Repealing and replacing the Affordable Care Act has been considered the new Trump administration’s top priority. But you wouldn’t know that from the new president’s earliest actions.
President Donald Trump’s brief inaugural address mentioned many of the issues he raised repeatedly on the campaign trail — jobs, immigration and trade policy. But there was not even a brief mention of his plans to improve health care.
The new White House website was similarly silent on anything health related. Under the “issues” section it includes energy, foreign policy, jobs, the military, law enforcement and trade. But no health section.
The website for the Department of Health and Human Services, however, while scrubbed of any outgoing Obama administration personnel, still features ways to sign up for coverage under the Affordable Care Act. Open enrollment continues until the end of the month.
Trump voters in Washington for the inauguration didn’t seem fazed by the lack of attention to the issue, however.Use Our Content This KHN story can be republished for free (details).
“I believe he’s going to make a difference when he changes Obamacare into something new and better,” said Kim Traffanstedt of Plant City, Fla. “With all the ideas they’ve been working on now for a while, it’s going to make a difference to a lot of people.”
“I think there is a specific plan, he just hasn’t revealed it yet,” said Kathy Bohn of Bloomington, Ill.
As recently as last week, Trump told The Washington Post that he was putting finishing touches on a health plan that would guarantee “insurance for everybody.”
Those comments, however, were quickly walked back by staff. Meanwhile, progress on the nomination of Trump’s choice to lead HHS, Rep. Tom Price, R-Ga., has been slowed by allegations of conflicts of interest involving his ownership of stocks in health companies while he served on congressional committees overseeing health issues.
Congress has already taken the first step toward overhauling the Affordable Care Act. Both the House and Senate passed a budget resolution that orders committees to begin writing bills that would eliminate portions of the law that directly affect the budget.
But even while that bill (which has yet to be written) could pass the Senate with a 51-vote majority, Republicans have only 52 seats in the Senate and more than a half dozen senators have expressed reservations about repealing the law without an immediate replacement.
House and Senate Republicans are scheduled to discuss the matter in more depth next week at their retreat in Philadelphia. Trump and Vice President Mike Pence are scheduled to attend.
Kaiser Health News reporter Rachel Bluth contributed to this article.
Should gun owners have to share information with health professionals about their firearms and whether they’re stored safely at home? This controversial issue gets a nod in the federal health law.
Tucked into the Affordable Care Act is a section that protects people from having to disclose information about guns they own to wellness programs and prohibits federal health law officials from collecting and keeping records about it. Insurers can’t factor gun ownership into health insurance premiums either under this section of the law. So gun owners may want to pay attention to the debate on revising Obamacare.
But the law doesn’t address an area of greater concern to both gun owners and physicians: whether it’s good practice for doctors to ask patients about gun access, storage and use to prevent people, including children, from hurting themselves and others.Insuring Your Health
KHN contributing columnist Michelle Andrews writes the series Insuring Your Health, which explores health care coverage and costs.
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This KHN story can be republished for free (details).
“Currently there is no federal or state law that limits doctors ability to ask or counsel,” said Dr. Marian Betz, an associate professor of emergency medicine at the University of Colorado, who co-authored a study published last year in the Annals of Internal Medicine that examined federal and state laws regulating physician-patient communication about guns.
Research isn’t conclusive on the impact of these conversations, but it suggests they can be important. One study found, for example, that when pediatricians talked with parents about guns, it led to safer gun storage practices, while another found that when psychiatrists counseled parents of suicidal adolescents about gun safety, they locked up guns that were in the home.
Some states have imposed restrictions on gun-related information that patients must provide or that can be collected by providers and state officials. The most notable is Florida, which in 2011 passed the so-called “Docs vs. Glocks” law that generally prohibited doctors from asking patients if they had a gun at home.
The law was found unconstitutional, then that decision was overturned by a divided three-judge panel of the 11th U.S. Circuit Court of Appeals in Atlanta. The full appeals court in turn vacated that decision and heard oral arguments last year, but has yet to rule. In the meantime, the Florida law has not gone into effect.
