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Between Private and Public: AIDS, Health Care Capitalism, and the Politics of Respectability in 1980s America

Published online by Cambridge University Press:  09 May 2018

JONATHAN BELL
JONATHAN BELL*
Affiliation:
Institute of the Americas, University College London. Email: jonathan.bell@ucl.ac.uk.
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Abstract

The AIDS crisis in the US in the 1980s radically transformed the relationship between sexual minorities and capitalism. Opportunistic infections given free rein in human bodies by HIV rendered employees visible to employers and to health care providers as an economic risk, and set the stage for battles between health capitalists, politicians, and AIDS activists over access to health care. Health capitalism in 1980s America was both an arena of integration of queer Americans into mainstream society and also a political cul-de-sac, blunting the radical possibilities of sexual politics that were alive in the years before the AIDS crisis. In this article I focus on activist groups, primarily ACT UP, Gay Men's Health Crisis, National Gay Rights Advocates, and National Gay and Lesbian Task Force, and the liberal politicians who led legislative battles at federal and state level to force the health care system to respond to AIDS. In shifting our gaze from the Reagan administration and the religious right as the primary foils to AIDS activism, we can gain new insights into the direction of liberal politics in an era of supposed conservative ascendancy. An understanding of how AIDS activists and their allies negotiated questions of health access suggests that health care activism was in part a marker of class privilege, as gay activists and liberal Democrats openly embraced a medical model for sexual minorities that lifted them above the stigma of a public welfare system and integrated them further into heteronormative capitalism.

Type
Articles
Information
Journal of American Studies , Volume 54 , Issue 1 , February 2020 , pp. 159 - 183
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Copyright
Copyright © Cambridge University Press and British Association for American Studies 2018

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References

1 Mark Senak to James Corcoran, 22 April 1986, Gay Men's Health Crisis Papers, New York Public Library, Box 48, Insurance Issues 1985–86 file. Emphasis mine.

2 See Bell, Jonathan, “Rethinking the ‘Straight State’: Welfare Politics, Health Care, and Public Policy in the Shadow of AIDS,” Journal of American History, 104, 4 (March 2018), 931–52CrossRefGoogle Scholar.

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9 “Health Insurers Face a Number of Challenges,” National Underwriter, 28 Sept. 1987, 18.

10 General histories of the 1980s all focus on AIDS activism in the context of Reagan-era conservatism: see Rossinow, Doug, The Reagan Era: A History of the 1980s (New York: Oxford University Press, 2015), 129–34Google Scholar, 212–15; Patterson, James T., Restless Giant: The United States from Watergate to Bush v Gore (New York: Oxford University Press, 2007), 179–82Google Scholar; Wilentz, Sean, The Age of Reagan: A History, 1974–2008 (New York: HarperCollins, 2008), 185–86Google Scholar. More specialist treatments also place a hostile administration at the heart of political responses to AIDS: see Turner, William B., “Mirror Images: Lesbian/Gay Civil Rights in the Carter and Reagan Administrations,’ in D'Emilio, John, Turner, William B., and Vaid, Urvashi, eds., Creating Change: Sexuality, Public Policy, and Civil Rights (New York: St. Martin's Press, 2000), 3–28Google Scholar; Turner, “Adolph Reagan? Ronald Reagan, AIDS, and Lesbian/Gay Civil Rights,’ Social Science Research Network, 2009, available at http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1433567; Brier, Jennifer, Infectious Ideas: US Political Responses to the AIDS Crisis (Chapel Hill: University of North Carolina Press, 2009)Google Scholar, esp. chapter 3. For discussions of international activist politics in the 1980s see Martin, Bradford, The Other Eighties: A Secret History of America in the Age of Reagan (New York: Hill and Wang, 2011)Google Scholar; Witham, Nick, The Cultural Left and the Reagan Era: US Protest and Central American Revolution (London: I. B. Taurus, 2015)CrossRefGoogle Scholar; Brier, chapter 4.

11 See Cohen, Peter F., “All They Needed: AIDS, Consumption, and the Politics of Class,” Journal of the History of Sexuality, 8, 1 (July 1997), 86–115Google Scholar; Escoffier, Jeffrey, “The Political Economy of the Closet: Toward an Economic History of Gay and Lesbian Life before Stonewall,” in Escoffier, , American Homo: Community and Perversity (Berkeley: University of California Press, 1998), 65–78Google Scholar; Stewart-Winter.

