Karen Fratti
October 30, 2017 8:09 am
T.J. Kirkpatrick/Bloomberg via Getty Images

It can be hard for anyone to keep up with the ins and outs of health care policy, even for people whose actual job it is to understand it.

This is especially true in the current political climate, when everything Trump does prompts outrage. It’s often difficult to see through the tweets and get into the nitty-gritty details of the policies his administration is proposing. And after the health care scares of this summer, when Republicans tried to pass two Trump-friendly health care bills in both the House of Representatives and Senate, it might feel like a good time to take a breather. They didn’t repeal and replace the Affordable Care Act right away, which feels like a win, right? Not at all. Actually, now is the time to make sure you’re watching Trump’s health care initiatives very, very closely.

Because he’s taking out the ACA “piece by piece” now instead.

Despite your politics, one thing most everyone can agree on is that the Trump administration and some of the leftover GOP establishment in Congress — like Speaker of the House Paul Ryan or Senate Majority Leader Mitch McConnell — are not fans of former president Obama or the ACA. They saw the health care initiative as a total overreach of government into what they believe should be a private health care market, even going so far as to disparagingly call the legislation “Obamacare,” like it was just one guy’s “bad” idea.

So it was a real bummer for the administration that they were unable to pass the American Health Care Act or the Senate’s bill and totally repeal and replace the ACA this year. That would have been a *huge* victory and a sign that the administration was “winning,” but it was a total loss all around. Remember, both of the bills eventually failed in part because the GOP refused to compromise with Democrats on their content. Since it looks like passing a huge, sweeping Republican-drafted bill that Trump can put his name on is a no-go, the administration has chosen to chip away at health care in even more terrifying ways.

And Trump can do it all without Congress.

It’s sort of ironic that Trump has resorted to using executive orders to “repeal” the ACA, since he spent Obama’s two terms railing against the use of them. Maybe he just loves signing things. And he has been signing whatever orders he can get his hands on.

The ACA was a massive piece of legislation with tons of rules and regulations and guidelines, which is why it took so long for it to get passed while Obama was in office. But by taking out just a few of those rules, Trump has already started dismantling it without any input from Congress or voters. Yikes, right? We wouldn’t let Trump organize our eyeliners, let alone our livelihoods. Yet here we are.

Here are some of the things he’s already done.

1Taking away subsidies for insurance companies.

The whole idea of the ACA was to make sure that everyone could afford health insurance. Instead of going all in and making insurance something that the government just *gave* Americans, the administration worked with insurance companies to make affordable health care possible. The ACA made it mandatory that insurance companies offer all sorts of low-cost plans for lower income customers and also offer some services free of charge, like birth control or blood pressure medicine, and other essential health benefits.

To make it easier on the insurance companies, the government shared the costs of these discounts with the companies, paying out subsidies so that they could stay in business while helping out people who couldn’t afford health insurance. The subsidies helped cover the cost of deductibles and co-payments for 7 million customers, according to the New York Times.

Last month, Trump signed an executive order saying that the federal government would no longer pay out these monthly cost-sharing subsidies. Eighteen states took the administration to court this month in response, saying that it would throw the market into “chaos.” But since so many states had already planned ahead, assuming Trump would do this, the 18 states’ legal argument just wasn’t enough to beat Trump.

The judge, Vince Chhabria of Federal District Court in San Francisco, an Obama appointee, conceded that the administration had the better argument and that some low-income customers might actually be better off or unharmed. Depending on how you view health care, this is not a win for anyone.

Just because some states planned ahead, knowing that Trump would dismantle the ACA, doesn’t mean that the subsidies weren’t working. In fact, some insurance companies have already raised the price of premiums to cover the costs. So the states might be able to cover some lower income customers, but those mid-level consumers? Their costs are going up, according to CNN Money.

2Rolling back birth control.

So some companies will still cover it, because they aren’t totally terrible. But 55 million women had access to birth control under the ACA and experts estimated that hundreds of thousands of them would lose that access because of Trump’s order. Legally, it might not last for long. The attorney general of Massachusetts, Maura Healey, and the attorney general of California, Xavier Becerra, both filed lawsuits blocking the order in their states, but there’s been no ruling yet.

3Making it really hard to get Obamacare.

According to Politico, the Department of Health and Human Services reduced Obamacare’s advertising budget by 90 percent to $10 million and also cut grants to enrollment assistance programs by 40 percent. In addition to that, it’s also shortened the enrollment period this year, so if you miss the deadline, you miss out on being insured.

This is kind of the most disgusting way to gut the ACA by the same agency that manages it: ensuring that fewer people sign up for coverage, make it through the enrollment process, or are properly informed about how things actually work.

In addition to these major steps, Trump has also promised to allow insurance companies to start selling “short term” plans again, which Obamacare regulated more heavily, since they don’t offer much coverage and are very expensive. It’s also threatened to deregulate the insurance industry in other ways, all in the name of allowing insurance companies to do whatever they want to stay in business as opposed to taking care of customers.

All of this is happening with just the flourish of a pen by Trump. Do you want him making any decisions for you? Just because health care isn’t in your timeline or on TV all day every day, doesn’t mean the administration isn’t working hard to make sure it’s as expensive and inaccessible as possible. Don’t forget to keep resisting.

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