The health law provisions were reportedly inserted into the law by then Senate Majority Leader Harry Reid, D-Nev., to mollify gun owners, who were worried that the law would be used to create a registry of gun owners or charge them more for coverage.
The National Rifle Association didn’t respond to a request for comment about potential repeal of the health law provisions.
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Lawmakers in Sacramento have halted a first-in-the-nation effort by California to expand access to health coverage for immigrants living in the state without legal documents.
At the behest of the state Legislature, Covered California, the state’s insurance exchange, withdrew its request to sell unsubsidized health plans to people who are here illegally. The withdrawal was first reported by the Sacramento Bee.
Under the Affordable Care Act, people who cannot prove they are in the country legally are barred from purchasing coverage on the exchange.
Immigrants in this situation had pinned their hopes on the state’s request for an exemption from that rule, submitted last fall to the federal government. Had it been approved, undocumented Californians would have been allowed to buy Covered California plans and join the roughly 1.3 million other people currently enrolled in the exchange.Use Our Content This story can be republished for free (details).
The effort to give undocumented immigrants access to the state exchange was spearheaded by state Sen. Ricardo Lara (D-Bell Gardens) and other Democrats. They passed legislation last year and Gov. Jerry Brown signed the measure in June. It authorized Covered California to submit an application to federal officials to waive the ban on such sales.
But the chances of federal approval dimmed considerably with the election of Donald Trump, who has pledged to deport immigrants in the country without official papers, and to repeal the Affordable Care Act.
Peter Lee, executive director of Covered California, declined to comment on the withdrawal of the state’s request for the waiver. He referred to a letter the exchange sent Wednesday to the Obama administration, which said the proposal was shelved at the request of Lara.
Lara said in a written statement that he was withdrawing the plan because he feared the Trump administration might use information gleaned from it for the purpose of deporting undocumented immigrants.
The plan to sell to undocumented immigrants is “the first California casualty of the Trump presidency,” Lara wrote. “I take Trump at his words that anyone is subject to deportation at any time, and California will not be part of a wasteful and inhumane campaign against immigrants who are working hard and playing by the rules.”
The decision to pull the plug on the plan comes as the future of health care for millions of Californians hangs in the balance, with Republican leaders in Washington, D.C. moving to repeal the main provisions of the Affordable Care Act.
Anthony Wright, executive director of the consumer advocacy group Health Access California, said California’s move reflects a reorganization of priorities. What is urgent now, he said, is to preserve the current gains in Californians’ health coverage. And in order to bring undocumented immigrants into Covered California, officials must first ensure the exchange survives, Wright explained.
“We didn’t want this waiver request, which was almost assuredly going to get rejected, to get in the way of defending these basic programs that provide coverage for so many,” he said.
The sale of Covered California health plan to immigrants without legal status had not been expected to boost enrollment in the exchange significantly, since they — unlike about 90 percent of current enrollees — would not have qualified for federal subsidies to reduce their premiums. That would have made it difficult or impossible for many of them to afford the policies. Moreover, immigrants in the state illegally can already buy health insurance in the private market, and the coverage options and premiums are similar to the plans sold on the exchange.
Covered California estimated last August that only 17,000 Californians would have gained health coverage as a result opening the exchange to the undocumented population.
Many experts and health care consumer advocates agreed that the effort was mostly a symbolic gesture – but an important one to many people.
Supporters said allowing undocumented immigrants to buy coverage on the exchange would have addressed a problem for many families composed of both legal and non-legal residents. The proposal would have allowed those “mixed-status” families to purchase their insurance together through Covered California, simplifying the process for them. Many argued that it was discriminatory to bar immigrants without papers from the state marketplace.
Lara and other backers of the effort saw it as an important step toward expanding health coverage to all Californians regardless of their immigration status.
Magdalena Velazquez of San Jose, who volunteers with the advocacy group Services, Immigrant Rights, and Education Network (SIREN), has been following the issue closely. Although she does not have legal authority to be in the U.S., she has health coverage through her husband’s employer. But many of her family members and friends are uninsured.
“Sadly, once again we’re seeing that the fight for our health care rights has to take a pause,” Velazquez said.
