Having failed – again – to gain congressional support for repealing the Affordable Care Act (ACA), US President Donald Trump last week took two actions that will undermine some of its core principles.
The President’s executive order allows for new, unregulated insurance packages – touted as expanding insurance options by the administration. However, many experts believe these changes will pull younger, healthier people out of the current insurance exchanges, where people can buy insurance compliant with the ACA, to buy so-called junk insurance. This would undermine the viability of the exchanges and leave those with greater healthcare needs – older people, those with low incomes, and people with pre-existing conditions – with too-high premiums, pricing them out of affordable health care.
The order makes it easier for small businesses and groups to work together and buy “association health plans” and short-term insurance coverage. These plans typically offer cheaper premiums, but include fewer benefits. Despite a problematic history of bankruptcies and failure to pay people’s medical bills, association health plans, like short-term insurance plans, are often attractive to younger, healthier consumers.
The ACA limited both options in order to spread the risk for insurers by including both healthy and sick people. After all, a person’s age or health history should not affect their ability to obtain coverage. Indeed, this is fundamental to Obamacare, which has promoted the right to health by making affordable insurance coverage available to millions of Americans. According to the Kaiser Family Foundation, a nonprofit group, these alternative health plans create a “parallel” insurance market not covered by ACA protections, such as essential benefits packages and coverage for pre-existing conditions.
At the same time, President Trump vowed to pull federal support from the subsidies that help people afford to purchase plans from the exchange.
As a result, premiums on ACA insurance exchanges may rise sharply, with negative consequences for public health. For example, women might find it more expensive to access prenatal and maternity care – something the US can in no way afford as maternal death rates are rising alarmingly. Amid a nationwide crisis of drug overdose that claimed more than 60,000 lives in 2016, coverage for substance use treatment may cost more.
The Trump administration should act to protect the right to health, not undermine it.