As politicians in Washington debate the timeline and breadth of our nation’s health care system reform, millions of Americans – those same Americans who cast their votes last November for a new dawn in American politics – sit around the family television nearly a year later no closer to medical care than they were when they raised their voices in unison on that cold winter Tuesday.

“The timing is not right.” “After the August recess.” “By the end of the year.” “We still have some details to work out.”

The time is right. The timing is now. The only detail that needs to be worked out is that health care must be provided to ALL Americans. That includes the GLBT community. In fact, it is of particular interest – and necessity – for the GLBT community.

In California, as we face a $27 billion deficit, the governor, on Tuesday, line-item vetoed a significant piece of early intervention funding for HIV/AIDS. Equality California estimates the cuts to be as much as $80 million. Tens of thousands of families affected by HIV/AIDS may see their medical assistance disappear.

On the one hand, health care reform legislation will help GLBT Americans in many of the same ways that it would help all Americans. Expanded access to meaningful health insurance coverage, effective preventive care, and delivery system reform provide all Americans necessary and life-saving benefits.

But GLBT people often face additional barriers to coverage and care due to ongoing stigma and policies that do not fully recognize their identities and relationships, sexual orientation or gender issues. The Department of Health and Human Services recognized these disparities in the 1990s during its 10-year plan for improving the nation’s health – Healthy People 2010, and commissioned a companion document specifically on GLBT issues.

Health care reform today offers an opportunity to address these disparities. The National Coalition for GLBT Health has developed a set of principles for policymakers to incorporate into legislation in order to ensure equity for GLBT Americans. These principles recognize that issues for the GLBT community often combine with those faced by other communities, such as a Spanish-speaking lesbian woman or an African-American transgender person who face negative health outcomes from multiple communities. This document aims to draw out a few of these key principles, including the need to measure and address GLBT health disparities, ways to expand meaningful insurance coverage, the need for cultural competency, and privacy issues in health information technology.

Congress has a unique opportunity this year to reform health care in a way that helps all Americans and addresses the needs of specific minorities, including GLBT Americans. The House bill currently contains a first step in this direction by including tax equity for employer-sponsored health benefits to domestic partners. Legislators can easily build on this by explicitly defining health disparities to include disparities faced by GLBT communities and including GLBT cultural competency training among the forms of competency that receive funding. With or without specific congressional inclusion, Secretary of Health and Human Services Kathleen Sebelius should use the flexibility granted to her in the legislation to take GLBT disparities into account as she implements health reform.

There are also a number of provisions that have not yet surfaced in the health reform debate, but will be important steps to fully inclusive health care reform. Federal health surveys should be instructed to include optional GLBT identities in their demographic information. And Congress and advisory committees should include transgender health benefits as they define minimum benefit packages. Privacy protections for health information technology should be specifically required to address GLBT concerns.

These steps will help reduce the health disparities facing GLBT Americans. But just as important, specifically including GLBT Americans in health reform shows that their communities and identities are an important part of American society.

They say that change comes from those willing to make it. It is our responsibility to remind those we sent to Washington why we sent them – for change. It is high time we clearly indicate that if they don’t effect health care reform NOW – for ALL Americans – voters will review their performance every two, four, or six years.

And those who oppose supporting health care for all Americans may just find themselves in the unemployment line, wishing they had access to public health care themselves.