments and agencies. Historic moments such as a storytelling event at the White House featuring LGBT elders, or the 2015 Supreme Court ruling that allowed same-sex couples the right to marry nationwide were part of a series of hard-earned achievements.
Yet all this progress would soon come to a screeching halt.
Donald Trump's election as president—as history has shown—reversed many of these wins, bringing about a frightening new policy landscape for LGBT older adults. During his four years in office, Trump’s White House set LGBT rights backward, but also fueled an LGBT aging movement that has long fought back against repressive policies and discrimination.
As President Joe Biden begins his tenure, what lessons can be drawn from the Trump years, and how can federal leaders bring about a new reality for LGBT older people?
Almost immediately after taking office, President Trump’s administration began implementing various measures that stripped LGBT people of their rights and harmed LGBT elders.
‘One especially callous rule aimed to allow healthcare providers to refuse to treat LGBT people as a matter of ‘religious freedom.’
In March 2017, HHS removed questions about LGBT people from two vital surveys: the National Survey of Older Americans Act Participants, which every year measures how older adults receive social support and nutrition services under the Older Americans Act—a signature federal law that provides billions of dollars annually to the national Aging Network—and the Annual Program Performance Report for Centers for Independent Living, which assesses whether people with disabilities (of all ages) are properly receiving necessary services in their homes and communities. Removing LGBT measures from these surveys made it more challenging to know whether LGBT people, and LGBT older adults in particular, were experiencing barriers to access—a longstanding challenge.
In the next few years, similar actions ensued. The federal government removed LGBT-specific references and resources from its various websites, appointed several federal officials and judges with known histories of anti-LGBT bias, and advanced lawsuits and policies to erode and ultimately eliminate protections for LGBT people, including older adults.
In early 2020, as COVID-19 emerged and took hold, HHS announced an especially callous rule that aimed to allow healthcare providers to refuse to treat LGBT people as a matter of "religious freedom," as well as a rule that undercut transgender protections in the Affordable Care Act. The health of LGBT people became expendable in the federal culture war—at a time when tens of thousands of people were dying in an unprecedented health crisis.
Alongside these egregious attacks, LGBT older adults were also harmed by the Trump administration’s efforts to roll back the Affordable Care Act (which, if eliminated, would make it more difficult for older adults to afford the costs of medications or insurance premiums); its unwillingness to negotiate more affordable drug prices through federal Medicare reform; and its weak and ultimately catastrophic response to the COVID-19 crisis, which disproportionately ravaged older adults and people of color, especially those living in nursing homes.
The Trump administration’s viciousness compounded discrimination faced by segments of the LGBT older adult population, including people of color, immigrants and low-income people. A few of the more salient policies in this regard included an executive order that banned entry to refugees and travelers from certain Muslim countries; numerous draconian measures related to immigration; and harmful federal budget cuts to Medicaid, SNAP and other safety net supports for low-income people.
While all these actions amplified the vulnerability of LGBT older adults, they also set the stage for an organized response from the LGBT field.
LGBT Aging Advocates Fight Back
I reached out to Aaron Tax, the director of advocacy at SAGE, to help me understand how SAGE and its allies responded to these concerning developments. Tax oversees SAGE’s federal advocacy and has worked with leaders on the Hill for years to coordinate and advance an LGBT aging policy agenda.
SAGE scored big when it succeeded in ensuring that the OAA designate a portion of its services and supports to LGBT elders.
When the Trump administration removed LGBT-specific measures from two federal surveys critical to LGBT older people, SAGE, the National LGBTQ Task Force, and other national organizations mobilized their sizable audiences of supporters to help reverse these changes—and they partially won. (Sexual orientation measures were re-inserted in the National Survey of Older Americans Act Participants, but gender identity was not.)
Throughout the Trump era, SAGE and other organizations also publicly condemned many of the other actions described above, educating the public and key decision makers about the potential harm of these new policies and strengthening their advocacy apparatus to better respond both during and after Trump’s presidency.
SAGE even scored a win when it recently succeeded in ensuring that the Older Americans Act designate a portion of its sizable services and supports to LGBT older adults.
"LGBT older adults cannot afford to wait for their rights," said Tax. "Even during turbulent times, we need to keep fighting to ensure that all LGBT people can age in good health, financially secure, and socially connected in their communities."
A Way Forward
President Biden's election represents a turning point for LGBT older adults and their advocates.
His expansive plan to “Advance LGBTQ+ Equality” includes historic measures related to LGBT aging services and supports, discrimination protections and healthcare access, among many other issues.
Additionally, his $775 billion caregiving plan outlines numerous ideas to strengthen long-term care and improve supports for family caregivers and direct care workers, which would also directly benefit older LGBT adults.
In early May, President Biden also barred federally funded healthcare entities from discriminating based on gender identity or sexual orientation, reversing former President Trump's rule that rolled back transgender protections in healthcare.
Aaron Tax believes that the Biden administration and a new pro-equality majority in Congress—whether through legislation or regulatory and administrative reform—can advance a range of policies that support LGBT older adults, including: non-discrimination protections based on sexual orientation, gender identity and HIV status in long-term care settings; improved data collection and additional research on various LGBT aging topics (including reinstating the gender identity question in the National Survey of Older Americans Participants); enhanced support for older adults with HIV, many of whom are LGBT; LGBT-specific COVID relief; an expanded definition of “family” that includes families of choice in all paid leave and family caregiving laws; and more.
Additionally, SAGE is championing many other issues in a variety of federal bills that were introduced last year, including the Anthony Gonzalez Equality for Survivors Act, the Elder Pride Act, the Inclusive Aging Act and the Ruthie and Connie LGBT Elder Americans Act—among key provisions addressing Social Security survivors’ benefits for same-sex couples, increasing funding for LGBT-specific aging services nationwide and more.
Another item of legislation, the Equality Act—which would explicitly ban discrimination based on sexual orientation and gender identity in housing, employment, federally funded programs and public accommodations, including many long-term care settings—already passed the U.S. House of Representatives in late February and is headed to the U.S. Senate for a vote. Its passage would be monumental.
As both the Trump era and the COVID-19 pandemic have reinforced, LGBT older adults remain vulnerable to lawmakers and pandemics, but they also embody the resilience that a lifetime of discrimination can create in a marginalized community.
The year 2021 will likely yield a positive shift for LGBT older people—but critical work will be needed in the years ahead to retain these gains and prevent another crisis like the one experienced over the last four years.
Robert Espinoza, MPA, is the vice president of policy at PHI in the Bronx, NY, and serves on ASA’s Board of Directors, as well as chairing ASA’s Editorial Advisory Board for Generations Today.