A Fight for Obamacare Is a Fight for LGBT Lives

Excluding preexisting conditions. Excluding transition-related care. Lifetime limits for HIV care. Denying routine cancer screenings because you're the "wrong gender." Refusing care at a clinic or hospital because you're LGBT. Being poor but still ineligible for Medicaid.

These are just some of the obstacles Obamacare -- or the Affordable Care Act -- has helped many LGBT people overcome. This year will see even more big improvements for transgender people. Even before a judge ordered the Department of Health and Human Services to hold off enforcing the law's nondiscrimination protections for trans people, most health plans had already eliminated their trans exclusions for this year based on HHS's rules and similar rules issued by several states. (Public service announcement: There's still time to enroll in a plan until January 31, and those eligible for Medicaid can enroll anytime.)

While the ACA will definitely be in effect in 2017, its future beyond that is in doubt. Lawmakers could vote as soon as next week to repeal much of the Affordable Care Act, stripping away many of these gains. Congressional Republicans say they want to "repeal and replace" -- but what they're actually proposing is a repeal with no replacement in sight.

Republicans' repeal-only approach is currently being called "repeal and delay" because it involves immediately passing a bill that would repeal Obamacare, subject to a delay period of a year or more. This repeal could strip 30 million Americans -- mostly working families -- of health insurance. It would cause premiums to spike dramatically for millions more. Ordinary LGBT Americans would lose tax credits, Medicaid, or health care through their job, while insurance and drug companies and the wealthy would get huge tax breaks.

The promise to "repeal and replace" is an empty one, because the congressional majority wants to rip up Obamacare with no replacement on the table -- just the vague pledge that ir'll come up with one eventually. Americans deserve to know what they're getting before the current system is shredded, not after. The various "replacement" ideas Republicans -- including Trump HHS secretary nominee Tom Price -- have floated in the past would gut protections for LGBT people and people with disabilities, access to preventive care, and tax credits for most Americans. But right now the American people are being asked to bet their health care on "we'll come up with something."

It's not yet clear if Republicans will be able to repeal key Obamacare consumer protections -- such as the provisions that prohibit discrimination against trans people by insurers and hospitals as well as discrimination in coverage of HIV drugs. (The current court injunction against HHS is preliminary and still allows individuals facing discrimination to bring their own lawsuits.) Repeal can only be passed by using the arcane "budget reconciliation" process to evade a Senate filibuster. If Republicans play by the rules, those consumer protections are safe for now. Still, they'd be little help to LGBT folks who will lose their insurance altogether or face skyrocketing premiums if Obamacare is repealed.

The ACA repeal bill will also include another dangerous rollback for LGBT people and other vulnerable communities -- defunding Planned Parenthood. Defunding means cutting half a billion dollars for cancer screenings, STI tests and treatment, and contraception that Planned Parenthood provides to people of all genders and orientations. Planned Parenthood is one of the largest providers of transgender health care in the nation today. All of Planned Parenthood's nearly 650 centers offer critical sexual and reproductive health care for people of all genders, including STI testing and treatment and regular exams. Dozens of health centers also offer hormone therapy and assistance with ID documents for trans people -- with more being added all the time, often in communities where care is hard to find. An attack on Planned Parenthood is a direct attack on LGBT health.

To sum up, "repeal and replace" is really just repeal. It would be devastating for tens of millions of Americans, and particularly devastating for LGBT people and anyone with HIV. It could cause trans people to lose access to preventive and transition-related care, pay more for insurance or lose it altogether, and lose access to hormones and other care through Planned Parenthood.

Here's the good news: We can stop it, by pressuring Congress and especially our senators not to ram through repeal without a simultaneous vote on a comprehensive replacement. Call and write your senators -- even if you think you know how they'd vote on repeal, the amount of constituent pressure could determine whether and when a vote happens and what it includes.

So-called repeal and delay could be a nightmare that comes back to haunt lawmakers -- they deserve to know what they're getting into, just like we do.

MARA KEISLING is the executive director of the National Center for Transgender Equality. Follow her on Twitter @MaraKeisling.