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Health Rising generally stays as far away from politics as possible. While one side of the political realm may at times offer more for chronic fatigue syndrome (ME/CFS), fibromyalgia, and chronic pain patients, the difference is rarely dramatic enough for Health Rising – a largely donor-supported organization – to tread into these rather treacherous waters of supporting one party over the other.

This time I think it’s different.  This time the potential exists for major changes to the availability and affordability of health care. So putting aside all other aspects of the Trump administration, and trying to avoid the hyper-partisan environment that prevails today in the U.S., below are some actions to consider when voting in the upcoming election.

The Nov. 6 election will determine which parties control the Senate and the House.

Affordable Care Act

“We’ve mostly obliterated Obamacare” President Trump

Evisceration of the Affordable Care Act (ACA) – Attempts to overturn the ACA began almost immediately after it passed in 2010 but over time a majority of Americans have come to support it. The ACA was never perfect; indeed, it was impossible that such a complex act would not run into problems expected and unexpected over time.

Affordable care act

Changes to the Affordable Care Act are reducing access to affordable health care for many.

Rates were clearly much too high for some, but the benefits, particularly for those with two issues rife in the ME/CFS and FM populations – pre-existing conditions and lower incomes – were substantial. Government subsidies and regulations allowed me, for instance, for the first time in years to get excellent health insurance at an affordable price.

The Trump administration has made the evisceration of the ACA a top goal. Recently, President Trump has said he has “mostly obliterated Obamacare”, “essentially gutted” the law and that “Obamacare is finished. It’s dead. It’s gone.”  No longer is there talk of repeal and replace – the focus now is simply on getting rid of the law. The Trump administration’s actions have not been wholly negative. At least in one case, a change made appears to have increased access to health insurance in some states.

Despite attempts to weaken the ACA, enrollments have held steady and premiums are down this year – in some states dramatically.  Plus health care costs are growing at a lower rate than before the Act was passed and per-person Medicare costs have actually declined. Plus after having problems with insurers dropping out of the market this year, a substantial number of insurers are actually joining the market this year. Problems obviously exist with the marketplace – for some deductibles are sky-high, drug prices can be exorbitant, etc. but the exchanges themselves are thriving.

Strengthening the ACA

Reinsurance Plans Help – The Trump administration has allowed reinsurance plans which allow the states to pay the largest claims with a combination of state and federal funds – an option which some states say has been very helpful – and has led to lower rates.

Hobbling the ACA

Unfortunately, the Administration and its Republican allies have made many changes which are resulting in decreased access to medical care.

Stopped Government Cost-Sharing Subsidy Payments – In October 2017, just as state officials were approving the final rates for 2018, the Trump administration suddenly stopped “cost-sharing” subsidy payments that helped lower co-pays and deductibles for people with modest incomes.

Dropped Core Revenue Source – The penalties for not having health insurance are now gone. There’s no way around the fact that health care is so expensive that the health care of people with illnesses needs to be subsidized.  Requiring healthy people to have health insurance was perhaps the easiest (and most controversial) way to do that.  it requires that healthy people bear an extra burden now with the knowledge that when they become sick – as they inevitably will – they will be covered. The fact that the healthy people are not now required to have insurance shifts the burden back to those least able to afford it – the chronically ill.

reduction subsidies

The removal of federal subsidies will primarily affect low income residents.

Attempt to Invalidate Protections for Those With Pre-existing Conditions – The Trump administration joined a court effort to invalidate protections afforded to those with pre-existing conditions. If this effort succeeds, insurance companies will be free, once again, to raise rates for those with pre-existing conditions and/or not provide coverage for them.  The Department of Health and Human Services estimated in January 2017 that 133 million Americans have conditions that could lead to their being denied insurance, or being offered insurance rates with exorbitant prices,

Offers “Junk” Insurance Plans – The Trump administration is allowing states to offer cheaper short-term insurance plans that are not required to cover pre-existing conditions or provide essential health benefits like maternity care, prescription drugs, mental health, etc.  While these plans – sometimes called “junk” insurance plans – are cheaper, they will likely quickly lead to bankruptcy if any serious illnesses are encountered.  Under some of these plans, being pregnant at the time of sign-up constitutes a “pre-existing condition” which is not covered.

Allowed States to Institute Work Provisions for Medicaid – For the first time, the Trump administration is allowing states to institute work requirements for Medicaid recipients, and apply for waivers which reduce the time participants are allowed on Medicaid, allow for drug testing to determine eligibility, etc.

