Metro Weekly

Trump’s ACA executive order could undermine LGBTQ health care

Trump's move could leave transgender people and those living with HIV facing extortionate costs

Photo: National Cancer Institute, via Wikimedia.

President Trump has signed an executive order giving federal agencies leeway to relax or repeal regulations governing health care plans under the Affordable Care Act, a move that could impact LGBTQ-specific health care

While the executive order does not detail which specific rules must be amended or repealed, it allows agencies charged with enforcing the ACA to potentially eliminate certain requirements if their leadership believes them to be overly “burdensome,” reports The Washington Post.

“Trump’s executive order is nothing more than a cynical attempt to sabotage the Affordable Care Act,” David Stacy, the government affairs director for the Human Rights Campaign, said in a statement. “Beyond undermining the ACA, President Trump’s order will put LGBTQ Americans at risk through substandard health plans that exclude essential health benefits and protections for those with pre-existing conditions and increase premiums for those remaining in other plans.”

Trump and Republicans have long maintained that the ACA’s requirements that all health care plans meet certain standards or provide a certain degree of care are harmful to businesses and have resulted in higher premiums for those who are healthy.

But critics argue that relaxing regulations will incentivize insurance companies to create thousands of “junk plans” that purport to provide coverage but leave consumers having to bear the burden of excessive out-of-pocket costs.

Still others may find their treatments for pre-existing conditions denied, even though such plans claim to not discriminate against individuals based on their past medical history.

For LGBTQ people, any reduction of the ACA’s quality-of-care or pre-existing condition requirements is highly problematic.

LGBTQ Americans specifically benefitted from the coverage provided by the ACA, with the percentage of LGBTQ adults without insurance falling from 28% to 11% between June 2013 and March 2015, when the ACA was implemented.

Other LGBTQ Americans, including many of those living with HIV, benefit from Medicaid, which Trump has promised to restructure, with the help of Congress, into a “block grant” format.

Under that format, the federal government would allot only a certain amount of money to states to help cover low-income Americans, lessening the program’s flexibility. According to the Kaiser Institute, Medicaid spending on HIV accounts for 30% of all federal spending on HIV care.

Yet another provision of the ACA that could be changed — and likely would be, given the vocal opposition of people like Roger Severino, director of the Office of Civil Rights at the Department of Health and Human Services — is a nondiscrimination provision that prohibits discrimination on the basis of “race, color, national origin, sex, age, or disability.”

It has been used to ensure that transgender people are not denied coverage for medical procedures or treatments based solely on their gender identity.

Under the Trump administration, it is conceivable that insurers would be allowed to once again deny hormones or gender confirmation surgery to transgender people under the guise that such treatments are “cosmetic,” even if a doctor deems them medically necessary.

LGBTQ advocacy groups wasted no time blasting the president’s actions.

“President Trump is working to sabotage the Affordable Care Act in any way possible; showing complete disregard for the health and well-being of millions of Americans, including many in the LGBTQ community, who rely on the ACA for coverage,” Sarah Kate Ellis, the president and CEO of GLAAD, said in a statement.

Ellis also noted that, even prior to the president’s executive order, the Trump administration had been working to undermine the law through various actions. Those actions include shortening the open enrollment period for people seeking to purchase individual insurance coverage, shutting down the Healthcare.gov website on which to purchase that coverage for 12 hours on all Sundays except the last one during open enrollment period, and cutting the budget for health insurance “navigators” who had been trying to help low-income Americans who might qualify for subsidies under the ACA sign up for the program.

Specifically, by relaxing standards on the quality of care that insurers must provide in all plans — or the requirement that 80 percent of consumers’ premiums must go to actual care rather than overhead costs — critics say that the order could undermine the entire health care market by allowing those who are younger or healthy to buy substandard plans that cost significantly less.

Unfortunately, when healthier people leave the marketplace or sign up for cheaper plans, those with pre-existing conditions, who require higher-quality plans (so as not to go bankrupt) are left in a much smaller pool of consumers.

Due to the size of the pool, and the health care that such people will consume, the laws of supply-and-demand will force people in that smaller group to pay higher premiums or out-of-pocket costs.

If the increases in costs of care eventually begin outstripping the amount of dollars coming into the system (via premiums), even those with severe illnesses and life-threatening pre-existing conditions will eventually be unable to afford care, creating an insurance “death spiral.” This could even lead some smaller insurers to go out of business completely.

“Healthcare is a human right,” Ellis said, “and now more than ever we must keep fighting to protect our care and demand the inclusive and affordable healthcare that the LGBTQ community, and all Americans, deserve to live and thrive.”

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John Riley is the local news reporter for Metro Weekly. He can be reached at jriley@metroweekly.com