Health and Human Services Secretary Alex Azar is currently on a media swing touting the Trump Administration’s pledge to end the HIV/AIDS epidemic by 2030. But given the administration’s actions to create a federal judiciary wholly inhospitable to both accessible health care and the LGBTQ community, this is breathtaking hypocrisy—and Azar should know it.
While Azar is pitching the plan to halt new HIV infections and end AIDS, the administration seems to be doing everything within its power to undermine that goal. Yes, the President’s budget has requested $291 million in additional funding for HIV treatment and prevention, but that modest increase is largely overshadowed by staggering cuts to other critical HIV-related programs, not to mention the administration’s efforts to halt Medicaid expansion. For example, Trump’s budget takes out $1.3 billion for the President’s Emergency Plan For AIDS Relief. And all of this is happening while the administration is steadily pursuing a court-focused strategy to eliminate access to health care for tens of millions—including those with pre-existing conditions like HIV.
The court strategy is brazen and two-pronged: 1) Pack the federal courts with judges whose records show hostility to the Affordable Care Act and its promise of Medicaid expansion and coverage for preexisting conditions; and 2) Deploy political appointees in the Department of Justice to advocate for the dismantling of the ACA in court.
Part one of this strategy has been underway since the earliest days of the administration. No fewer than a dozen circuit court judges appointed by Trump have records of opposing the ACA. One obvious example is Chad Readler, a former Justice Department official. The very day Readler signed a brief arguing to gut the ACA, Trump announced he would nominate him for an influential seat on a court of appeals. On the Supreme Court, Trump appointee Brett Kavanaugh is known for twice dissenting in rulings upholding the ACA while he served on the D.C. Circuit.
And now, the second part of this strategy has come into public view, with the Department of Justice alerting a federal court that it will argue for the entire ACA to be declared unconstitutional. In so doing, the DOJ actually reversed its own former position on the law, and has left defense of the statute largely to state Attorneys General. It is simply impossible to square this administration’s aggressive attack on health care with a goal to eradicate HIV—or any public health crisis, for that matter.
Yet Azar forges ahead as if he were unaware of the wholesale assault on health care, as if he himself were not a savvy lawyer who understands how Trump and his allies are using courts to advance their agenda. Reports suggest that Azar initially fought the White House on its plan to litigate against the ACA, but now—like countless other Trump officials who have caved to the president’s whims—Azar claims that he “fully supports” the administration’s action.
Azar must also know that the Trump Administration’s credibility on LGBTQ welfare is approximately zero. Transgender people are three times more likely to contract HIV than the national average. Yet the administration fights transgender rights at every turn, including a ban on transgender people in the military. And again, a key tactic is federal judicial appointments as Trump repeatedly appoints, or tries to appoint, fervently anti-LGBTQ individuals to the federal bench.
One nominee, Jeff Mateer, memorably called transgender children part of “Satan’s plan.” The public outcry was overwhelming, sinking his nomination. Yet nearly 20 newly minted Trump judges have clear anti-LGBTQ records. Neomi Rao formerly headed a government office involved in an HHS rule that would allow medical providers to refuse care to patients—including LGBTQ people—due to “conscientious objections.” Kenneth Lee, a pending nominee, wrote that “homosexuals are generally more promiscuous than heterosexuals” and that combating AIDS is more about addressing “values” than medical research. Sadly, another vocal anti-LGBTQ activist, Matthew Kacsmaryk, could be confirmed in the coming days. Putting so many anti-LGBTQ individuals on the federal bench speaks volumes about the administration’s real attitude toward the community.
Want to know the administration’s real agenda? Pay no attention to PR campaigns, but look at what’s happening with the courts.
Nan Aron is the founder and president of Alliance for Justice (AFJ), the leading progressive advocacy organization on justice issues since its inception in 1979.
Sharon M. McGowan is the Chief Strategy Officer and Legal Director of Lambda Legal, the country’s largest and oldest legal organization committed to achieving full recognition of the civil rights of lesbians, gay men, bisexuals, transgender people and individuals living with HIV.