12 There is a huge literature on AIDS activism, much of it framed in terms of activist battles against discrimination on the part of the state or political inattention to the civil rights and treatment needs of sexual minorities. See France, David, How to Survive a Plague: The Inside Story of How Citizens and Science Tamed AIDS (New York: Knopf, 2016)Google Scholar; Gould, Deborah, Moving Politics: Emotion and ACT UP's Fight against AIDS (Chicago: The University of Chicago Press, 2009)CrossRefGoogle Scholar; Strub, Sean, Body Counts: A Memoir of Activism, Sex, and Survival (New York: Scribner, 2014)Google Scholar; Petro, Anthony, After the Wrath of God: AIDS, Sexuality, and American Religion (New York: Oxford University Press, 2015)CrossRefGoogle Scholar.

13 Vaid, Urvashi, Virtual Equality: The Mainstreaming of Gay and Lesbian Liberation (New York: Random House, 1995), 74–78Google Scholar.

14 Hoffman, Beatrix, Health Care for Some: Rights and Rationing in the United States since 1930 (Chicago: The University of Chicago Press, 2012)CrossRefGoogle Scholar, chapter 8; Freeman, Howard E., Blendon, Robert J., Aiken, Linda H., Sudman, Seymour, Mullinix, Connie F., and Corey, Christopher R., “Americans Report on Their Access to Health Care,” Health Affairs, 6, 1 (Spring 1987), 6–18CrossRefGoogle ScholarPubMed.

15 Oppenheimer, Gerald M. and Padgug, Robert A., “AIDS and Health Insurance: Social and Ethical Issues,” AIDS and Public Policy Journal, 2 (Winter 1987), 11–14Google ScholarPubMed. The term “ARC” means “AIDS-related condition” a 1980s term for HIV-related conditions that the Centers for Disease Control had not categorized as AIDS.

16 “AIDS Cost Could Lead to National Insurance Plan,” National Underwriter, 9 Nov. 1987.

17 AIDS – interview with AIDS patient, April 1987, in David Rogers papers, New York Hospital, Weill-Cornell Medical Center, Archives, Box 19, AIDS files.

18 For an example see “Company Ousts Gay Workers, then Reconsiders,” New York Times, 28 Feb. 1991, at www.nytimes.com/1991/02/28/us/company-ousts-gay-workers-then-reconsiders.html, concerning homophobic discrimination at Cracker Barrel.

19 Wendy Zellers, Catherine McLoughlin, and Kevin Fisher, “Small Business Health Insurance: Only the Healthy Need Apply,” Health Affairs, Spring 1992, 174–80. Gay bars would come under particular scrutiny by insurance companies. The insurance industry seemed not to notice the racist lineage of the term “redlining.”

20 Interoffice memorandum, MARC-Life Company, 23 Sept. 1985, “Underwriting guidelines for AIDS”, Stan Hadden papers, GLBT Historical Society, San Francisco, Box 7, Insurance ’85 file.

21 Jerrold Nadler (D-NY) to James Corcoran, 26 Aug. 1985, GMHC papers, New York Public Library, Box 48, Insurance Issues 1985–86 file.

22 “The Circle K Affair,” New York Native, 5 Sept. 1988, 15. The battle for health coverage had a class dimension, as not all Circle K employees were able to afford the company's health plan in the first place. See also “Company Halting Health Plan on Some ‘Lifestyle’ Illnesses”, New York Times, 6 Aug. 1988, at www.nytimes.com/1988/08/06/us/company-halting-health-plan-on-some-life-style-illnesses.html, accessed 23 Nov. 2017.

23 Starkey statement, n.d., Starkey papers, Stonewall Library, Fort Lauderdale, Florida, AIDS Discrimination box 1 of 2.

24 Starkey to Ben Schatz of NGRA, 23 Nov. 1987, Starkey papers, AIDS Discrimination box 2 of 2, AIDS Discrimination Lawsuit – NGRA file.

25 William Winkelwerder, Austin R. Kessler, and Rhonda M. Stolec, “Federal Spending for Illness Caused by the Human Immunodeficiency Virus,” New England Journal of Medicine, 15 June 1989, 1598–1603.

26 See Bell, “Rethinking the Straight State.”

27 Pascal, Anthony, Cvitanic, Marilyn, Bennett, Charles, Gorman, Michael, and Serrato, Carl A., “State Policies and the Financing of Acquired Immunodeficiency Syndrome care,” Health Care Financing Review, 11, 1 (Fall 1989), 91–103Google ScholarPubMed.

