The Trump administration seems laser-focused on crippling the Affordable Care Act (ACA), even as millions of Americans prepare to take part in the open-enrollment period to sign up for health coverage beginning Nov. 1, 2017.
The passage of the ACA, also known as Obamacare, significantly increased the number of Americans who had health-care coverage and greatly supported the poor and communities of color in accessing quality care.
“People of color, who had higher uninsured rates than non-Hispanic Whites prior to 2014, had larger coverage gains than non-Hispanic Whites,” according to the Kaiser Family Foundation.
Uninsured rates for nonelderly Blacks decreased 7.2 percent, while Whites experienced a 4.6 percent decline in their uninsured rates.
Sable Nelson, a policy analyst with NMAC (formerly the National Minority AIDS Council), a non-profit organization that advocates for health equity within communities of color, says that people should know that the Affordable Care Act is still the law of the land.
“Despite [dozens of] attempts to repeal and replace the law, the major components are still there to protect people of color, especially people of color living with HIV,” Nelson says. That’s the good news.
The bad news is that “the Trump administration is making every effort to systematically dismantle the ACA,” Nelson says, adding that President Donald Trump’s full-frontal assault on the law will have significant negative effects on the most vulnerable communities, including African Americans and women.
The Trump administration announced recently that not only does it plan to slash the enrollment period in half, but the Centers for Medicare & Medicaid Services will also cut its marketing budget during the enrollment season by 90 percent.
CNN Money reported: “The administration will spend $10 million on promotions during open enrollment season this fall, compared to $100 million a year ago, [according to] the Centers for Medicare & Medicaid Services (CMS), which administers Obamacare. It will focus on radio and digital ads, as well as email to existing enrollees.”
The CNN Money article continued: “At the same time, it is cutting funding for so-called navigators—who help people sign up for coverage—by 41 percent. The 98 navigator groups will receive a total of $37 million for the coming enrollment season.”
Nelson says that if people don’t have someone to talk to about the prescription-drug options associated with the different insurance plans, some might choose plans to get their coverage but may find themselves unable to afford their prescriptions.
“Trump’s efforts amount to full-on sabotage, while paying lip service to the most vulnerable among us,” Nelson says. “The Trump administration’s actions do not align with their words.”
Nelson adds that because Blacks often score lower on health literacy, the draconian cuts will have an even more severe impact on their ability to sign up for health insurance.
According to a 2015 study published in the Journal of Health Communication, “two-thirds of African American adults and three-fourths of Latino adults have poor health literacy, compared to 32 percent of non-Latino Whites.”
Karen Pollitz, a senior fellow at the Kaiser Family Foundation, who works on the Program for the Study of Health Reform and Private Insurance, says that last year, about $70 million was spent on television advertising in federal-marketplace states.
“After a fair bit of consideration and market research, [the Centers for Medicare and Medicaid Services] last year figured out that television advertising, even though it’s the most expensive form of marketing, was the most effective for driving enrollment,” Pollitz says.
According to the Daily Beast, “The Trump administration has spent taxpayer money meant to encourage enrollment in the Affordable Care Act on a public relations campaign aimed at methodically strangling it.”
The Daily Beast reported that under Health and Human Services (HHS) Secretary Tom Price’s leadership, “HHS has filmed and produced a series of testimonial videos featuring individuals claiming to have been harmed by Obamacare. Those ‘viral videos’ have had decidedly limited reach, often gathering somewhere between 100 and 200 views each. But the Department has made a heavy investment in them nonetheless. To date, it has released 23 videos.”
The Daily Beast report continued: “Each testimonial has the same look, feel, and setting, with the subjects sitting before a gray backdrop and speaking directly to camera about how Obamacare has harmed their lives. They were all shot at the Department’s internal studio, according to numerous sources who worked for or continue to work at HHS.”
At the end of a video featuring an emergency medical doctor from Lexington, Ky., small text appears under an HHS logo that reads, “Produced at U.S. taxpayer expense.”
Pollitz said that it’s not clear how much of the HHS advertising budget will be spent on anti-ACA advertising versus promoting open enrollment and letting people know about changes to health insurance coverage and premiums.
This year the enrollment period to sign up for health insurance coverage under the ACA will run from Nov. 1 through Dec. 15, just 45 days, half as many as last year.
Vox reported that five states and the District of Columbia have opted to extend their enrollment periods into January: Colorado (open enrollment extended until Jan. 12); Minnesota (open enrollment extended until Jan. 14); Rhode Island (open enrollment extended until Jan. 1); Washington (open enrollment extended until Jan. 15); California (open enrollment extended until Jan. 31) and the District of Columbia (open enrollment extended until Jan. 31).
“Twelve states and the District of Columbia run their own insurance marketplaces. The rest are run either completely by or in partnership with the federal government, and rely on the Healthcare.gov platform,” Vox.com reported. “These states have significantly less ability to change the rules around their marketplaces.”
Lindsey Dawson, the senior policy analyst for HIV policy at the Kaiser Family Foundation, says that staying covered, staying enrolled in health care, is especially important for Black people living with HIV.
“When we’re talking about minority populations, looking at the continuum of care, we know that there are lower rates already for diagnoses, receipt of care and engagement of care,” Dawson says. “Every enrollment period is an opportunity” to increase those levels and to help more people living with HIV become virally suppressed.
When it comes to health care and equality, Nelson says, these are very harrowing times for the LGBTQ community, people of color and women.
Nelson adds that the Trump administration has forced AIDS groups to get back to their roots.
“From a national organization’s perspective, it’s about making sure that at every meeting that we have on the Hill, we’re impressing upon members of Congress the impact that certain provisions or executive orders or budget proposals have on their constituents, and encouraging members of the grass roots to have those conversations with their elected officials,” Nelson says. “This political climate has underscored the need for that two-way communication . . . to make sure everyone is aware of what’s going on.”
Pollitz says that because the same number of people will be searching for health coverage during an enrollment period that has been cut in half, everything is going to be busy.
“The wait for the call center will probably be longer. The wait to get an appointment time for a navigator to get in-person assistance might be longer,” Pollitz says. “The website might be running slower, because more people are using it . . . really don’t wait. Waiting until the last minute will be even riskier than it was before. ”
Freddie Allen is the senior Washington correspondent for Black Press of America and a frequent contributor to the Black AIDS Weekly. You can follow him on Twitter.