By Stephon Robert

I knew I was dead. I looked up to a white ceiling and attempted to move my head around. Yeah, I was definitely dead. It was too peaceful. True, this wasn’t really how I imagined the afterlife to be, but whatever. At least I was comfortable and the room smelled pretty good.

It wasn’t until I witnessed my family running down the stairway to Heaven—otherwise known as the hospital’s hallway—that I realized I had IV drips in both of my arms. Apparently Celie was wrong when she said, “Heaven lasts always.”

I was diagnosed with nocturnal epilepsy in April of 2015. With a lack of knowledge about the severity of my condition and the weight of stress on my back, I was on the road to crashing and burning. Each and every night for six months, I lived in fear of going to sleep and waking up in a pile of my own sweat. For the entire summer I was lucky if I made it from Monday to Friday without at least two seizures. After an episode, I would breathe myself back to life, take a quick shower and make the trek to work.

The average price of the medications I take is $310 without insurance. Even with my insurance, if I ended up in the hospital the total bill would be $2,500, which would probably leave me penniless. I needed someone to explain how it cost $2,500 to flood me with drugs and water.

When The Affordable Care Act, affectionately known as “Obamacare,” came into existence it seemed to be a solution for those without insurance, especially those battling debilitating pre-existing conditions such as HIV/AIDS, lupus and diabetes. Under Obamacare, requirements were implemented for universal health care options for all. Emphasis on the “options.”

With GOP legislatures rallying behind another regressive health care reform, Black LGBTQ who are uninsured will continue to go without. However, the narrative around the dangers of this “reform” is commonly framed around the elderly and poor whites. Issues facing those who are Black and LGBTQ remain in the shadows, an oversight that is pervasive and long-standing.

Even before the threat of Obamacare repeal, I was piss poor with barely enough money to pay half on my box of an apartment. My insurance plan was inconceivably limited and my job was anticipating rehiring for my position because of my need for a week of recuperation. Ain’t no sick days for temps.

Yes, Obamacare has offered online marketplaces, tax credits and other choices to benefit uninsured Americans, but these are limited to particular areas. New York City has health plans and levels of care offered to low income individuals and families. But there are 19 states that refuse to expand Medicaid coverage. This creates a “coverage gap,” with 2.8 million uninsured.

These 19 states are mostly located in the South, with 91% of families making up those uninsured. 31% of the coverage gap are of African descent. The state of Mississippi is the state of oppression. The Confederate flag still soars in the sky and cotton remains King. Mississippi also has the fourth highest rate of HIV-infected Black gay and bisexual men in the country. There are no “comprehensive benefits packages.”

The exclusion of trans men and women from care is met with elitist wordplay relating to transitioning or hormone therapy. While it is illegal in theory to discriminate against trans-people of color in terms of medical care, there aren’t many protections in place to prevent discrimination in practice.

The announcement from our beloved Cheetos-complexioned President banning trans people from serving in the military is illuminating. His excuse, that providing “sex changes” is an extreme drain on the military’s budget, is ludicrous considering that it’s more expensive to provide cis-men with erectile dysfunction medication. They sell EztenZe at the corner store. But this is a reminder of the substantial issues concerning the current health care crisis.

In this context, “reform” is a meaningless term. If there’s already a tremendous fight to live, there’s a lack of insight as to how to afford to survive. It would be an irresponsible assumption to believe all Black low-income people in the South would benefit much from Obamacare and its complex structuring.

Ruminating on these issues, I awoke with the understanding that I had a second chance at life. A second chance where I could find a job with suitable health insurance that provided a well-informed neurologist and inexpensive medication. My story is a story of privilege. It’s an unrealistic concept for my queer loved ones in Florida, Mississippi and Louisiana. The present day circumstances involving the fight for health insurance are not the same in New York as it is in the South, and this crucially informs how we talk about health care “reform.”

Our existence does not merely rest in the hands of Trump. There’s a larger and more vital fight for those left behind even in the progressive push for universal health care. It cannot be solved in a small period of time or through a quick decision from government officials. My story and struggle are not unique by any means, but being aware of these stories can cultivate change. We cannot be in fear for our lives if our bodies have already been laid to rest and our names still remain forgotten.

Stephon Robert is a 24-year old Black gay writer living in Harlem. His work has been published on Ebony.com and Soule.LGBT.