No Social Protection for Sex Workers

Last June, The Lancet published an article entitled, “Sex workers must not be forgotten in the COVID-19 response.” Its authors stated that, “it is imperative that sex workers are afforded access to social protection schemes as equal members of society.” With regard to sex workers with HIV, they pointed out that, on average globally, “use of antiretroviral therapies is already low among sex workers who are HIV positive in high-income and low-income settings. It is crucial that disruption to health services does not further reduce access to HIV treatment and prevention.”

In the U.S., public health services explicitly for sex workers aren’t being disrupted because they have never existed per se. Sex workers (by that or any other name) have not been mentioned in any edition of the National HIV/AIDS Strategy or any of its updates. The U.S. simply does not list sex workers as a “key population” vulnerable to HIV.

In late 2019, sex workers’ rights activists and their allies persuaded Representatives Ro Khanna (D-CA) and Barbara Lee (D-CA) to introduce legislation called the SAFE SEX Work Study Act. Elizabeth Warren (D-MA), Ron Wyden (D–OR) and Bernie Saunders (I–VT) also introduced it in the Senate. The bill calls for funding to document what happens when sex workers are deprived (as they have been since passage of the FOSTA/SESTA bills in 2018) of their right to use online harm reduction strategies, such as client screening, in the course of their work.

The SAFE SEX Work Study Act will be reintroduced in the new congress in 2021 –possibly providing a chance to recognize and correct this dangerous and discriminatory omission. Stay tuned!

No HealthCare.Gov Services for Georgia?

Late last December, the state of Georgia requested permission from the DHHS’ Centers for Medicare and Medicaid Services (CMS), through a 1332 waiver, to disengage the state from HealthCare.gov, the federal ACA system currently used by 500,000 Georgians to purchase their health insurance (both private plans and Medicaid).

At present, Georgians have the choice of enrolling through HealthCare.gov, private web brokers or insurance companies. The proposal they submitted, however, would allow the state to “cap the amount of financial assistance it provides and would put their potential insurance consumers on a ‘waitlist’ once the cap is reached,” according to the Brookings Institute. The Institute adds that the revisions the state of Georgia is requesting fails other procedural tests and that DHHS and the Treasury Department “cannot legally approve this waiver.”

Despite this evident roadblock, the state of Georgia appears to be determined to proceed if CMS approves their application. In that case, the state’s consumers would be limited to selecting from an array of options offered by private insurance companies and web brokers – with no objective guidance from HealthCare.gov advisors regarding their Medicaid options also available.

According to the National Health Law Project, “this could leave tens of thousands of people uninsured, while others would end up in short-term and other subpar plans that impose high out-of-pocket costs when enrollees get sick.” By eliminating HealthCare.gov advisors from the mix, Georgia’s proposal to CMS would effectively rob consumers of their access to unbiased information when making their coverage choices. Without this, participants would be more vulnerable to commercial providers who emphasize profit and seek it by promoting subpar plans that often exclude coverage for pre-existing conditions and subject consumers, once enrolled, to punitive coverage exclusions and limitations.

The Academy has submitted its Public Comment, expressing our opposition to the proposed change. We have urged Georgia’s administration to reduce the state’s uninsured rate by adopting Medicaid expansion – thus making health care available to thousands of Georgians at rates that both they and the state administration can really afford.