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Wellness Corner - The Changing Face of Healthcare


The Changing Face of Healthcare


With Donald Trump’s election and the appointment of Dr. Tom Price as Secretary of Health and Human Services, many in healthcare are deeply concerned about what upcoming policy changes may mean for patients (i.e. Americans). I want to review my top concerns for access in the coming years – most are related to a likely repeal of the Affordable Care Act (ACA).

Rolling back the Medicaid expansion means  millions of people will lose health insurance.

One key provision of the ACA was expanded eligibility for Medicaid (in California, Medi-Cal) to Americans under 65 whose annual income fell below 138% of the poverty line ($16,394 per person in 2016) – including previously ineligible childless adults. Currently in California, over 10 million people (26% of our population) have Medi-Cal as their health insurance. If the ACA is repealed, up to 4 million Californians (15 million Americans) will lose their insurance. The Urban Institute’s December 2016 report predicts that if the Medicaid expansion is repealed, California will have 146% more uninsured patients; 82% of these would be working families. This report predicts that newly uninsured patients would seek $1.1 trillion in uncompensated care between 2019-2028. This will put a tremendous strain on state and local resources. Where I work at West County Health Centers, our population used to be 40% uninsured; it is now 6%. Taking away people’s health care coverage is insanity-- for patients, for providers, and for our limited resources.

Repealing the ACA threatens access to birth control.

The ACA does not specifically protect birth control; however, it requires coverage of “all preventive health benefits for women” and allows the Secretary of HHS to interpret the scope. In 2011, the Obama administration issued regulations that birth control be considered a “preventive health benefit”, thereby ensuring no-cost contraception for all women. Since that time, insurance companies have been required to offer no-cost birth control. The new administration has every right to reinterpret this language and revoke women’s current access to birth control – they have already hinted they will do just this. Fortunately, in California, state law ensures access, but millions of women across the country are likely to be less fortunate.

Preventive health care will be deprioritized.

Currently, evidence-based preventive health care benefits are required to be no-cost to all Americans. These include (among others): mammograms, pap smears, colon cancer screenings, immunizations, domestic violence counseling, well child visits, and prenatal care. If ACA is repealed, there is no guarantee these services would be protected. We know that many of these interventions are cheap, easy, and literally save lives. We must advocate for continued coverage of prevention for all Americans.

Less protection (and more cost) for people with pre-existing conditions.

The ACA prohibits insurers from denying health insurance coverage due to pre-existing conditions via two provisions: guaranteed issue (insurance companies have to accept everyone who applies) and community rating (everyone has to be charged the same price). In fact, the individual mandate was created as a means to be able to pay for this coverage. While Trump and his colleagues have intimated they can ensure Americans with pre-existing conditions would still have access to health insurance, they have not been specific about how they will make this happen. Trump has hinted that he would reinstate state-based “high risk pools”, which were previously failures in many states, often due to underfunding.

Substance abuse and addiction treatment may be cut.

Another important provision of the ACA ensured coverage for substance abuse treatment. California was the first state to receive a special waiver from the federal government enabling spending flexibility in helping people get and stay sober. Changes include access to reimbursable inpatient stays (up to two 90-day stays) for Medi-Cal patients – an estimated 14% of people on Medi-Cal have substance abuse disorders – and the pairing of mental health services with substance abuse disorders. It sure would be a shame to see these advances disappear with the new administration.

A woman’s right to choose is under threat.

Roe vs. Wade was upheld in 1973 by the Supreme Court, confirming a woman’s right to make a choice regarding abortion; the 1992 decision in Planned Parenthood vs. Casey said states can create restrictions as long as they don’t place “an undue burden” on a women seeking an abortion. Ever since, there have been dogged attacks and trap rules enacted to restrict women from having real access. Many states require waiting periods, others require women see an ultrasound image, others require physicians to tell lies (e.g. that having an abortion increases your risk of breast cancer). Since 2010, 70 abortion clinics have been closed, and four states each have only one place in the entire state to get an abortion. Congress is already looking to cut funding to Planned Parenthood, and vacant seats on the Supreme Court could pose a real threat to the rights guaranteed by Roe vs. Wade. 

These are serious concerns, my dear fellow humans. The ACA isn’t perfect but it has some really wonderful provisions. We must raise our voices, write, and advocate loudly for progress forward for healthcare for all. Consider joining a group like California Health+ Advocates to help advance this urgent cause.