No one is sure how the astonishing election of Donald Trump as president will impact health care in the United States. But with the backing of a Republican-controlled Congress, experts are warning Americans — and especially the 20 million who have gained health insurance through the Affordable Care Act (ACA) — to expect big changes.
Here, Ana Núñez, MD, and Anita Gupta, DO, both professors at Drexel University College of Medicine, weigh in on what health care in America might look like in 2017 and beyond. Núñez is an internist who specializes in women’s health, and the College’s associate dean for diversity, equity and inclusion. Gupta is vice chair of the Division of Pain Medicine and Regional Anesthesiology.
Trump has promised to repeal Obamacare (the ACA).
While the Senate may lack the 60 votes needed to completely erase the ACA, it’s clear that Trump plans to challenge the law, which Republican leaders will be happy to help him with.
“In January, the GOP passed a bill, which eliminated the subsidies that help many Obamacare recipients afford their health coverage, as well as Medicaid expansion. The bill also eliminated the requirement that everyone must have health insurance or pay a tax penalty,” Gupta said.
After the bill was passed, President Obama used his executive power to veto it, and it never became law. Once Trump takes office, Congress could send the bill back to the president, who will likely pass it.
Still, Gupta adds, “there are more questions than answers right now. Many Republican leaders, including House Speaker Paul Ryan, have said there are provisions that are likely to stay, but are yet to be determined.”
The provisions Ryan proposed include keeping coverage for those 26 and younger if they are under their parents’ insurance plan, and banning the bar on people with preexisting conditions from getting insurance.
For more information about just how difficult it would be to actually repeal the ACA, read this commentary from Robert I. Field, PhD, JD, a professor in the Dornsife School of Public Health and Kline School of Law, on Philly.com.
Repealing the ACA could have dire consequences.
If all parts of the ACA are eliminated, it could put many Americans’ health in jeopardy, said Núñez. She explained that doing away with the law (though it is unclear what would replace it), could lead to:
- Up to 25 million Americans losing health insurance. These people are primarily working-class, most with a high school or less education. About 40 percent are young adults and half of them non-Hispanic whites.
- Insurances going back to denying coverage for pre-existing conditions like hypertension or cancer, or writing stiff premiums — if they offer coverage at all.
- Young adults under 26 being kicked off their parents’ insurance.
- Death rates rising — people without insurance have about a 25 percent increase in death rates as compared to those who are insured.
- Health care exchanges being eliminated.
Trump wants to give states more freedom about how to allocate Medicaid funds by turning the social health care program into a block grant program.
Sounds good in theory, but according to Núñez, “Increasing state’s latitude of funds on Medicaid dollars — usually in the form of state grants — in my opinion, rarely helps the health of the population. States who cut back on taxes, and therefore have less revenue, can redirect these block grants to other state needs that are not health-related. The impact of poorer health conditions result in sicker, later arrival to care and increased health expenditures, as well as potentially avoidable, adverse health outcomes or deaths.”
Women’s access to abortion could be limited.
“Full and comprehensive care for women means women can choose when and if they have children,” Núñez argued. “It means they have access to reproductive services and can have planned pregnancies when it makes the most sense for them and their families.”
With so-called Targeted Regulation of Abortion Providers (TRAP) laws, lawmakers have already made it challenging, if not impossible, for many women to have access to safe, legal abortions in many states. In June, the U.S. Supreme Court struck down parts of a restrictive Texas law that could have drastically reduced the number of abortion clinics in the state.
But if enough vacancies arise on the Supreme Court while Trump is president, he could appoint conservative justices, who might tip the balance of the court enough to overturn the legal precedents set forth in Roe v. Wade, the 1973 decision that struck down state laws that banned abortion and formed the bedrock for our current protections of reproductive rights. It is likely that Trump will have to fill one, and as many as three, vacancies on the Supreme Court during his term.
“The current political regulations by those in government have made it such that most poor women have little or no access to termination as a reproductive option. So, in fact, repealing Roe v. Wade is likely to affect middle and higher income women more than others,” Núñez said.
During his candidacy, Trump also promised to defund Planned Parenthood. Further, some women are concerned that a Trump administration might end ACA provisions that require insurers to cover intrauterine devices (IUDs) and other types of contraception.
But the health care forecast remains unpredictable.
Gupta’s outlook for the future of health care remains hopeful. “Change is good, and trying to embrace the ideas put forward with a positive outlook is critical to understand everyone’s views,” she said. “The ACA was already in trouble before the election.”
Núñez, on the other hand, remains cautious. “Mr. Trump has demonstrated his unpredictability. It is not clear he is as aligned with other members of his party, ideologically speaking. Hopefully, recognizing the needs of women, he will not support a war on women and women’s health. Hopefully, he will demonstrate a practical stance in this matter — not one blindly adhering to his party’s most extreme members.”
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