Trump Administration Intensifies Efforts to Erode Nation’s Access to Healthcare

  

The Trump administration has recently escalated its attacks on the health system under the Affordable Care Act (ACA) and continues to undermine the ability of Americans – particularly low-income women and individuals with pre-existing conditions – to access affordable and comprehensive healthcare coverage. These policy decisions – which come at the same time as a U.S. Supreme Court ruling with implications for access to reproductive healthcare services – are certain to erode the healthcare coverage gains made since 2010 and create significant harm, risk, and uncertainty for some of America’s most vulnerable populations.

The Centers for Medicare & Medicaid Services (CMS) on July 10 announced that it would further cut grants to nonprofit organizations that assist individuals in signing up for health insurance coverage on the ACA’s individual market. The federal government provided $63 million to such organizations in 2016, $36 million in 2017, and will provide only $10 million this year – a total reduction of roughly 84 percent. CMS, in another significant shift, will also encourage such organizations to enroll individuals in Association Health Plans (AHPs) as opposed to the more comprehensive ACA health plans. These plans – which the administration expanded last month and which ANA strongly opposes – offer coverage without essential health benefits guarantees and will disadvantage individuals with pre-existing conditions.

The administration argues that insurance companies and brokers are much better at enrolling individuals into insurance plans, and that AHPs offer a less expensive option for Americans struggling to pay for health insurance. However, despite major outreach efforts last year by outside groups – including ANA – to enroll individuals in ACA plans, enrollment dipped for the first time since the law was implemented. Meanwhile, the expansion of AHPs will result in higher premiums and fewer coverage options for Americans with pre-existing conditions, while individuals who purchase coverage through an AHP will have less comprehensive coverage than what is required of ACA health plans.

The administration on July 7 also announced that it would suspend billions of dollars in risk adjustment payments required by the ACA to be paid to insurance companies. These payments are intended to stabilize the individual market by preventing insurance companies from only seeking out healthy individuals and encouraging them to promote coverage for individuals with costly pre-existing conditions.

Suspending these payments creates uncertainty in the individual market, just as insurance companies are determining premiums for calendar year 2019, and could significantly increase premiums in the individual market. The administration’s moves to expand the use of AHPs and decrease the amount of funding available for outreach could be disastrous for individuals who purchase health coverage through the individual market and will likely lead to another year in which the number of Americans without health insurance coverages rises.

The administration, however, has not only taken aim at the ACA’s healthcare coverage regulations. In June, the administration issued a proposal to change regulations related to Title X funding, which provides grants for critical family planning services for millions of Americans, particularly low-income women. This proposed rule would prohibit a recipient of Title X funding from “performing, promoting, referring for, or supporting, abortion as a method of family planning, nor take any other affirmative action to assist a patient to secure such an abortion.” This represents a gag order on providers and denies patients full medical information. This was recently bolstered by the U.S. Supreme Court ruling in NIFLA v. Becerra, where the Court ruled that it is unconstitutional on First Amendment grounds for the state of California to require family planning facilities to post information about state-sponsored abortion services.

This is antithetical to the Code of Ethics for Nurses which states that the nurse’s primary commitment is to the patient, whether an individual, family, group, community, or population. This proposed rule interferes with that relationship and violates basic ethics of the profession, while threatening the ability of millions of Americans to access basic, preventive reproductive health care, such as birth control, cancer screenings, STI testing and treatment, and well-woman exams. The uninsured, women of color and low-income families will be disproportionately affected if the clinics and health centers in their communities can no longer offer the needed care and critical medical information.

ANA firmly believes in universal access to comprehensive and affordable healthcare services for all Americans. The recent moves by the Trump administration fly directly in the face of that goal and represent major steps backward in the effort to ensure that all Americans – especially vulnerable populations such as low-income women and those with pre-existing conditions – have access to all necessary healthcare services. The midterm elections this November are an incredibly important opportunity for ANA’s members to make their voices heard when it comes to determining the future of healthcare in this country. We urge you to make nursing’s voice heard loud and clear by supporting candidates who align with ANA’s principles for health system transformation and who are proven to be advocates for nurses and their patients!

Why Medicaid is More Important Than Ever

  

Too often overlooked in recent debates is the role that Medicaid plays in children’s healthcare coverage. Of the 74 million Americans covered by Medicaid, nearly 36 million are children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) – which was enacted in 1997 to ensure affordable and accessible healthcare coverage for low-income children. Roughly 38 percent of American children receive healthcare services through these two programs, and they have been critical in increasing the percentage of American children with health insurance coverage to a historic high of 95.5 percent in 2016.

Medicaid and CHIP are particularly important to some of the nation’s most vulnerable children – 76 percent of children living in poverty, 48 percent of children with special health needs, and 48.8 percent of children ages three and under are covered under Medicaid and CHIP. Furthermore, 49 percent of births are covered by Medicaid. Without these two programs, millions of children would go without crucial healthcare services, positioning them for a lower quality of life further down the road.

