Trump on the ACA

In one of Donald Trump’s first executive orders of his presidency, his instructions make it apparent that the dismantling of the controversial Affordable Care Act, widely known as Obamacare, has begun.

Trump urged the Department of Health and Human Services (HHS) and other federal agencies to “exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay” any sections of the law that cause states, consumers, or providers financial hardship. This week, his administration is working with members of Congress on specifics to replace Obamacare. His advisor, Kellyanne Conway, shared on Sunday that one possible solution is a “block grant” program to allow for Medicaid programs that are designed by each state.

Most policy makers agree that the new president will target the individual mandate. The mandate – a requirement that everyone purchase health insurance coverage or be penalized by a tax – has been one of the most hotly debated portions of the law.

Rep. Tom Price, Trump’s choice for secretary of the HHS will have the technical power to reduce the reach of the mandate. Sylvia Mathews Burwell, the current secretary nominated in by Obama in 2014, has granted hardship exemptions to consumers whose earnings were less than 138 percent of the federal poverty level.  Exemptions were also available to people with extenuating life circumstances, such as domestic violence and homelessness.  During his confirmation hearing this week, Price refused to  promise that consumers would not lose their coverage, instead saying he would “make certain that we have the highest-quality health care and that every single American has access to affordable coverage.”

A Harvard Medical School study published this week in the Annals of Internal Medicine, reported that despite the ACA’s expansion Medicaid expansion in some states, many poor Americans with chronic illness were unable to gain coverage in states where there was no expansion. A shortage of physicians in some states was also a factor.  A lack of cancer care was a key finding in another study released by Georgetown University in their research of the Medicaid program in the state of New York. There, it was found that African American and Hispanic patient’s access to cancer care did not change after Obamacare, despite an expansion in Medicaid.