New York has always been a city of arrivals. A sanctuary for those seeking safety, dignity, and a future they couldn’t find at home. That same promise has drawn LGBTQ people here for decades. From Midwestern towns, sterile suburbs, and countries where queerness is criminalized, they’ve come not just to survive, but to be seen, cared for, and free.
That promise wasn’t just rhetoric. It was made real through policy. Federal support for Medicaid, the ACA marketplace, and mental health programs like the 988 crisis line laid the groundwork.
Local and state leaders built on it with some of the strongest LGBTQ protections in the country. And community institutions — from the Hetrick-Martin Institute to Callen-Lorde to Ali Forney Center — filled in the gaps, offering affirming care, housing, and healing for thousands.
But that delicate ecosystem is now buckling under the weight of new federal policy.
The recently passed One Big Beautiful Bill Act (OBBBA) threatens to dismantle the very systems that help LGBTQ New Yorkers survive. Framed as a budget package, it slashes Medicaid, strips ACA subsidies, bans federal coverage for gender-affirming care, and eliminates targeted mental health funding — including LGBTQ-specific crisis support.
More than 1.5 million New Yorkers are expected to lose insurance, including many of the city’s 569,000 LGBTQ residents — the largest queer population in the country. This city isn’t just a sanctuary in name. It’s a lifeline.
Many rely on Medicaid or ACA plans for PrEP, hormones, puberty blockers, therapy, and HIV treatment. Under OBBBA, premiums will spike. Coverage will lapse. And care will vanish.
At the Hetrick-Martin Institute, we’ve seen a 200% spike in mental health service requests since January — despite receiving no federal funding. The youth coming through our doors are already falling through the cracks: uninsured, off their meds, or barely holding on. When this bill takes full effect, we won’t just be a safety net — we’ll be the only net left.
This isn’t theoretical. This is your city. Your neighbors. A 17-year-old trans girl in the Bronx forced off HRT. A Black queer 21-year-old in Crown Heights who lost access to therapy. A recently out teen sleeping on the F train, waiting for a shelter bed that may never come.
We talk a lot about culture in this city — about what makes New York New York. The truth is, our cosmopolitan reputation has been held together by queer brilliance for decades. This is the city that gave the world ballroom, where vogueing became a global export.
This is where Greer Lankton sculpted trans bodies into reliquaries, David Wojnarowicz smeared rage and desire across gallery walls, and Cookie Mueller spun downtown chaos into sacred text. Where Marsha P. Johnson and Sylvia Rivera marched while Studio 54 and Paradise Garage became temples of transcendence. Where queer fashion, theater, and visual art collided in a cultural Big Bang.
That culture still pulses through basements and backrooms across the boroughs. But it’s no longer just underground — it’s the brand. Queer expression is now a cornerstone of New York’s economy and identity.
So what happens when our community can no longer afford to live here or even stay alive?
New York must treat OBBBA not as a distant federal fight, but as a local emergency — and respond accordingly.
We must fully fund a state-level Essential Plan to replace lost federal dollars and cover all current enrollees, including immigrants. OBBBA is set to cut 730,000 New Yorkers from the program, leaving at least 224,000 without affordable coverage.
We need a NYC Medicaid guarantee for gender-affirming care. The federal ban directly targets trans New Yorkers. The city must step in with legislation to fund and expand access through clinics like Callen-Lorde and Apicha.
We need an emergency fund for frontline health providers. Clinics and public hospitals are bracing for deep cuts to pediatrics, OB/GYN, and behavioral health. A local fund could soften the blow and preserve services.
And we must expand LGBTQ-focused crisis care and housing. With LGBTQ-specific 988 support ending in 2025, New York must invest in culturally competent crisis teams and convert vacant city buildings into affirming shelters and long-term housing.
These aren’t aspirational fixes. They’re survival strategies. If New York wants to remain a queer sanctuary, we must match that promise with policy. Because right now, lives are on the line.
Harclerode is CEO of the Hetrick-Martin Institute. Cummings is a NYC political activist and world renowned drag artist.
