Identities and Political Unity: An Exploration in Five Voices

Healthcare

Jennifer Disla: I begin with healthcare because as a Healthcare for America Now organizer campaigning for the Affordable Care Act, I saw democracy work at its best. I was impacted by the broken healthcare system: I was one of the many who faced bankruptcy after a medical emergency.

Since the Affordable Care Act, I have reaped the benefits of having access to preventive services like therapy and medical management to treat Bipolar Disorder. Without such measures, I would not be able to live an ordinary, everyday life. Additionally, my medical team continues to lean in with the lens of cultural competence to understand my lived experience as an Afro-Latina in professional and personal settings.

I called in Roshnee Vázquez, a sister in Chi Upsilon Sigma National Latin Sorority Inc. Corazones Unidos Siempre, and a psychotherapist committed to culturally competent practice to provide more insights.

The Affordable Care Act and Mental Health

Roshnee Vázquez: The Affordable Care Act (ACA) has been vital to the improvement of overall healthcare for millions of individuals. Specifically, it has helped safeguard access to behavioral health treatment. The ACA designated mental and behavioral health services as essential care and protected those with pre-existing conditions, increasing coverage for individuals with mental health needs.

Studies have shown that the ACA has specifically increased access to outpatient psychiatric services. This has been impactful in addressing disparities in behavioral health care. The ACA has also supported adherence to recommended treatment plans, helping prevent premature termination of services that can lead to inadequate care and symptom relapse, and reduced overall health and quality of life.

By current estimates, more than one in six individuals enrolled in the health insurance marketplaces created by the Affordable Care Act has at least one mental health diagnosis. These mental health diagnoses include, but are not limited to, anxiety disorders (approximately three million people), depression disorders (two million people), trauma and stressor related disorders (approximately one million), and bipolar disorders (approximately 500,000 individuals). Keeping these statistics in mind, it is important to remember that mental health conditions often co-occur. This underscores the need for integrated and sustained care.

The consequences of changes to the marketplace

Roshnee Vázquez: The current political climate is raising concerns around access to mental health coverage due to policy changes. Such changes include the One Big Beautiful Bill Act (OBBBA) and the expiration of enhanced premium tax credits. These changes may lead to 8.2 million people becoming uninsured by 2034. Additionally, Deferred Action for Childhood Arrivals (DACA) recipients are now no longer eligible for marketplace coverage options.

The consequences of changes to the marketplace will likely be a devastating hit to care accessibility and public health efforts. The potential ramifications of healthcare access are not limited to a specific group of people. Hospitals could see a rise in uninsured patients seeking care without the means to pay, straining healthcare resources and increasing costs for everyone. The entire healthcare system is interconnected and limitations in access to healthcare, including mental health treatment, can have significant effects.

How clinicians can help

Roshnee Vázquez: Mental health clinicians can take meaningful action to mitigate behavioral health disparities related to care delivery. They can play a critical role in advocacy efforts aimed at expanding access to mental health services. One strategy for improving access is the integration of behavioral healthcare into primary care settings. Integrated care models can increase early identification of individuals who may benefit from mental health services and support more coordinated treatment. Although these models may require orientation for clinicians unfamiliar with primary care environments, this should not be viewed as a significant barrier to adopting more integrative practice approaches.

Staying informed about policy developments has become increasingly important, enabling providers to discuss potential changes in care with patients in an informed and transparent manner. Clinicians can also document how changes to the Affordable Care Act (ACA) and related policies disrupt care continuity, access, or affordability. Such documentation may strengthen healthcare advocacy efforts and support initiatives to preserve and expand access to behavioral health services.

Additional provider-level strategies include offering sliding-scale fees, expanding telehealth services, and collaborating with community-based organizations, all of which may help address gaps in treatment access.

Moreover, mental health providers can engage with professional organizations such as the American Psychological Association (APA) and the American Counseling Association (ACA) to support policy advocacy efforts, including the enforcement of mental health parity regulations. Ideally, this advocacy is conducted in collaboration with patients. When individuals with lived experience are actively involved, advocacy can shift from merely identifying problems to co-creating solutions, ensuring that efforts to sustain and expand behavioral healthcare access are responsive, equitable, and grounded in patient needs.

Spiritual practice

Jennifer Disla: My capacity to grow in all aspects of my life keeps me healthy. This past fall, I marked my ten-year anniversary of staying healthy and out of the hospital. I reached this milestone and recovered from a recent depressive and manic cycle with both science and spiritual practices. As an Afro-Latina, I hold both a Christian faith and ties to indigenous practices native to the Dominican Republic’s Taínos. Additionally, I uphold the rich history of slave rebellion and enriched African culture on the island.