28 Tom Gibson to Pat Buchanan, 18 Oct. 1985, Ronald Reagan papers, Reagan Presidential Library, Simi Valley, HE001 subject file 3499533.

29 David Rogers to Jeremiah Beronders of New York Academy of Medicine, 30 Nov. 1990, Rogers papers, Box 23, AIDS Miscellaneous file.

30 “New York Health Care Failure Charged,” New York Times, 8 Dec. 1988, B3.

31 Remarks of Stephen Joseph to the fifth international conference on AIDS, 5 June 1989, Steve Morin papers, GLBT Historical Society, Box 1, Folder 1.

32 See Koch to Daniel Patrick Moynihan, 23 Sept. 1986, Moynihan papers, Library of Congress, Box 1712, Folder 1.

33 Testimony of Catherine Daley, director of the Office of Ombudsman, GMHC, to New York City Department of Health, 2 May 1989, GMHC papers, New York Public Library, Box 46, Health and Hospitals Corporation NYC file.

34 See Potter, Claire Bond, “Paths to Political Citizenship: Gay Rights, Feminism, and the Carter Presidency,” Journal of Policy History, 24, 1 (Jan. 2012), 95–114CrossRefGoogle Scholar; Vaid, Virtual Equality, 74.

35 Mark Senak, Legal Services director GMHC, to James Curran, CDC, 16 Jan. 1986, GMHC papers, Box 48, Insurance Issues file.

36 Summary of COBRA 1985 continuation of health insurance provisions, Starkey papers, AIDS Discrimination box 1 of 2, Legal Information file.

37 GMHC leaflet, Legal Answers about AIDS: Questions and Answers about the Legal Aspects of Acquired Immune Deficiency Syndrome, Starkey papers, AIDS Discrimination box 1 of 2, AIDS Discrimination Lawsuit – Legal Information file.

38 Summary of Medicaid AIDS and HIV amendment of 1990, Daniel Patrick Moynihan papers, Box 1711, Folder 3. See also memo in same from Curtis Kelly to DPM, 3 April 1990, re meeting with GMHC representatives to discuss the bill.

39 Pascal et al., “State Policies.”

40 See Moynihan to Jeffrey Carples, New York Department of Social Services, 4 Dec. 1986, Moynihan MSS, Box 1717, Folder 2.

41 McAlister press release, 1 Oct. 1986, California Association of Social Workers MSS, Box 30, Folder 21.

42 Notes from meeting between Stan Hadden (State Sen. Roberti's office), Anne Powell (Assembly Health Committee), John Dunn-Mortimer (AIDS Project LA), Alan Lofaso (LIFE), and Sherry Shewry (MRMIP), 28 Jan. 1991, Stan Hadden papers, Box 1, Correspondence Incoming/Outgoing Jan.–Sept. 1991 file. Note that of the initial 4,000 applications for MRMIP coverage, between a quarter and a third were HIV-positive.

43 “Health Issues in California 1988,” California Association of Hospitals and Health Systems report for CA congressional delegation, Morin papers, Box 20, Folder 5.

44 Testimony of Everett Koop, hearings of Congressional Subcommittee on Health and the Environment of the House Committee on Energy and Commerce, 19 Feb. 1988, Morin papers, Box 6, File 5.

45 Jeffrey Levi and Benjamin Schatz, “AIDS-Related Issues and Insurance: A Position Paper,” Dec. 1986, Moynihan MSS, Box 1718, Folder 2.

46 Ben Schatz, director, AIDS Civil Rights Project, NGRA, position paper on AIDS and insurance, Starkey papers, AIDS Discrimination box 1 of 2, AIDS Discrimination Lawsuit – Legal Information 1986–89 file.

47 Larger corporations sometimes moderated their restrictive policies on AIDS as a result of political pressure, protected by their large workforces that mitigated the level of risk in insurance provision. See “Employers Endorse AIDS Guidelines,” New York Times, 18 Feb. 1988. Yet they also rolled back insurance coverage during the neoliberal era of the 1980s–2000s. For an example see Tiemeyer, Phil, Plane Queer: Labor, Sexuality, and AIDS in the History of Male Flight Attendants (Berkeley: University of California Press, 2013)CrossRefGoogle Scholar, chapter 8.

