By Freddie Allen
President Donald Trump just delivered two more gut punches to the Affordable Care Act (ACA) in an ongoing effort to knock out President Barack Obama's legacy.
On the same day that Trump signed an executive order crafted to open up the health insurance marketplace to barely there plans that may leave people living with pre-existing conditions, like HIV and AIDS, with higher premiums or priced out completely, the White House also announced plans to discontinue the health insurance subsidies that made it easier for low-income people to access quality health care.
The ACA, also known as Obamacare, has significantly decreased the rate of uninsured nonelderly adults in Black communities. The law also requires health insurance companies to cover preventive services, like HIV screening; diversity and cultural competency training for health-care providers; the expansion of the health-care workforce; and an increase in funding for community health centers, an important safety net for low-income individuals and families, according to the Centers for Disease Control and Prevention.
Now many health-care advocates fear that those gains will be lost as Trump continues to slash key provisions of the ACA.
The White House press secretary issued a statement that said there is no appropriation for cost-sharing-reduction payments to insurance companies under Obamacare.
"The bailout of insurance companies through these unlawful payments is yet another example of how the previous administration abused taxpayer dollars and skirted the law to prop up a broken system," the statement reads. "Congress needs to repeal and replace the disastrous Obamacare law and provide real relief to the American people."
The reaction was swift from health-care advocates, with some suggesting that Trump's actions would effectively segregate Blacks and people living with HIV in high-risk insurance pools.
HIV/AIDS advocacy groups urged their constituents to write to their elected officials and contact the attorneys general in their states to demand legal action to protect the ACA.
In a statement about Trump's refusal to fund the cost-sharing-reduction subsidies, Neera Tanden, president and CEO of the Center for American Progress, said that Trump and Republican leaders in Congress have proved that they will do everything in their power to take away health care from hardworking Americans.
"This is an unprecedented action: The president of the United States is purposefully hurting millions of the people he is supposed to serve by driving up their health-care costs," Tanden said. "All to further his petty, political agenda and to undo Obamacare."
Tanden added: "People will recognize that Trump—who has spent every last second of his presidency trying to tear down the ACA—is the one solely responsible for breaking health care in America, and congressional Republican leaders have stood by and watched him hurt Americans families while refusing to help them."
Trump said that the executive order would "increase choice and increase access to lower-priced, high-quality health-care options" and would "cost the United States government virtually nothing."
The order promises to expand access to association health plans; increase the availability of short-term, limited-duration insurance plans; and also expand the availability and permitted use of health reimbursement accounts.
Association health plans allow small-business owners to pool their resources to buy health insurance plans; the plans may also be available to individual buyers. The association health plans offer greater flexibility to business owners, which in the past has led to "a race to the bottom, with some associations offering lower-cost plans that covered virtually nothing," a former insurance regulator told Vox.
"Policy experts warn that together, these changes could represent a serious threat to Obamacare: Trump wants to open more loopholes for more people to buy insurance outside the health care law's markets, which experts anticipate would destabilize the market for customers who are left behind with higher premiums and fewer insurers," Vox reported.
That's because industry watchers believe that younger, healthier consumers will flock to the cheaper plans that offer fewer benefits.
Topher Spiro, vice president for health policy and a senior fellow for economic policy at the Center for American Progress, says that Trump is trying to take us back to the bad old days before the Affordable Care Act, when coverage wasn't there when you needed it, and people who were older or had pre-existing conditions faced sky-high costs.
"These changes would be devastating for small businesses, sending their premiums soaring and undermining the small-group insurance market," Spiro says. "And while many consumers in the ACA marketplaces would be protected from the higher individual-market premiums resulting from this order, confusion will depress enrollment, some insurers may exit markets and middle-income Americans with pre-existing conditions would face premium spikes."
Some lawmakers also expressed their contempt for the president's latest executive order on social media.
Rep. Barbara Lee (D-Calif.) tweeted: "Spiteful. Destructive. Cruel. New low from President Trump - deliberately undermining health care for low-income families."
Sen. Kamala Harris (D-Calif.) echoed those sentiments, tweeting: "This is cruel and vindictive. This decision could cause premiums to skyrocket for millions of Americans."
Even though Trump often criticized Obama's use of the executive order, he's on pace to nearly double the number of executive orders that the former president signed.
The executive order on health care is the 50th that Trump has signed as president.
On Oct. 13, Newsweek reported: "Obama had signed just 26 at this point of his presidency. He would eventually average 35 a year during his eight years in the White House—the fewest of any president for 120 years—en route to a total of 277. Trump is currently on pace to sign 275 executive orders. In one term."
In a statement about Trump's executive order on health care, Sen. Cory Booker (D-N.J.) said that it was another example of Trump working relentlessly to sabotage the Affordable Care Act.
"By weakening coverage requirements on some plans, called association health plans, this order will destabilize health-care markets and drive up insurance costs, particularly for older Americans and people with pre-existing conditions," Booker said. "Before the consumer protection measures guaranteed by the ACA, association health plans ripped off consumers and left hundreds of thousands of Americans with unpaid medical bills."
Booker continued: "If he's really serious about ensuring great, affordable health care for all Americans, the president should work across party lines to improve the Affordable Care Act, not try to sabotage it."