Michelle Higgins, Executive Director for Faith in Justice and Senior Pastor at St. John’s Church, Beloved Community, reflected on ways religious practice can feed a practice of democracy. She and I are both proud members of Movements for Black Lives.

Inherently interfaith

Michelle Higgins: Faith work in this latest of revolutionary eras is inherently interfaith. And interfaith work requires radical new pathways of democracy. Religion has been employed in the defense of revolution. And “God commands it” has been used as the validating claim for conflicts worldwide. If religion has a share in Black radical political power, it must be for freedom. Religious freedom in partnership with Black liberation movements has expanded our view of what is possible for our people. The Black church was a convening space and moral center for some civil rights pursuits.

Today’s opportunity for progressive Christianity is to refuse to hold hands with gendered racial capitalism, transphobia, and other hypocrisies that marred traditions. Liberation Theology asks how the freedom of our people and justice for all oppressed people influences the way we understand God, and insists that it should. Many senior pastors of Black Liberation congregations have been grateful to watch the movement make meaning of ministry. Liberated faith, by many names, is an increasingly practiced expansion of “traditional” spiritual and Christian beliefs that I have observed among so many individuals and congregations.

Revolutionary democracy’s invitation to interfaith work is a practice of patience. Whether long- or short-term goals are in play, we must employ tactics to amplify inclusive democracy. Faith spaces and faith leaders have the resources to host caucuses, assemblies, and other convening events. We can learn from and offer support for direct action, and we join the vanguard of comrades committed to transformation.

Black identity

Jennifer Disla: Michelle’s reflections remind me how important spiritual practices and healing leadership offerings are for many of us in the movement space. My Black identity made me eligible to participate in Rockwood Leadership Institute’s Heart of Black Leadership program. Through this program I was able to place my Black experience in the context of American culture, especially history.

As we live in racial capitalist society, I am aware of how my race plays a role in all aspects of my life, including movement leadership. Racism sets limiting beliefs about Black leadership, and without community, you may not be able to build capacity. False narratives are loud—such as those casting doubts on our intellectual capacity or professionalism.

The Heart of Black Leadership provided language and support to navigate these waters. I was curious to learn the origin and development of such an amazing program. Darlene Nipper, CEO of the Rockwood Institute, was kind enough to lean in with me.

The Heart of Black Leadership

Darlene Nipper: In early 2021, after George Floyd’s murder in 2020, Rockwood hosted a community call. That call led to more conversations and turned out to be the genesis of the Heart of Black Leadership program. There was a deep yearning among those who arrived to the conversation to deepen their own practice of leadership in community with other Black people. Jasmine Burnett and Maura Bailey, who led those early community conversations, along with Jamal Nelson and Romeo Jackson, approached Rockwood leadership about designing a Rockwood program for Black folks by Black folks. All Black staff, no matter their role, co-designed this program for Black people to have space to evolve their leadership in a Black-only cohort. After we all met, several of the team members hunkered down to design the program based on lived experience, what they’d heard from the team, and what they’d heard from the Black folks who’d shown up for a community call.

I define Diversity, Equity, and Inclusion as seeing ways to meet multiple community or organizational needs to achieve goals and missions. The Heart of Black Leadership provides this grounding with Jasmine and Maura’s leadership. It continues to meet this moment, providing the support and tools needed to navigate our society’s oppressive systems and institutions on a daily basis.

Rockwood learned [that] it’s about shifting the narrative and practices to counter the oppressive structures built into the system: it’s about equity. The democratic ideals upon which this country was formed are not the basis for the lived experience of most Black people. Rockwood programs aim to shift the balance of knowledge, understanding, and power so that Black people are able to fully and freely participate in our democracy. Jennifer learned to ground herself in Black skin. Most importantly, she was grounded in skills on how to navigate the world in her Black body—navigate authentically and aligned with her values.

I wish a similar impact for more Black leaders and communities. It won’t level the playing field for all Black people, but it will open up enormous possibilities for leaders.

Rockwood continues to believe we are making a small difference in the lives of Black communities. We may never see where all the ripples will land, but we know there’s value in sharing tools for a more just and equitable society. That’s what democracy is supposed to afford us all.

Sexuality and reproductive justice

Jennifer Disla: Darlene’s reflections hit home; democracy in matters concerning my body and health has always been top of mind for me. In 1994, my generation was introduced to Pedro, a gay man dying of AIDS in the Real World TV series. I felt the pain of his loss and struggles. I didn’t have to go too far to see the impact on AIDS in my life. My fifth-grade sex ed teacher shared that her friend was dying of AIDS. Fast-forward to college, I participated in the National Latina Health Network (NLHN). We lobbied to ensure comprehensive sex education in New Jersey and resources for AIDS prevention.