And yet, despite the indubitably positive impacts that these programs have for America’s youngest and most vulnerable, Congressional Republicans and the Trump Administration have repeatedly attempted to scale them back and reduce the number of Americans who receive coverage. Congress voted on several bills in 2017 – all of which failed to pass both chambers – which would have reduced Medicaid eligibility, slashed funding, and imposed caps on state Medicaid programs. Congress also chose to play political football with CHIP, which expired on September 30, 2017, and did not re-authorize the program until January 2018, a full four months after its funding had expired. The Trump Administration has also opened the door for states to impose work requirements on Medicaid recipients. These proposals have all been aimed at low-income Americans, who are burdened enough already as they work to make ends meets.

Reducing coverage to reduce poverty and encourage work is counterintuitive given that Medicaid actually encourages Americans to remain employed, and implementing such proposals would have drastically negative impacts on the nation’s low-income and vulnerable populations. Seventeen percent of American parents receive health insurance coverage through Medicaid; reducing Medicaid eligibility and funding for adults would also reduce coverage for those children whose parents receive coverage through Medicaid. Medicaid also helps to keep millions of Americans out of poverty and out of debt. The burden of this reduction in coverage, meanwhile, would fall equally, and unfairly, on parents and their children.

While CHIP has been fully re-authorized for 10 years and there are currently no legislative proposals to roll back Medicaid coverage that appear close to passage this Congress, it is important to recognize not only during this Medicaid Awareness Month, but all year, the impact the Medicaid has on such a large segment of Americans. ANA continues to support universal access to affordable and accessible healthcare coverage and continues to stress the importance of preventive services. Medicaid and CHIP are some of the most important programs toward achieving those principles, and we urge Congress and the Trump Administration not to jeopardize Medicaid coverage for any Americans.

Congress Passes Bipartisan Spending Measure with Funding for Critical Health Programs

  

Following a brief, overnight government shutdown, President Trump this morning signed a spending measure and continuing resolution which reopens the government and provides funding through March 23rd while setting broad spending levels through FY 2019. The measure provides roughly $500 billion in additional funding over the next two years, including roughly $140 billion in additional non-defense domestic spending, a similar increase in defense spending, and roughly $90 billion in federal relief funding for Puerto Rico, the U.S. Virgin Islands, Texas, and Florida, which were pummeled by devastating hurricanes last summer, and for those impacted by the California wildfires. The bill also waives the debt ceiling until March 1, 2019.

Crucially, the spending bill provides additional funding for some of the nation’s most important public health programs. It provides $7 billion in funding for the nation’s 2,600 community health centers, which provided care to 26.5 million Americans in 2016; this was a critical need and the $7 billion in this bill represents roughly 2 years of federal funding for the nation’s centers.

The spending measure also extends the Children’s Health Insurance Program (CHIP) for another 4 years, meaning that the program will now be fully funded at the federal level for 10 years. CHIP provides healthcare coverage for roughly nine million American children and is a critical provider of healthcare services. The measure also provides an additional $2 billion in funding to the Department of Veterans’ Affairs to better manage their health system and prevents automatic cuts to Medicare and Medicaid, while eliminating the Independent Payment Advisory Board (IPAB). The measure critically provides $6 billion in funding over the next two FYs to fight the opioid epidemic.

With a large portion of the nation’s fiscal policy taken care of, the House and Senate have now cleared their plates to work on a solution to the Deferred Action for Childhood Arrivals Program, better known as DACA. The Trump administration plans on ending the DACA Program on March 5th, giving Congress roughly four weeks to come up with a solution to shield hundreds of thousands of young immigrants from deportation. ANA supports the DACA program and urges the House and Senate to quickly come to an agreement to keep these young Americans in the country. The Senate has already taken up a measure this morning to begin debate on the fate of DACA; ANA will continue to monitor this important issue.

We applaud Congress for coming to a bipartisan, long-term spending deal which ensures that several of the nation’s most important healthcare programs receive long-term funding. CHIP, the nation’s community health centers, and the VA all provide critical healthcare access to some of the nation’s most vulnerable populations, and Congress should be commended for recognizing their importance.

ANA also applauds Congress for providing additional funding to areas hit hard by this summer’s devastating hurricanes and by the wildfires in California; the American Nurses Foundation teamed with the Texas Nurses Association in August to raise donations for victims, and numerous nurses went down to Texas, Florida, and the Caribbean to help out. The spending measure signed into law this morning, however, only provides funding for the government through March 23rd; until then, members of Congress will continue to work to hammer out appropriations for federal agencies and programs for the remainder of FY 2018 and FY 2019. We strongly urge you to make your voices heard and let your member of Congress know that funding for the nation’s healthcare programs is critical to the overall health of the nation.

Photo Credit: Tom Brenner/The New York Times