WU faculty envision healthcare under Trump administration

Bailey Winston | Staff Reporter

Alpha Epsilon Delta, Washington University’s pre-health honor society, hosted a panel to discuss what further steps might be taken by President Donald Trump’s administration in reforming the existing healthcare system April 10.

During his first few months in office, Trump has prioritized repealing and replacing the Affordable Care Act (ACA), also known as “Obamacare.” Trump’s proposed alternative, the American Health Care Act, was withdrawn March 24, due to a lack of Republican support, and did not come to a vote in the House of Representatives.

President Donald Trump, then the Republican presidential nominee, debates onstage against Hillary Clinton Oct. 9. Trump’s recent push to repeal the Affordable Care Act failed March 24.

President Donald Trump, then the Republican presidential nominee, debates onstage against Hillary Clinton Oct. 9. Trump’s recent push to repeal the Affordable Care Act failed March 24.

Since the ACA was enacted, the rate of uninsured individuals in the United States has decreased by almost half. Dr. William Peck, a medical professor and co-director of the University’s Center for Health Policy, discussed the successes of the ACA and the struggles to keep it in place.

“Just over seven years ago,” Peck said, “the ACA became law, and since then, there have been over 50 efforts in the House of Representatives to discontinue it, several of which required [former President Barack] Obama’s veto.”

ACA was passed with the primary goal of considerably lowering the uninsured rate in low-income areas, according to Derek Brown, an associate professor of the Brown School of Social Work. Senior lecturer at the Brown School Linda Raclin believes the Obama administration met this goal and sees potential for backtracking under Trump.

“Speaker [of the House Paul] Ryan’s proposed American Health Care Act would have ended up denying healthcare to 24 million Americans and [would] have been pretty devastating to thousands of communities across the nation and here in St. Louis as well… especially to low-income and minority communities,” Raclin said.

The effects of Trump’s proposed bill, as estimated by the Congressional Budget Office, would bring the uninsured rate near what it was at the beginning of Obama’s first term. The similarities between individuals who gained health care coverage under the ACA and those who are projected to lose it under the ACHA is not a coincidence, according to Brown.

“The groups that recently gained insurance under the Affordable Care Act would be the first to lose it,” Brown said. “Those with stable and secure employment [are] probably relatively unaffected. For a safety-net hospital like Barnes-Jewish [Hospital], we likely would be seeing even more uninsured patients.”

While a large number of people who have gained health insurance under Obamacare, that number limited by some states’ decision to opt out of the Medicaid expansion.

Missouri’s choice to take this action is something that Brown attributes to the state government’s shift to the right during the November 2016 election cycle. Raclin believes it is possible that the Trump administration will incentivize the expansion of Medicaid.

“The Trump administration is indicating some willingness to impose work requirements on people with Medicaid under an expansion, which allows conservative legislatures to feel more comfortable with the idea of expanding Medicaid,” Raclin said.

An expansion of Medicaid may provide insurance to individuals who were previously unable to fully take advantage of the ACA. Brown believes the uninsured rate will level off if the ACA stays in place, as the Trump administration has many options aside from legislation to influence how the act is enforced.

According to Raclin, there are additional ways in which the Republican majority government can limit the healthcare services provided through the Department of Health and Human Services (HHS), despite the implementation of the ACA.

“For instance, it’s an HHS regulation that all healthcare plans that provide preventative services, such as contraceptive services, have to do so without a copay,” Raclin said. “That is something that Secretary [Tom] Price can change without any extra input from Congress.”

Some professionals in the field, including Peck, advocate for the continued implementation of the ACA in its current state. Peck believes it has been as effective as many imagined it could be.

“What’s happened for the people who were able to get health care under the ACA is that their health improved,” Peck said. “They found jobs and doctors and were cared for very well.”

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