The staff at NLHN made a huge impact on my sexual health. They shared how they received a full panel of tests for sexually transmitted diseases, even when others might think they were “safe.” They taught us that regardless of your marital status, knowing your sexually transmitted disease status was vital to your health. So, when I became sexually active it was a no-brainer to go to Planned Parenthood, blocks away from my college alma mater. I continued to practice safe sex and test annually for sexually transmitted infections. Most importantly, I matured to ask sexual partners about their health status. I encourage sexually active people to always have status conversations as well as practice safe sex.

Sex is also how children may or may not come to the world. I have supported several friends and family members who had to make a choice on having an abortion. I am so grateful that legal and medically sound locations were provided for the services.

As a cisgender woman, it speaks volumes to my ability to enjoy democracy in decisions about my body and health. I chatted with Maria Elena Perez, who works towards stronger paradigms to meet reproductive rights—meeting my wildest dreams and desires.

Reproductive justice

Maria Elena Perez: Jen’s story of learning about AIDS, choosing safer sex, and finding her way into reproductive justice highlights a central truth of this powerful movement, and that is that reproductive justice is always deeply personal, rooted in lived experience, and shaped by systems of power that extend far beyond individual choices.

And let’s be clear: while reproductive justice has, over recent years, become synonymous with reproductive rights—or even seen as the more politically correct term—it is far from a buzzword. Reproductive justice is a framework developed in 1994 by Black women activists who recognized that the reproductive rights movement focused exclusively on abortion access and failed to address the full spectrum of needs facing women of color, poor women, immigrants, and LGTBQ+ people. By establishing reproductive justice, they reframed the conversation to be about the human right to bodily autonomy and the right to have children, the right to not have children, and the right to parent children in safe, healthy environments. 

For many BIPOC folks, entry points into reproductive justice are not always through policy or activism, but through the realities of their lived experiences, including the realities of survival. Learning about HIV/AIDS during the height of its crisis, as Jen describes, meant grappling not only with a public health emergency but with the deep racial and economic inequities that shaped who had access to care, who was blamed, and who was left to die. Practicing safer sex wasn’t just a private decision, it was a political act, grounded in self-preservation, collective care, and stigma reduction.

Intersectionality and democracy

Maria Elena Perez: This is what intersectionality, a concept central and core to reproductive justice, demands that we understand: that issues of sexuality, reproductive health, race, gender, class, and immigration status are not separate, but overlapping and interconnected. Intersectionality, a term coined by Kimberlé Crenshaw, is a lens that helps us see how systems of oppression operate together to deny people access, dignity, and autonomy.

In my earlier days in the reproductive justice movement, I led RJ 101 trainings with immigrant Latinas and promotoras across the country, providing them with the language to make meaning of their lived experiences. One activity that we led and that was introduced to me by my movement comrade and now author, Miriam Zoila Perez, involved us drawing a stick figure and asking folks to speak about the various identities they held. Around the person we’d write down, for instance: Mexican, mom, community member of the Valley, have a chronic illness, undocumented, etc. 

We would then explain that reproductive justice, and specifically intersectionality, means that all of these things shape who we are and our experiences, including the decisions that we make and the services we have access to. Reproductive justice goes beyond establishing the right to reproductive health, because what good is this right if you are undocumented and live in the Valley in Texas and can’t access that service if you have to pass through checkpoints from southern Texas to northern Texas? (And yes, this is true.) This is what reproductive justice is about. 

And make no mistake, reproductive justice is directly tied to democracy. Controlling reproduction is never just about women, but rather it’s about regulating who has power over their own body, who is deemed worthy of autonomy, and who gets to participate fully in society. Reproductive justice expands the conversation beyond gender alone, encompassing the rights of trans, nonbinary, poor, disabled, and undocumented people, and linking the fight for reproductive freedom to the broader struggle against authoritarianism. In this way, reproductive justice is not a side issue—and many, including myself, would argue, is a frontline defense of democracy itself.

Grounded in connection

Jennifer Disla: These reflections are grounded in our connections as co-authors. We not only connect relationally, ideologically, and demographically: we have a collective desire for freedom. Our stories matter and are interconnected. They can provide a foundation for multiracial democracy: let’s continue to share them.

Healthcare, spiritual, and reproductive freedoms allow us to have democratic lives. These freedoms are not abstract or merely political talking points. Diversity, Equity, and Inclusion practices focus on building multicultural, multiethnic, and multiracial talent in organizations and society. We need more campaigns leaning into our stories, demonstrating our interconnected community. “Injustice anywhere is a threat to justice everywhere,” Dr. Martin Luther King, Jr. said. As we defend the democracy we have, let’s act in deep solidarity on demands to move towards a new and deeper democracy.