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Saturday, April 29, 2017

100 days under the Trump Epoch and what it means for your Health

The first 100 days under the Trump reign have seemed like a thousand years of muffled screams and insults, which at times were hilarious because of the inaccuracies and grammatical errors. However, as William O. Douglas, former supreme court justice, once said, "freedom steals away in the night while we are sleeping." This article reviews the thrust of the Trump Administration and the Republican majority's stabs at "healthcare reform." Round deux, dos, or two, depending on your preference, of the attempt to repeal the Patient Protection and Affordable Care Act has slunk away in the night, lacking the requisite number of votes for approval. However, this latest iteration provides a glimpse at the approach the Republicans will apply to future legislation, in healthcare, and many other programs. Essentially, the R's want to shirk national leadership and have the states assume responsibility for more programs and consumer protections. The only area in which they shrink from this is for gun proliferation, where the Trump Administration wants to force all states to accept looser standards for transporting weapons across state lines, including concealed weapons.
Trump Posturing
Right up until the federal government deadline for shutting down, Trump threatened to withhold the tax credits which provide 20 million middle class and low-income Americans with medical insurance. This is of course, an administrative maneuver to choke the life out of the act, since he hasn't been able to gain agreement from his own party. It should be noted however, that Trump has already cut funding mechanisms which flow to the program, including a 3% tax born by the lucrative medical device industry, which will flow directly to their executives and NOT reduce the cost of your cardiac or orthopedic devices. And of course, let's not forget his forgiveness of the "tanning bed" tax, which has zero health benefits and does contribute to skin cancer. 
Regarding the thousands of people who hate the Affordable Care Act, there are exemptions for those who don't want to participate, and about 20 million folks have made this election or paid the tax penalty. Though the Affordable Care Act is not beloved and is flawed legislation, as they all are, it is still a starting point from which to make further reforms. This chart shows provisions of the act which are now being targeted by the Trump goon squad and what the impact may be on your health care.

Affordable Care Act
Trump Round 2 Health Plan
Protection from Pre-existing Medical Condition Exclusions
Insurance companies are prohibited from denying coverage or reducing benefits to persons with existing medical conditions
The Republicans are proposing that individual states decide how they want to handle insurance offerings to those who need it most-including being able to charge astronomical prices, limit benefits, and deny coverage
Lifetime Limits for Benefits
Insurance companies are prohibited from limiting benefits
The Republicans think states should be allowed to offer restricted programs, contracts with minimal benefits, instead of comprehensive medical insurance
Standardized Benefit Levels Nationally
In the insurance exchanges, participating insurers must offer benefits which adhere to certain benefit designs and guarantees
The Republicans see no advantage in mandating benefit standards and wish to leave this provision up to the states
Protection from Predatory Pricing Based on Age or Need
In the insurance exchanges, there are tiers of rates and people who are in the older tiers cannot be charged more than 3 times the rate of the younger tiers
The Republicans want to allow strict age rating, which means if you are over 50, it will be a long expensive wait until age 65 when you can join America’s national healthcare plan, Medicare
Birth Control Coverage
The insurance exchanges require plans to offer birth control in all plans
The Republicans are opting to use streaming videos of talk show host Alex Jones as birth control
Mental Health Services Coverage
Included under the ACA, as any other benefit
More homeless people, which impacts cities, who didn’t support Trump anyway, so a win for them
Chemical Dependency Treatment
Covered under the ACA, which is critical with the opioid crisis
You are on your own

To all the winners who voted for Trump, stop whining about the millions of engaged citizens who are demonstrating against his horrible policies, the first amendment guarantees their right to free speech, and this is part of a real democracy.
 And this is the healthpolicymaven signing off wishing you all informed consent. Also, TIP OF THE DAY-don’t sign blanket authorizations at hospitals or medical facilities, please add the words,“I agree to pay charges for in-network providers”, which can save you a mint. Those words of wisdom come from Dr. Elizabeth Rosenthal, author of An American Sickness-How Healthcare Became Big Business and How You Can Take It Back. Please do buy and read her book.

Roberta Winter is the author of Unraveling U.S. Healthcare-A Personal Guide, published in 2013 by Rowman and Littlefield.