This year, Congressional Republicans repeatedly failed to repeal and replace the signature healthcare law of former U.S. President Barack Obama (aka. the Affordable Care Act or Obamacare), so yesterday and today, U.S. President Donald Trump signed an executive order and made an additional announcement later in the day that effectively hobble the law. Here’s a quick explainer of Trump’s Obamacare plans and how it will affect LGBTQ people.
Expanding short-term and “association” healthcare plans
His Thursday executive order directed federal agencies to look for ways to expand short-term insurance and “association health plans” (when many small businesses join together to purchase healthcare). Both types are exempt from the rules and requirements of Obama’s healthcare law and would allow the sale of “cheaper policies with fewer benefits and fewer protections for consumers, according to The New York Times.
If employers, self-employed people and other individuals are free to buy these short-term and “association” healthcare plans, Larry Levitt of the Kaiser Family Foundation told Vox.com that Trump’s Obamacare plans could result in the Obamacare marketplace having fewer plans with higher prices:
The clear intent of the executive order is to create a parallel insurance market exempt from many of the consumer protections in the Affordable Care Act. This has the potential to siphon off healthy people with skinnier benefits and cheaper premiums, leaving behind a sicker pool of people under ACA plans.
The New York Times adds that “association plans have a troubled history” because they can skirt state regulations requiring insurers to be financially solvent, leaving some association providers unable to pay bills when their buyers get sick.
Ending subsidy payments for low-income people
His additional announcement said that the federal government will stop paying subsidies meant to help reduce the out-of-pocket healthcare costs for poorer citizens. The government was expected to pay $9 billion for the subsidies over the next year and $100 billion for them over the next year.
Congress could step in and pass a bill to continue the subsidy payments, but it’s unclear whether they will. Healthcare analysts say that both of Trump’s recent moves will likely result in lawsuits from insurers who had invested millions to comply with Obamacare’s rules and state attorneys general who say that the subsidies are fully authorized (and guaranteed) by federal law.
How Trump’s Obamacare plans may hurt LGBTQ people
Trump’s executive orders are just instructions to his cabinet secretaries to carry out his wishes, so any changes won’t likely take place immediately. In fact, we might not even see any notable policy changes until 2019.
However, as we have explained in the past, if the Obamacare marketplace is left with more expensive plans without subsidies to help low-income people afford them and if the new association and short-term plans don’t cover things like PrEP — HIV-prevention medication — or medical treatments for HIV, the poorest and sickest LGBTQ people will be harmed, and Trump will be directly to blame.