Future of health care uncertain under Trump administration

Demonstrators hold signs relating to women’s health during the Women’s March on the Iowa Capitol in Des Moines on Jan. 21.

Brandon Ghazali

As with every new administration, there are many questions that Americans are asking regarding the nation’s future under President Donald Trump.

One of the most prevalent questions is about the current state of the American health care system.

A prominent part of Trump’s campaign was his promise to repeal former President Barack Obama’s health care law. To begin fulfilling that promise, Trump signed an executive order Friday night initiating a freeze on any new “Obamacare” regulations.

The action, one of Trump’s first from the Oval Office, sets into motion efforts to repeal and replace the Affordable Care Act, which has been a goal for Republicans on Capitol Hill since the law’s inception.

The act has been a controversial issue in Washington and throughout the country since it was signed into law by Obama in 2010. 49 percent of Americans favor the law, while 47 percent oppose it, according to a CNN/ORC poll released earlier this month.

Obama’s signature health care law has been touted by Democrats for numerous reasons. One is that it requires insurance plans to cover 10 essential health benefits, including coverage of maternity care, mental health and chronic diseases.

While this has the possibility of creating better plans that allow people to receive better preventative care, many have argued that people have had their plans cancelled by insurance companies because they don’t meet the requirements. The cost of replacing these plans is higher because people may be paying more for services they don’t use.

Other key benefits of the Affordable Care Act include an expansion of Medicaid that covers more low-income Americans and a mandate that prevents insurance companies from denying coverage for those with pre-existing conditions.

Perhaps the biggest criticism of the act is the fact that it is mandated. People are required to have health insurance, and if they don’t, they are assessed additional taxes on their income.

Sen. Rand Paul, R-Kentucky, released some details of his proposed replacement plan for the Affordable Care Act, including “getting rid of the Obamacare mandates” on insurance plans, which supporters say will lower costs for people who don’t need the robust plans offered through the Affordable Care Act.

Paul’s plan left some unanswered questions, including what effects it would have on Medicare. He told CNN’s Wolf Blitzer last Monday that it would be up to the states to decide whether to foot the bill.

Possible replacement plans from Trump are unclear. In an interview on Jan. 14 with The Washington Post, Trump said his plan would include “insurance for everybody,” but he declined to offer more specific details at that time.

Steffen Schmidt, university professor of political science, believes repealing the act without a concrete replacement plan is a risk for Republicans on the Hill. He said people often forget that there are elections every two years where Republicans have been promising constituents they would “kill” the act.

“The political part of it always comes into play,” Schmidt said.

Speaking of the roughly 18 million Americans who gained coverage thanks to the Affordable Care Act, Schmidt said they would “fall into a hole” without a substitute for their insurance, which would disappear if the Affordable Care Act is repealed.

Schmidt stressed that the United States doesn’t have a government health care program.

“Obamacare is just a law that says you need to get health insurance and insurance companies have to come up with good insurance plans,” Schmidt said. “The whole thing is run by the private sector.”

Schmidt also believes that health providers will feel the effects of a repeal without a replacement.

“The whole industry that provides health services would be in turmoil because they don’t know what the next thing is, and they’ve spent a lot of time trying to make it work with this plan,” Schmidt said.

Schmidt also addressed the privatization of Medicaid, which happened last April when three for-profit companies took over management of the $4 billion program.

“We shifted all these people from a state-run Medicaid program to one that is delivered by companies that are questionable and have had all kinds of legal problems,” he said.

He said because doctors in Iowa are not reimbursed well by the state, many are not accepting patients who get their coverage from Medicaid.

Another health care issue in Iowa is a recent bill proposed in the Republican-majority Legislature that would cut public funding to Planned Parenthood and any clinics that provide abortion services.

Abortions made up 2.5 percent of services offered by Planned Parenthood of the Heartland, which serves Iowa, in 2015, according to the fiscal report for that year. Contraception accounted for half of the services provided.

Iowa lawmakers who support the bill said that if it passes, family planning money would be given to family planning clinics that don’t offer abortion services.

While Democrats and Planned Parenthood supporters argue that public funds aren’t used for abortions, Republicans and pro-life advocates contend that it helps to pay overhead costs, indirectly subsidizing abortions.

Planned Parenthood said that without the state and federal funding that accounts for nearly a fourth of its financing in Iowa, many people would lose access to birth control and services such as cancer screenings and testing for sexually transmitted diseases.

Rachel Lopez, Planned Parenthood of the Heartland spokeswoman, said other clinics in Iowa don’t offer the same level of care and services, and they may not be prepared to absorb the large number of patients should Planned Parenthood lose public funding.

Abortion is another divisive subject in the United States, and it was a major issue for those who took part in organized marches Saturday.

While an unexpected high turnout of about 26,000 people marched for women’s rights in Des Moines, Iowa State alumna Ayla Heder took part in the Women’s March in Washington, D.C., and offered her thoughts on women’s rights to health care.

Heder, who is currently pursuing a master’s degree in public health from Des Moines University, said she had been planning to visit a friend in D.C. and decided to take the trip during the inauguration weekend.

Heder believes that while the Affordable Care Act has its problems, it has allowed more citizens access to health care.

“Overall, preventative services from a public health and economic perspective are very important for sustaining health care costs and other expenses,” she said.

Heder said the range of preventative services, such as contraceptive care, offered by Planned Parenthood makes it “one of the largest providers of women’s health” outside of traditional clinics and hospitals.

“It’s so important for places like Planned Parenthood to stay funded to give women access to preventative services like cancer screenings and mammograms,” Heder said.

Heder said the march was “intersectional and inclusive” to all issues and that women’s rights to contraceptives and preventative services were key among them.

Heder said she hopes Trump and Republicans in Congress will try to still provide health care access to people regardless of their ability to pay for it and continue to make preventative care a requirement.

“The Affordable Care Act was a step in the right direction to give people more care, because if people have access to preventative services, it’s going to decrease costs in the long run,” she said.

Trump remains untested as the country’s leader, and it is too early to judge what health care will look like during his administration’s time in the White House. Indeed, we won’t know exactly what will replace current health care policies until Trump and Republicans in Congress release a comprehensive plan.

While promises of “inexpensive care for all” are easy to make, the notions of lowering costs while increasing health care coverage have always conflicted with each other.

In the coming weeks, lawmakers on all levels will debate how Americans will access health care.

“There are many things that can and should be fixed,” Schmidt said. “And there is on the other hand doing away with [the Affordable Care Act] completely, which is a very drastic step, and there’s now a lot of nervousness about it.”

The 2016 election was divisive experience for Americans, who chose between two vastly different candidates. It seems fitting that the duality in politics continues today as the newly-elected president’s first priority of health care reform mirrors that of his predecessor, albeit with different objectives.