Current campaigns 

POLICY PREPAREDNESS

Build a proactive early-warning system and rapid-response engine for policy threats and opportunities.

COVERAGE LANDSCAPE

Insurance coverage, and the policies that shape it, are constantly evolving. Monitoring changes across both public and private insurance markets is essential to understanding how LGBTQ+ people may be affected, particularly when shifts threaten access to gender-affirming care or other essential services. For example, recent federal reinterpretations of coverage standards have removed gender-affirming care from Essential Health Benefits in some ACA plans, increasing out-of-pocket costs for transgender patients.

Additionally, the Employee Retirement Income Security Act (ERISA) governs many employer-sponsored health plans and frequently preempts state-level protections. This limits states’ ability to mandate coverage for essential services, including gender-affirming care.  

The Alliance will actively track changes to ERISA, ACA regulations, and other federal guidance in order to anticipate coverage threats, advance nondiscriminatory benefit standards, and advocate for comprehensive coverage across all payers.

REGULATORY THREATS

Recent reinterpretations of existing federal regulations pose significant risks to LGBTQ+ health and safety. Narrow definitions of sex and gender, for instance, undermine inclusive health research and restrict access to appropriate clinical care.

At the state level, policies affecting telehealth access, clinician licensing, and provider liability vary widely. Restrictions on telehealth prescribing or the absence of clinician shield protections can severely limit access to care, particularly for patients in hostile or underserved regions.

The Alliance will identify regulations vulnerable to harmful reinterpretation, assess their potential health impacts, and deploy targeted advocacy strategies to counter restrictive policies before they take effect.

For more information, check out our Administrative Attacks issue brief.

RAPID MOBILIZATION

Healthcare access can change rapidly in response to regulatory reinterpretations, court decisions, or administrative guidance. Sudden shifts in policy can disrupt care delivery, create confusion among providers, and cause patients to lose access to essential services with little notice.

LGBTQ+ healthcare is particularly vulnerable to abrupt policy change due to its reliance on regulatory protections, clinical guidance, and cross-state care models. When policies shift without clear communication, providers may pause services out of legal uncertainty, and patients may experience gaps in care even when services remain technically lawful.

The Alliance will maintain a standing rapid-response infrastructure to identify emerging threats, coordinate timely advocacy, and support providers and patients through periods of policy change. This includes an early-warning system, coordinated comment and engagement campaigns, and the rapid development of clinician toolkits and guidance to maintain continuity of care.