- President Donald Trump signed an executive order focused on healthcare issues.
- Health experts don’t expect the executive order to result in many large-scale changes.
- Additionally, the Trump administration is trying to overturn the Affordable Care Act, which requires insurance companies to provide coverage to people with preexisting conditions.
Last week, President Trump signed an executive order that claims to help protect Americans with preexisting conditions like cancer, asthma, or diabetes.
Trump also outlined a potential healthcare plan that aims to protect people from surprise billing, ensure better care, and invest in critical areas.
“This includes a steadfast commitment to always protecting individuals with preexisting conditions and ensuring they have access to the high-quality healthcare they deserve,” the order states.
But experts point out that the administration is trying to overturn the Affordable Care Act (ACA), which already offers protections for preexisting conditions. Additionally, the executive orders cannot be enforced unless other laws are passed.
The threat to the ACA
In order to guarantee protection for people with preexisting conditions to have insurance coverage, there needs to be a law not just an executive action.
We already have a law protecting people with preexisting conditions: the ACA.
Currently, the Trump Administration is suing to overturn the law in the Supreme Court.
Following the Trump’s administration announcement, many health experts expressed criticism and claimed the executive orders lack substance and will likely have little impact.
If the ACA is overturned without another law in place, there will be little in place to protect those with preexisting conditions.
“These executive orders will not likely result in any large-scale changes. While the President here states a policy to preserve coverage for preexisting conditions, a policy statement does not have any legal impact and will not bind insurance companies,” says Jennifer Piatt, a research scholar with the Center for Public Health Law and Policy at Arizona State University.
What does an executive order actually do?
President Trump’s executive order essentially means he says he is committed to protecting people with preexisting condition without putting anything real into effect, explains Tara Sklar, JD, MPH, a professor of health law at University of Arizona’s James E. Rogers College of Law.
In order to guarantee insurance companies won’t reject or increase prices for people with preexisting health conditions, there needs to be a law.
“You need a law to protect access to health insurance coverage for Americans with preexisting conditions, and we have a law — it is called the Affordable Care Act,” Sklar said.
Without a law, an executive order cannot force an insurance providers to cover preexisting conditions.
An executive order essentially lays out a goal, but it doesn’t make anything concrete, says Dr. Daniel B. Fagbuyi, an emergency physician and Obama administration biodefense and public health advisor.
“This executive order is basically meaningless and has no legal effect,” says Sklar.
The ACA already protects people with preexisting conditions
The ACA, which was signed into law in 2010, already protects Americans with preexisting conditions.
Under the law, health insurance companies cannot refuse coverage or increase prices based on any preexisting conditions a person may have.
Before it was passed many people with preexisting conditions had difficulty purchasing individual health insurance. Even if they were able to obtain coverage they often had to pay far higher premiums.
“A good number of people who didn’t have coverage before have coverage,” says Fagbuyi.
The Kaiser Family Foundation found that about 52 million people had a preexisting health condition that could have prevented them from purchasing individual health insurance if the ACA had not been passed.
Thirty-nine states have expanded Medicaid coverage meaning that now about 130 million Americans have insurance through Medicare and Medicaid.
“If you’re not adding any value, like fixing any other loopholes or making it better, I don’t know what you’re doing,” Fagbuyi added.
If the ACA were to be repealed without a legal, meaningful replacement, it would put Americans with preexisting conditions at risk.
The Health Insurance Portability and Accountability Act (HIPAA) provides some coverage for people with preexisting conditions. If you switch jobs, your new employer-based health insurance has to cover you if you haven’t been without coverage for more than 63 days.
But if you do not have employer-based coverage, without the ACA it may be impossible to get coverage.
What’s even more concerning is that this is all taking place during a pandemic in which people with underlying health conditions are more at risk.
And with employer-based healthcare, people who have preexisting conditions who lost their job could be at risk for being unable to get new insurance coverage if the ACA is overturned.
Evidence has shown that people with preexisting conditions may be 12 times more likely to die from COVID-19 than health people.
During this public health crisis, we need health and public health security, says Fagbuyi.
“If President Trump is truly committed to protecting Americans with preexisting conditions to have access to health insurance coverage, then he could have used an executive order to prevent the Department of Justice from trying to get rid of the Affordable Care Act,” Sklar said.
The executive orders will likely have little impact
Health experts don’t expect the executive orders to result in many large-scale changes.
“This executive order, while stating that it is national ‘policy’ to protect insurance coverage for individuals with preexisting conditions, does nothing to substantively protect that coverage,” says Piatt.
While lengthy, there’s not much to the executive order in terms of substance. Therefore, the impact will likely be minimal, according to Piatt.
What we really need, Fagbuyi says, are concrete steps to provide the country with health security.
“Please tell me you’re addressing the areas that need to be fixed, not ripping down something that’s already being a safety net for millions of people,” Fagbuyi said.
Until a detailed plan is drafted and agreed upon during the legislative process, it’s unclear how these protections and goals will be enforced.
“It is important to ask how,” says Sklar. “How will access to health insurance for Americans with underlying health conditions be maintained if the Supreme Court invalidates the Affordable Care Act? This executive order does not do this and if that is President Trump’s commitment, then how will he ensure this?”
The bottom line
Last week, President Trump signed an executive order to help protect Americans with preexisting conditions like asthma or diabetes.
Following the announcement, many health experts expressed criticism and claimed the executive orders lack substance and will likely have little impact. To guarantee protection, a law needs to be in place.
The ACA already protects people with preexisting conditions. If the ACA were to be taken down without another law in place, millions of Americans with preexisting coverage could lose coverage.
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