Trump's steady erosion of health insurance protections

Abstract

43% of US households report that at least one family member has a pre-existing medical condition, according to a survey released by Gallup on Dec 6, 2019. 49% of Americans (156 million people) receive health insurance through employers, and before the 2010 Affordable Care Act (ACA), a change of situation, such as losing or switching a job, would have allowed insurance companies to decline coverage or potentially make people uninsurable because of chronic health conditions. Although Democrats and Republicans both argue that they support the ACA ban on pre-existing condition denials, in power, Republicans have actively (but so far unsuccessfully) worked to repeal the ACA without providing an alternative. President Donald Trump has, however, in ways large and small, managed to chip away at those protections. Trump has extended the length of cheap, short-term health insurance plans from 3 months to 1 year. Those plans do not meet the standards of insurance in the ACA, including requirements to cover pre-existing conditions. On average, these plans pay less than 40% of premiums towards medical care, versus a minimum of 80% for ACA-compliant plans. In 2019, Trump slashed the budget for ACA enrolment outreach by 90%, although nearly 5 million of the 27·5 million remaining uninsured people (10% of the non-elderly population) would be eligible for health-care plans that include all ACA-mandated coverage with no monthly premium. The ban on pre-existing condition clauses in insurance has become a central tenet of all debates on health care in the USA, something every politician must claim to support, even if they act against it. Trump's efforts to erode ACA protections will lead to poorer health and higher health-care costs. In addition to numerous states that still refuse to accept the Medicaid expansion, Trump's touting of short-term health insurance plans that offer scant medical coverage at greatly reduced prices will draw younger, healthier people away from insurance pools and make insurance coverage more expensive. The ACA has proven resilient to major changes, but the minor changes continue to pile up, and their impact will continue to be felt with every denied claim.