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.
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. On the other hand, a number of Republican
leaders and Trump himself have said there are provisions that are likely to
stay, 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.
If all parts of the ACA are eliminated, it could put many
Americans’ health in jeopardy. Doing
away with the law 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 increasing state’s latitude of
funds on Medicaid dollars — usually in the form of state grants — 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, 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. 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.
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.
Excerpted from an interview with
Ana E. Núñez, MD
Professor of Medicine, Associate Dean of Diversity, Equity & Inclusion
