The Centers for Disease Control and Prevention (CDC) has funded a program targeting transgender women of color ages 18-26, a large demographic. This provides opportunities for APLA Health, in partnership with the LGBT Center of Long Beach, to have a larger and more lasting impact on the transgender community in South Los Angeles and Long Beach. The emphasis will be on HIV testing and prevention, but we will be also be engaging with their partners, a unique feature of this program. The hope is that getting partners involved—beyond just HIV testing—will provide a more holistic approach to care and prevention.

The program design was based on previously modeled interventions, involving APLA staff and focus groups to determine the best fit for the community. To ensure that the need for culturally appropriate care is being met, APLA Health surveyed staff and external stakeholders to design staff trainings and reinforce the status of APLA Health as the provider of choice for transgender individuals across Los Angeles.

In addition to the CDC-funded program, we have Caring Loving Adoring Spiritual Sisters (CLASS), a project supported by the City of Los Angeles AIDS Coordinator’s Office. This program targets transgender women of color and is designed to provide information and education beyond HIV. Participants discuss the challenges, opportunities, and perspectives of their community. A common refrain among transgender women attempting to navigate healthcare is that service providers only talk about HIV prevention, condom negotiation, or sharing their status. In CLASS, women are able to discuss a broad range of concerns and stresses in a safe space.

APLA Health is proud of staying true and thoughtful to our communities. As these transgender-focused programs grow, we want to make certain that as soon as anyone walks into our facilities they know they are in an place that not only welcomes them, but also provides them with the medical services they need and the customer service they deserve in a safe, affirming space.

To meet demand, Covered California has extended the deadline to December 22 to buy coverage effective January 1. Open enrollment in California will continue until January 31 even though the enrollment period ended last week in many other states. To get coverage starting February 1, you must purchase a plan by January 15. Plans purchased after that date will become effective March 1. A recent Covered California analysis found that the net monthly premiums for enrollees who receive subsidies are about 10 percent lower than what new and renewing consumers paid last year.

In Washington this week, the Tax Cuts and Job Act moved through Congress and included a repeal of the Affordable Care Act’s individual mandate. The repeal of the individual mandate will send shock waves through the health insurance marketplace, increase the number of uninsured and cause double digit premium increases during the next decade.

In addition, the legislation adds more than $1.5 trillion to the federal deficit, which will cause cuts in domestic spending. House Speaker Paul Ryan and other Republicans are now saying that entitlement programs like Medicare and Medicaid will have to be cut to lower the federal debt. Ryan managed to deliver this message in a radio address without ever mentioning the bill giving large corporations and the rich massive tax breaks.

President Trump also announced in October that his administration would no longer make payments to health insurance companies—called cost-sharing reductions—that help lower out-of-pocket costs for millions of low- and middle-income Americans.

The elimination of the cost-sharing payments will have little immediate impact in California. Covered California has already added a premium surcharge to Silver-level plans in anticipation of the cost-sharing reduction payments ending, and consumers who are eligible for tax credits to help pay their premiums should not be affected by the surcharge. Consumers who are not eligible for tax credits may need to switch to a different metal tier or off-exchange plan to keep their coverage affordable. Also, lawmakers in Sacramento are already talking about enacting an individual mandate in the state.

Long-term prospects for California’s healthcare programs, however, are problematic. Any significant cuts to Medicaid and other social safety net programs could have a devastating impact on state revenues. California gets some $107 billion in federal dollars, with three-quarters of the money going to health and human services including Medicaid. Earlier in the year, when Congress tried to repeal the entire ACA, non-partisan sources estimated that California could lose roughly $20 billion. It’s not clear how anticipated cuts to federal payments will impact the upcoming state budget, due to be released in early January.

Medicare and Medicaid (Medi-Cal in California) are the largest sources of funding for care and treatment for people living with HIV. Any cuts to these programs could have a devastating impact on hundreds of thousands of Americans living with HIV. The Tax Cuts and Jobs Act will increase the likelihood of across the board cuts to domestic spending including the Ryan White Program, HIV and STD prevention programs at the Centers for Disease Control and Prevention, food stamps and more.

Finally, funding for the nation’s community health centers and Children’s Health Insurance Program (CHIP) expired in September and needs to be extended. Earlier this month the House passed the Championing Healthy Kids Act that would extend this vital funding, including some $3.6 billion for the community clinics, for two years. There is bipartisan support for extending this funding in the House and Senate. However, action has stalled as Congress wrangles over passing another short term continuing resolution to extend federal funding beyond a current December 22 deadline. Without an extension of this funding, community health centers like APLA Health’s Gleicher/Chen and Long Beach Health Centers could lose up to 70 percent of their funding. Some clinics would be forced to close their doors, and millions of low-income Americans who access healthcare through these clinics will have nowhere to turn except emergency rooms.

To stay up to date on the latest news and how to get involved, sign up for APLA Health’s “In the Loop” newsletter at aplahealth.org/get-involved/sign-up.

Robert has been a staple of the NOLP program for the last four years and a loyal supporter of APLA Health since his first donation in the late 1980s.

A Los Angeles native, Robert’s life was directly impacted by the beginning of the epidemic as he watched friends die of HIV-related causes during the early ’80s. When one friend reached the point of selling all his belongings, Robert helped by buying his 1968 Camaro. Every time he drives it, he is reminded of his friend and the consequences of an AIDS diagnosis in those dark times.

However, it was the death of his father Leon that had the greatest impact on his support for APLA. Leon contracted HIV during open heart surgery in 1981 and died in 1987 from AIDS-related complications. At the time, his mother was ashamed of the true cause of his death and told her friends that he had succumbed to cancer or heart failure.

“I wish she had lived to see the advancements that have been made and the de-stigmatization that started to happen,” Robert said of his mother, Evelyn, who died in 1994.

After a few months of volunteering at NOLP, Robert wanted to make a donation to upgrade the mobile unit in the parking lot at the David Geffen Center. When it was time to name the refreshed facility, there was only one obvious choice. Now Leon’s name is engraved on a plaque outside the door.

“It’s just really nice to see his name up there,” Robert said.

Robert was pleased with the introduction of APLA Health and the addition of primary care and of PrEP counseling to the suite of services we provide. “It’s impressive that APLA Health is providing full services for clients,” Robert said. “It’s not just food. It’s dental, healthcare, job counseling, housing assistance, or providing social workers for them. Whatever is necessary.”

The work is exhausting, especially around the holidays when NOLP provides free hams and turkeys for clients, but Robert enjoys it. “I wish my parents could see what I’m doing now. It makes me feel good,” Robert said. “I’ll continue to support APLA in any way I can.”