48 For full details of Starkey's case see Starkey papers, AIDS Discrimination 2 boxes.

49 Karin Timour interview with Sarah Schulman, 5 April 2003, ACT UP Oral History Project, interview no. 15, available at www.actuporalhistory.org/interviews/index.html, 9.

50 Ibid., 56.

51 Ibid., 11–12. An open enrollment policy was one you could acquire without a medical questionnaire, usually for a limited period of time during the year.

52 In addition to permanent open enrollment, also known as “guaranteed issue,” the New York law banned insurers from charging different premiums to different group policy members (experience rating), and allowed employees moving to new policies credit from their previous coverage when exposed to waiting periods against preexisting conditions in new policies. Preexisting-condition waiting periods could be no longer than 12 months, and the law applied to individuals and to small businesses of up to 50 employees. See Timour interview, 56–57.

53 Ibid., 41–43. Timour credited Mark Scherzer, consulting attorney for GMHC, with providing the legal know-how to lobby for the bill.

54 Ibid., 19–21.

55 Risa Denenberg interview with Sarah Schulman, 11 July 2004, ACT UP Oral History Project, no. 093, 31–32.

56 Terry McGovern interview with Sarah Schulman, 25 May 2007, ACT UP Oral History Project, no. 076, 12.

57 ACT UP information packet, Women Don't Have AIDS, They Just Die from It, 6 Nov. 1990, Women and AIDS Collection, Education Awareness 1990–95 file, Stonewall Library.

58 Jim Eigo interview, 5 March 2004, ACT UP Oral History Project, no. 047, 34.

59 ACT UP Golden Gate general meeting agenda, 26 Nov. 1991, ACT UP Golden Gate papers, UCSF special collections, General Meeting and Other Documents file.

60 See Gould, Moving Politics.

61 Dr. Kenneth Kizer testimony at Hearing of California Senate Select Committee on AIDS, 31 March 1989, Steve Morin papers, Box 6, File 9.

62 See final report of Presidential Commission on HIV in Commission papers, National Archives II, College Park, Box 1; press release of National Commission on AIDS, 28 June 1993, “Commission Closes after Four Years: Final Report Faults Government Leadership,” National Commission papers, National Archives II, Box 1, Press Releases file 3 of 3.

63 Bill Dannemeyer to Gary Bauer, 6 March 1987, including copy of Koop's speech to California legislature, Ronald Reagan papers, Ronald Reagan Presidential Library, record file OA19222, AIDS VIII file 2 of 4.

64 Alan Plumley to Everett Koop, 11 Aug. 1987, Koop papers, National Library of Medicine, Bethesda, Box 55, AIDS Evangelical Opposition file.

65 Unattributed clipping, “Group Demands Justice Official Resign for Remarks,” Starkey papers, AIDS Discrimination box 2, National Gay Rights Advocates file 1987–88.

66 Testimony of Mark Senak to Commission, 25 June 1987, GMHC papers, Box 48, Insurance Issues 1986–89 file.

67 See Timour interview, 55–56.

68 A telling comparison is with the early women's Equal Rights Amendment battle in the 1920s, when legal formalists became estranged from those pushing for social protections for working women as well as a simple commitment to legal equality. See Joan Zimmerman, “The Jurisprudence of Equality: The Women's Minimum Wage, the First Equal Rights Amendment, and Adkins v. Children's Hospital, 1905–1923,” Journal of American History, 78, 1 (June 1991), 188–225.

69 See Pratt, Murray, “The Defence of the Straight State: Heteronormativity, AIDS in France, and the Space of the Nation,” French Cultural Studies, 9, 28 (1998), 263–80CrossRefGoogle Scholar; Broqua, Christophe and Fillieule, Olivier, “The Making of State Homosexuality: How AIDS Shaped Same-Sex Politics in France,” American Behavioral Scientist, 61, 13 (2018), 1623–39CrossRefGoogle Scholar; Berridge, Virginia, AIDS in the UK: The Making of Policy, 1981–1994 (Oxford: Oxford University Press, 1996)CrossRefGoogle Scholar, especially Part 2. In the US, the emergence of a state-centered approach to LGBT health tended to focus on questions of research rather than of treatment. See Epstein, Steven, “Sexualizing Governance and Medicalizing Identities: The Emergence of ‘State-Centered’ LGBT Health Politics in the United States,” Sexualities, 6, 2 (2003), 131–71CrossRefGoogle Scholar.