We are living in a dangerous moment for LGBTQ+ people in America. Across the country—and especially in battleground states like Ohio—legislation targeting the rights, dignity, and healthcare access of our communities is advancing at an alarming pace. While we have come so far since Stonewall, marriage equality, and transformative progress in HIV care, those gains are now under relentless attack.

As leaders of organizations grounded in health equity and civil rights, we see the harm these policies cause—not just in headlines, but in real people’s lives. And today, in Ohio, a new law is creating an ethical and moral crisis for mental health providers and a devastating barrier for patients who rely on Medicaid.

In July, the Republican supermajority in the General Assembly enacted a biennial state budget that included a cruel provision: barring Medicaid reimbursement for any mental health services that “promote or affirm social gender transition.”

For licensed therapists, the provision is both legally confusing and ethically indefensible. Mental health care is not about directing someone to a predetermined conclusion. It is about walking with them on their path of self-discovery—whether that journey includes exploring gender identity, past trauma, or relationship patterns. Cutting off reimbursement for this work puts therapists in the impossible position of choosing between their license and their patients.

The impact of this provision is not theoretical. It is lived and felt, especially by transgender and nonbinary people who already face elevated rates of anxiety, depression, and suicidal ideation. The same forces pushing these anti-LGBTQ+ laws are fueling stigma and fear, especially in healthcare. When conversations about gender identity or HIV are silenced, when care is withheld or criminalized, the result is a deepening public health crisis.

That crisis is no accident. This provision is one part of a broader legislative onslaught. Just last year, the General Assembly overrode Governor Mike DeWine’s veto to enact a sweeping ban on gender-affirming care for minors. Lawmakers also passed a ban on trans student athletes,  limitations on restroom access, and are currently seeking restrictions on pronoun and name use in schools. These are not isolated incidents—they are part of a deliberate and coordinated campaign to erase LGBTQ+ people from public life.

And it continues to get worse. Congress recently passed deep funding cuts to Medicaid and Medicare, endorsed by every Republican in the Ohio congressional delegation. These cuts—combined with burdensome Medicaid paperwork, re-certification hurdles, and reduced Affordable Care Act subsidies—could leave over 436,000 Ohioans uninsured. Rural hospitals will shutter. Healthcare jobs will disappear. Our communities will suffer.

That is why the Human Rights Campaign launched the American Dreams Tour. Across the country, we are hitting the road to share stories like Alex’s—stories that expose the truth, affirm life, and demand justice. From town halls to storytelling trainings, from rural towns to major cities, we are building power, connection, and care. On our terms. In our voices.

At Equitas Health, we don’t push an agenda. We meet patients where they are. We advocate for their right to make informed decisions about their bodies, their lives, and their futures. We believe every person deserves ethical, evidence-based care.

And we believe that when access to healthcare is used as a political weapon, everyone loses.

Whether you’re a policymaker, provider, or community member: remember, every reader is also a patient at some point in their life. What happens to Alex could one day happen to you. We hope you will stand with us—for care that is ethical, professional, and centered in dignity.

*indicates pseudonyms

David Ernesto Munar is President and CEO of Equitas Health and Kelley Robinson is CEO of the Human Rights Campaign