Trump Issues Executive Order to Reverse Federal Agency ACA Policies

Main Digest

Two weeks before the healthcare insurance enrollment period for 2017 ends, President Trump decided not to wait for Congress "Repeal and Replace the ACA" bills that will be making their way through the Senate and the House of Representatives over the next several months. In his first day in office, he signed an executive order instructing federal agencies to decrease economic burden of any policies and regulations that impact the constituencies of the Affordable Care Act (ACA).

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Those constituencies include physicians, hospitals, other providers, insurance and drug companies and consumers. "Latinos are the consumers who will be impacted the most since they continue to have the highest rates of uninsured," commented Dr. Elena Rios, president and CEO of the National Hispanic Medical Association, and they should continue to apply for insurance at www.healthcare.gov until Jan. 31st.

According to the Kaiser Family Foundation, after the ACA became law, between 2013 and 2015, the uninsured rate for Hispanics fell from 26 percent to 17 percent - a sharper decline than for any other group. Nationally, the total number of uninsured less than 65 years old fell from 41.1 million to 28.5 million, reducing the overall uninsured rate from 15 percent to a historic low of 10 percent over the period.

Historically, Hispanics (now the largest ethnic group at 54 million or 17% of the US population) have had less access to healthcare due to having the highest rates of uninsured, living in mostly urban medically underserved areas with few physicians and healthcare services, and face limited culturally competent and language services in healthcare facilities. Hispanics also live in low income areas which tend to have food deserts without fresh fruits and vegetables, poor air and water quality that impact on asthma and lead poisoning, and face greater rates of mental illness.

The impact of the Trump executive order could be a major roll back of the individual mandate which requires Americans to buy insurance or pay a penalty, which would create chaos in the individual insurance market. But since insurance companies do not decide on rates and participation in the health exchanges until spring for 2018, there will not be much change this year in the insurance market. Next year, however, as healthy persons opt out from buying health care insurance, leaving the pool with increased sick persons, could increase insurance premiums. Thus, there is a need for Federal subsidies for the insured to continue to have affordable access to insurance.

Another impact of the executive order could be the elimination of the set of essential benefits under healthcare insurance plans that includes mental health and prevention services which are needed by our communities. We would need increased support of federal programs for Hispanic and other minority health communities in urban and rural underserved areas and safety net funding for hospitals, clinics and physician practices. Yet another impact expected from this executive order is the decrease in Medicaid services for the poor as State waivers are allowed to be more flexible and not meet the 138 percent of poverty of the ACA coverage level and adding more to the individual insurance market.

Last week, the Congressional Budget Office published a report with its estimate of what would happen under a law that eliminated the mandate and some other provisions: 18 million people would lose their insurance next year alone. NHMA will continue to work with policymakers on health care reform and its impact to our communities.

National Hispanic Medical Association (NHMA) is nonprofit association with physicians committed to improving the health of Hispanics in the U.S. www.nhmamd.org

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