Proposed Allowing Small Businesses to Band Together to Buy Health Insurance – At first blush, allowing small businesses to band together to achieve lower rates is an excellent idea but, because this effort occurs outside the Affordable Care Act, it will likely enroll healthy individuals who would otherwise have participated in the Act, leaving the ACA burdened with more ill people – increasing premiums and further destabilizing the Act. Because small businesses will be able to offer less bountiful plans than the ACA, their employees may also suffer when faced with illness.

Stopped Insurer Reviews – The Trump administration pulled back on reviews to determine whether insurers have enough doctors and hospitals in their networks to provide for their participants.

Cut Back Funding for ACA Promotion and the Time Period for Enrollment – In an effort to undercut the law, the Trump Administration vastly cut back funding for advertising and reduced the time period to enroll in the ACA.

Other Health-Related Changes

drug prices

It hasn’t happened yet, but the Trump administration is attempting to reduce drug costs.

Reduce Drug Costs – on a brighter note, the Trump administration is attempting to find a way to reduce drug costs. Its latest gambit – to tie Medicare drug prices to those found overseas in developed countries – could help. Plus, the Administration is attempting to reduce drug costs for people on Medicare B – a program which covers a large swath of the population. Give the Trump administration credit here.

An Attempt to Stop Requiring Hospitals to Report Infections – The Trump administration produced a rule to stop federal regulators from reporting on infection rates at hospitals. (In-hospital infections affect about 600,000 people a year.) The administration eventually backtracked on this proposed rule change.

Impede Cannabis Research and Availability – Cannabis presents opportunities to people with chronic pain  and sleep problems. Besides symptom relief, several studies suggest medical marijuana results in significant drops in prescription opioid drug usehospitalizations, and even deaths due to opioid drugs as users switch to the safer drug. Support for medical marijuana and legalization is higher than ever.

Trump’s attorney general, Jeff Sessions, rolled back Obama-era rules which assured states that federal prosecutors were not going to spend time and money going after marijuana users, producers and providers in states that legalized marijuana. Under opposition, the Trump administration rescinded its rollback but is still blocking efforts to increase cannabis research – efforts that could result in more effective pain drugs.

The Trump administration formed a  “Marijuana Policy Coordination Committee” which asked federal agencies to provide “data demonstrating the most significant negative trends” about marijuana and the “threats” it poses to the nation.

The Trump administration has also produced new rules to undercut the financial capabilities of cannabis-related businesses. A new rule prohibits banks from using Small Business Administration (SBA) backed loans from financing any business that directly or indirectly interacts with the marijuana industry. Such a rule could apply to a garden supply company which sells potting supplies or fertilizer to a marijuana grower.

GOP tax cut

The 2017 GOP tax bill did help out corporations and the wealthy but at the cost of a soaring deficit which has prompted calls for cutbacks in health- related programs and the social safety net that chronically ill people may rely on.

Mismanagement of the Veterans Administration –  One of the largest governmental organizations, the Veterans Administration employs almost 400,000 people and its budget runs to almost 300 billion a year.

The Trump administration attempted to replace the head of the VA as the VA was in the midst of a mind-bogglingly complex transition – with Ronny Jackson, his White House doctor – a man who had no experience running even mid-level organizations. Despite his lack of experience, Trump called Jackson “highly trained and qualified”.  Allegations of misconduct torpedoed Jackson and he is no longer Physician to the President…

NIH Funding Cuts – The Trump administration has three times attempted to drastically cut funding for medical research, twice through budgetary proposals and once through an administrative change. Thankfully, both Republicans and Democrats resisted the cutbacks, but they reflected an administration which places little value on medical research.

2017 GOP Tax Bill – The GOP’s tax bill primarily cut taxes for corporations and the wealthy. While a corporate tax cut was probably in order, the bill raised the federal deficit dramatically – resulting, as opponents suggested it would – in Republican calls to cut Medicare, Medicaid and Social Security – three programs people with low income, the disabled and the elderly depend on.

The massive increases in the deficit resulting from the tax bill will surely put pressure on Congress to reduce spending levels for medical research and health care.

Instead of investing in more equipment or research, or increasing wages, corporations used their tax windfalls mostly to buy back stock options – and reward their investors. Wage growth has been mostly unaffected.

Conclusion

While a few benefits have occurred, for the most part Republican control of the Presidency and both houses of Congress has resulted in reductions in support for the chronically ill. Exploding deficits have already resulted in calls to cut back support for people who are ill and/or have low incomes.  Attempts to reduce protections for those with pre-existing illnesses are hard to understand.

More of the same is likely to come, however, if one party continues to control all three branches of government. Joint control of Congress would hopefully force the kind of bipartisanship John McCain asserted in his last days is missing today in the U.S. and is needed to solve the complex health care problems facing the U.S.

 

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