By Ernest Hopkins and Courtney Mulhern-Pearson
In the few short weeks since Trump’s inauguration, the Administration has begun with a series of Executive Orders consistent with their election promises. These stand to bring sweeping changes to how the country—and individual states—address immigration, security, climate change and health care. In this month’s policy update, our experts highlight what’s happened already and what to expect.
Changes Coming to the Affordable Care Act
Out of the Executive Orders already signed, one in particular states the Administration’s intent to repeal the Affordable Care Act (ACA). The order instructs the Secretary of Health and Human Services (who has not been confirmed yet), to take steps to repeal the ACA “to the maximum extent permitted by law.” Because the ACA is the law of the land, the impact of the order is to state the Administration’s intent, but it has no legal impact on funding to, regulations on, or coverage under the ACA.
Medicaid and People Living with HIV/AIDS
The primary focus of HIV/AIDS advocates will be the upcoming battle to repeal the ACA and turn Medicaid into a block grant; and Congress has begun its process through Budget Resolution and committee review. ACA replacement bills have been introduced by Congressman Tom Price-HHS Secretary nominee, and Senators Cassidy, Collins and Paul. While none of these bills are comparable to the ACA in comprehensive coverage, affordability, and patient protections, they will be used to start the conversation on replacement legislation at the Republican Retreat with the President and HHS Secretary nominee, where it is expected that serious discussions will occur to come to consensus on a replacement bill and strategy for passage.
The problem will continue to be how to pay for the legislation and guarantee the same if not better benefits at lower cost than those provided through the ACA.
Administration officials have also stated their intent to block grant Medicaid, removing the federal entitlement nature of the program, under the guise of flexibility and choice to states. However, loss of the guarantee of health care coverage to the low income, disabled, elderly, and seriously ill would be an historic breech of federal commitment to the public. Fully 70 million people are covered by Medicaid. Capping federal resources to state and imposing per capita caps on states, while giving them added flexibility over the program will surely reduce the scope of benefits, and increase out of pocket costs to recipients.
Medicaid is the largest payer of HIV care, treatment and prevention services in the U.S. and we must protect the guaranteed coverage for eligible citizens.
Immigration Changes to Impact Sanctuary Cities
One Executive Order directs government agencies to identify and redirect resources to start building a border wall on the Southern border of the U.S. with Mexico, and another calls for the removal of federal grant funds from ‘Sanctuary Cities’ in California like San Francisco, Los Angeles and San Diego.
Another one gives Department Secretaries the power to take steps to restrict access to federal grant funds to sanctuary cities and states that give safety to the undocumented. Once again, most federal grants are appropriated by Congress and restrictions would have to be passed by Congress. If enacted by Congress, removal of federal grant funds from these cities would impact all aspects of society: education, transportation, trade, public safety, and health care.
California State Policy
At the state level, lawmakers are preparing to respond to the Trump administration’s proposals.
Governor Brown delivered his state of the state address on January 24th and used forceful language to assert that he will defend the efforts California has made on healthcare, climate change and immigration, saying, “California is not turning back, not now, not ever.” The legislature introduced spot bills on Medicaid and the ACA, which will serve as placeholders for the state’s response to protect these vital healthcare programs.
Even with the uncertainty of the federal response looming, California’s budget process is moving forward. HIV/AIDS advocates are preparing to ask for some key investments to help ensure that we have sufficient enrollment workers to help people navigate various programs such as the AIDS Drug Assistance Program and the Health Insurance Premium Payment program. We are also asking for funding to help backfill some federal cuts to HIV prevention and testing money, as well as funding to bring provider rates to parity in Medi-Cal’s HIV home health waiver program.
In addition to all of this, the AIDS Drug Assistance Program (ADAP) is continuing to experience systems challenges as a result of the state’s decision to switch contractors in the middle of last year. As a result, there have been numerous problems that have impacted clients who are trying to access HIV medications and a significant increased workload for enrollment workers. We are continuing to advocate for the state to work quickly to address these issues.
If you have experienced ADAP issues as a result of this transition, please be sure that you are reporting them to the State Office of AIDS and to us (email@example.com).
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