Hours after being sworn in as president, Donald Trump made good on his promise to repeal Obamacare by issuing an executive order which gives federal agencies the power to limit, delay, or waive provisions which they deem too costly for taxpayers.
This executive order comes after House Speaker Paul Ryan gave his own promise to repeal and replace the Affordable Care Act (ACA) and Senate Republicans’ introduced a budget bill that would collect ideas on how to cut funding from key components of the law. Although GOP lawmakers have promised to smoothly transition out of the ACA, they have refused to propose a replacement and this first step from Trump shows that the transition will be anything but smooth.
As it is written now, this executive order gives federal agencies the space to ease what they deem economic and regulatory burdens for insurers, drug makers, doctors, patients or states. Although federal agencies aren’t necessarily being granted any new powers, they have been given permission to scale back regulations and penalties put into place by the ACA.
Federal agencies could now for example, weaken the individual mandate, which requires individuals to obtain health insurance or pay a tax penalty (with few hardship exemptions). Under this executive order, there is now potential to apply waivers to the mandate or to implement a more lenient interpretation of those hardship exemptions. Bypassing the mandate could cause chaos in the individual insurance market – a highly regulated market that sells health plans to those who don’t have insurance through work or public programs, like Medicaid – by causing a ‘death spiral,’ a cycle of increased premiums and healthy, young folks leaving the market. This would significantly impact the affordability of insurance for people who are chronically ill and older people who do not qualify for public programs.
The order also provides leeway for agencies like the Department of Health & Human Services to limit or eliminate the medical benefits that the ACA required insurers to include in their health plans. Obamacare requires that insurers cover pre-existing conditions, like pregnancy or cancer. If these benefits were eliminated, it would have widespread implications mostly for marginalized communities.
A recent study published in the medical journal Cancer reaffirms that Black women would be among the groups most severely impacted by the repeal of the ACA. The study found that the mortality rates for cervical cancer in the United States are significantly higher for Black women compared to White women, with 10.1 out of every 100,000 Black women dying of the disease compared to 4.7 White women out of every 100,000 – which is considerably higher than previous reports. One way to decrease these numbers is through regular cervical screenings, a preventive service covered by the ACA. The continuous attacks against family planning clinics like Planned Parenthood, which provide these potentially life-saving screenings, and the gutting of Obamacare could increase that mortality rate gap.
The repeal of the ACA would not only impact Black women, but the millions of other people people who have gained health access through the law and will lose coverage. If you want to speak out against the repeal of the Affordable Care Act, you can call or send a postcard to your congressional representatives or House Speaker Ryan.