When California submitted its request to the federal government last year, supporters hoped the Obama Administration would review it quickly, increasing its chances of approval, Wright said. But as of Tuesday, the application process had only gone through a preliminary review.
Some health care experts believe approval would not have been guaranteed even if the Obama administration had completed its review before Trump took office. Excluding immigrants without documents was a compromise that helped get the ACA through Congress in the first place, they noted, and Obama officials would have been reluctant to renege on it.
Amid the cacophony of confirmation hearings for Cabinet nominees, President-elect Donald Trump reportedly has settled on former Georgia Gov. Sonny Perdue to fill the final Cabinet-department vacancy: secretary of Agriculture. Although consumers may simply think of the Department of Agriculture (USDA) as responsible for overseeing the farming industry, it also plays a key role in promoting health.
The department is influential in maintaining the nation’s health in four key areas:
Although food insecurity across the nation has declined in recent years, the USDA found 12.7 percent of all households in 2015 faced hunger. The department helps address this problem by managing the nation’s food assistance initiatives.Use Our Content This KHN story can be republished for free (details).
The Supplemental Nutrition Assistance Program (SNAP) is among the best known of those efforts. SNAP, formerly called food stamps, provides a monthly stipend to eligible residents through an Electronic Benefit Transfer, or EBT, card to use at any qualifying grocer. Since its inception, SNAP has become the nation’s largest safety net for the hungry, feeding more than 44 million Americans last year.
Other pivotal food assistance comes through the Women, Infants and Children (WIC) program, which provides benefits to pregnant and nursing women and children up to their fifth birthday. WIC has assisted 53 percent of all infants born in the U.S.
Older children also receive help through USDA initiatives that provide low-cost food at school. Kids from families with incomes below 185 percent of the poverty threshold (nearly $38,000 for a family of three) can receive breakfast, lunch, dinner and snacks there for little to no cost. The National School Program helped serve low-cost lunches to an average of more than 30 million kids each day in 2015.
When school is not in session, the Summer Food Service Program distributes meals at public areas such as churches and playgrounds. This program helped feed 2.6 million children every day during the program’s peak month of July in 2015.
Supporting Rural Medicine
The Department of Agriculture provides a variety of grants to help rural communities meet their health needs.
Among those efforts is the Distance Learning and Telemedicine Grants, which distributes millions of dollars to strengthen telecommunications in rural communities and increase access to resources such as teachers and doctors. The money has been used in a variety of ways, including setting up a tele-pharmacy dispensing system in Alaska and connecting a medical school to rural clinics in Georgia.
Access to clean water is also a priority for the department. Water and waste disposal grants are available to federally recognized tribal lands, communities along the U.S.-Mexico border and rural towns. The funds are used to install proper waste disposal systems and, in some cases, outfit homes with new plumbing.
For decades, the USDA has been involved in efforts to educate Americans of all ages how to keep off excess weight and lead a healthy lifestyle.
Since 1969, the Expanded Food and Nutrition Education Program has worked with low-income families to develop healthy diet and exercise habits and educate them about food safety.
The program uses peer educators from the participants’ communities and operates in all 50 states, the District of Columbia and six territories. In 2015 alone, the program reached nearly half a million Americans.
Agriculture also plays a hand in developing the nation’s nutritional guidelines. In partnership with the Department of Health and Human Services, the department issued the 2015-2020 Dietary Guidelines for Americans. The report outlines five key strategies to develop healthier eating patterns, as well as templates to maintain healthy Mediterranean and vegetarian diets. Online tools to assist in healthy eating, such as choosemyplate.gov, are also maintained by the department.
Preventing Foodborne Illness Nationally And In Your Home
The USDA helps protect the food supply through the Food Safety and Inspection Service. The office monitors the importation of meat, poultry and egg products by issuing safety certifications to some foods from other countries and auditing their food inspection systems.
Domestically, the same agency monitors food processing and distribution through microbiological testing. It also maintains a system that tracks and alerts potentially dangerous foods. For consumers, the office maintains a USDA Meat and Poultry Hotline to answer individual questions about food preparation.
This week at CBPP, we focused on the federal budget and taxes, health care, and poverty and inequality.