Despite polls showing that a vast majority of Americans believe that the Trump administration should make the Affordable Care Act (ACA) better rather than seek its demise, the administration is once again seems determined to do the latter.
After joining across the country to beat back previous threats to the program, including participation in waves of mass arrests at Congress, the HIV community once again called for repudiation of Trump's care-killing strategies. From heated organizational statements to impassioned pleas for direct action via social media, it's clear that people with HIV, their loved ones and their providers are not going to give up when it comes to attacks on care.
Advocacy and Service Organization Reactions
From HIV Medicine Association chair Melanie Thompson, M.D.:
This order could undermine critical health insurance consumer protections in the small group market and lead to the erosion of these protections in the individual market depending on how it is implemented. Under these new options, some people living with HIV and others with chronic medical conditions would be unable to afford health insurance and the life saving medications and healthcare it provides.
This Executive Order could begin to unravel health reforms that leveled the playing field for individuals with HIV and 52 million other Americans living with pre-existing conditions. It will threaten the health of those left uninsured due to unaffordable health care costs and add additional stress to our safety net health systems such as public hospitals, dealing a blow to our attempts to control and eliminate our domestic HIV epidemic, especially in the South.
Instead of undermining health reforms that have improved the lives of tens of thousands of people living with HIV and millions of other Americans, HIVMA calls on the Administration and Congress to collaborate on bi-partisan strategies that will stabilize the non-group health insurance market, including supporting a robust open enrollment period and ensuring sustained federal funding for cost sharing reductions.
From a joint statement by AIDS United, National Alliance of State & Territorial AIDS Directors, National Coalition of STD Directors, National Minority AIDS Council and The AIDS Institute:
Following repeated legislative defeats to repeal the Affordable Care Act (ACA), President Trump is taking steps to further sabotage the ACA. This includes ending cost sharing reduction (CSR) payments to issuers and issuing an executive order that would destabilize the health care marketplace and erode patient protections.
Both actions would have devastating effects on people living with or at risk of HIV and STDs. Ending the $7 billion in CSR payments would serve to increase premiums and force the Ryan White HIV/AIDS Program to bear a greater share of insurance costs. It would drive insurance companies out of the state health care marketplaces and in turn, put the marketplaces out of business.
In addition to this action, President Trump signed an executive order that directs federal agencies to expand association health plans and short-term limited insurance. Such plans would not have to meet "essential health benefits," virtually ensuring they will be useless for people with pre-existing conditions, including people living with HIV and STDs. The executive order creates the opportunity for younger and healthier people to exit the more regulated marketplaces and destabilize the entire insurance market.
From The Black AIDS Institute:
What this administration has done not only goes against the values of this country, but it is also unabashedly ignores the voices of the millions of Americans who called, wrote, or otherwise contacted their representative to fight for the care they need. In the last few days, President Trump has given the American people an astonishingly clear view into who and what he values. We know that the Affordable Care Act has insured that over 16 million Americans can sleep easily at night knowing that in the event of the unfortunate, they have a healthcare plan that is there to meet their needs. The ACA ensured that more Black Americans have insurance than ever before, more women are receiving essential care, and people living with HIV no longer have to go without care because of their pre-existing condition. The President's actions and thereby his and the Republican party's position on healthcare is to ignore the basic needs of everyday Americans and instead cater to the wallets of the wealthy. This is Trumpcare. The President's announcement and plan to end subsidies to insurance companies is a significant blow to the Affordable Care Act and its ability to ensure care for the millions of Americans who depend on it. By allowing insurers to offer unregulated and substandard insurance policies across state lines, the President has all but ensured that communities disproportionately affected by HIV, HCV, and other pressing health issues will receive substandard healthcare, if they are able to afford any healthcare at all. By expanding short-term coverage and association health plans, this administration has gone against the public will in order to satisfy Wall Street. I say it again; this is Trumpcare.
We know where Mr. Trump stands; now is the time for us to make sure he knows where we stand. It is urgent that we act and make our voices and our concerns heard. Even though it may not appear so, we have the power to change the dialogue around the current healthcare discussion right now. Make no mistake, healthcare is a social justice issue and like the many men and women who came before us, we must resist these efforts to turn back the clock. If we as a nation, as leaders of the free world, deem it acceptable to allow Black and Brown communities to access substandard and second-rate care, then what are we really saying about who we are as a country. We are better than that. Women should not be forced to pay more for insurance or medications that are essential to their health and well-being than men -- or be denied essential health services unique to them all together. Black people and people of color should not be forced to pay more because of where they live or who represents them in Congress. Black Americans and people living with HIV should not be effectively segregated into high risk pools because the top 1% would like to pay a little less in taxes. This country was founded on the ideals of equal rights, equal opportunities, and equal protection under the law; Trumpcare fails to meet this standard. We can change this.
From AIDS Foundation of Chicago:
The ACA has been transformative for people living with HIV in Illinois. At least 12,000 people living with HIV in Illinois newly gained health care coverage through the ACA. That's 32% of people with HIV in Illinois, or 1 in 3 of the 37,788 people who are reported as living with HIV in Illinois. In addition, nearly 3,000 people with HIV gained coverage through the health insurance marketplace, and had premiums and out-of-pocket costs paid by the AIDS Drug Assistance Program (ADAP). It is likely that most -- if not all -- were previously uninsured.
Tens of thousands of Illinoisans, including working people and families, rely on the ACA's cost-sharing subsidies to help cover their life-saving treatment, including those living with HIV. These subsidies help health insurance companies pay for out-of-pocket costs that lower-income people and families simply cannot afford. Without these subsidies, insurance companies have one fewer reason to do their job of providing affordable access to health care.
AFC believes this policy shift by the Trump administration is mean-spirited and harmful to the financial and health stability of the country. We demand the Trump administration withdraw this plan; we also call on the Illinois Congressional Delegation, Governor Bruce Rauner, and other elected officials to speak out against this spiteful and mean-spirited act. Together, we can continue to protect the Affordable Care Act and help Americans thrive.
From Housing Works national advocacy coordinator Paul Davis:
Today we see an Executive Order the White House states is "is the beginning of the unraveling of the ACA." The President is trying to do an end run around us, and around the law. Trump has directed cabinet agencies to come up with plans to permit insurance companies to sell junk insurance on the individual markets. These plans will be cheap (but useless) for the young and healthy, and drive up rates faster on ACA-compliant health plans. The EO takes us back to the days when having a pre-existing condition made you uninsurable, and before the essential health benefits ensured coverage for women's reproductive health, mental health, addiction treatment and physical disabilities.
We can stop this in Congress. We need to pass a bipartisan stabilization bill that starts to undo some of the sabotage. A a promising bill has been stuck for weeks now in the Senate Health, Labor, Education and Pensions (HELP) Committee, even after four positive bipartisan hearings. The Committee Chair, Senator Lamar Alexander (R) from TN and the Ranking Member Patty Murray (D) from Washington unable to find a text that enough republicans will support without dismantling the protections ensured by the ACA.
Community Member Reactions
Webinar: HIV Community Update -- Administrative Actions on Healthcare, Oct. 17, 2-3 p.m. ET
Over the past couple of days, the Administration has taken some actions to undermine the Affordable Care Act. Are you wondering what exactly is changing? Want to get your questions answered? Join this webinar, co-organized by AIDS Alabama, AIDS Foundation of Chicago, AIDS United, Positive Women's Network and Treatment Access Expansion Project.
Ken Stockwell is senior web producer for TheBody.com and TheBodyPRO.com.