Trump signed the executive order Thursday in the Oval Office in front of Vice President Pence, senior administration officials and Sen. Rand Paul (R-Ky.), who opposes Obamacare, but has threatened to vote “no” on legislative replacement plans.
“With these actions, we are moving toward lower costs and more options in the healthcare market and taking crucial steps towards saving the American people from the nightmare of Obamacare,” Trump said.
LGBT groups, which predominantly were vocal opponents of Trumpcare in its legislative form, panned the executive order shortly after Trump signed it.
Carl Schmid, deputy director of the AIDS Institute, said the executive order sets up health care plans that don’t provide essential health benefits — like prescription drugs or preventative care — which he said is “really important for people at risk of HIV or with HIV.”
“I don’t know what these plans have to cover,” Schmid said. “They’re not regulated by the insurance commissioners. We’re been working so hard to get the insurance commissioners to look at problems in the insurance market; these plans don’t even get regulated by the insurance regulators, so it seems like it’s really substandard.”
Schmid added the executive order will “also hurt the overall insurance market,” which includes people with pre-existing conditions who may forced to pay higher premiums and deductibles.
“The people who are sick will stay in those, and other people will go in these plans and people don’t know when they’re going to have HIV, or going to have cancer down the road, and that’s what insurance does, it spreads it out,” Schmid said.
The executive order contains three key portions, each of which the White House says is designed to curtail the escalating costs of health insurance and assist the estimated 1,500 counties that will be left with one provider in 2018:
* The order directs the Labor Department to consider expanding access to association health plans to allow employers to form groups across state lines to offer healthcare coverage to their employees. Employers participating in these associations cannot exclude any employee from joining the plan and cannot develop premiums based on health conditions.
* The order instructs the administration to consider expanding coverage through low cost short-term limited duration insurance — typically cheaper plans that under Obamacare were slated to last a maximum of three months, but not subject to the same requirements for pre-existing conditions.
* The order directs the administration to consider changes to Health Reimbursement Arrangements, employer-funded accounts that reimburse employees for healthcare expenses, such as deductibles and copayments.
David Stacy, government affairs director for the Human Rights Campaign, said the executive order amounts to assault on health coverage provided under the Affordable Care Act.
“Trump’s executive order is nothing more than a cynical attempt to sabotage the Affordable Care Act,” Stacy said. “Beyond undermining the ACA, President Trump’s order will put LGBTQ Americans at risk through substandard health plans that exclude essential health benefits and protections for those with pre-existing conditions and increase premiums for those remaining in other plans.”
Dan Bruner, senior director of policy for the D.C.-based Whitman-Walker Health, said the executive order has no immediate impact until U.S. agencies act, but nonetheless expressed concern.
“If you get healthy people, or people who think they’re healthy, to leave the regulated plans that are in ACA’s health exchanges to sign up for this cheaper health insurance with less coverage then when you do is drive up the costs for the folks who need full health insurance because the risk pool gets skewed more and more towards people with high medical casts,” Bruner said.
Bruner added that could “really harm people with HIV or other high-cost medical conditions” as well as LGBT people.
“Although lots of folks don’t realize this, there are an awful of folks in the LGBT community who are low-income who potentially would be harmed by this as well,” Bruner said.
According to a March report from the Center for American Progress, the rate of low- and middle-income LGBT people who are uninsured has dropped by 35 percent since before the Affordable Care Act’s coverage reforms took effect in 2013.
Asked whether the Trump executive order would hamper Whitman-Walker’s ability to administer care, Bruner replied, “We certainly hope not and, of course, we’re committed to serving everyone regardless of their ability to pay.”
“The concern is that if folks have less insurance coverage that is less generous, or covers fewer conditions, or has much deductibles, then when they come to get the health care they need, either from us or from someone else, they’re going to be hit with much higher out-of-pocket costs that insurance won’t cover,” Bruner said. “One real concern is folks in that situation will just not get the care they need.”
Also speaking out against the executive order was Stephen Boswell, CEO of the Massachusetts-based LGBT organization Fenway Health.
“Today’s executive order is a significant step backwards for the nation’s health. Weakening the mandate to ensure that all health insurance plans offer essential health benefits means that core health services such as HIV/STI screening and prescription medications will become more costly and less accessible,” Boswell said. “Health insurance costs for people living with HIV will likely increase significantly, and insurance markets will become destabilized.”
Trump signed the executive order after repeated attempts in Congress to make good on Republican campaign pledges to repeal and replace the Affordable Care Act. Although the U.S. House passed a version of Trumpcare, the U.S. Senate has been unable to reach an agreement on legislation.
Gregory Angelo, executive director of Log Cabin Republicans, in contrast to other LGBT groups said the executive order is “a step in the right direction.”
“The goal of President Trump’s executive order on healthcare is to provide Americans — particularly middle-income Americans — with more affordable healthcare choices and to allow Americans to exercise greater control over their healthcare decisions,” Angelo said. “These are principles that all Americans should get behind, especially those who have been impacted directly by Obamacare’s ongoing collapse.”
Unlike other LGBT groups, Log Cabin has joined with other Republican groups in calling for repeal of the Affordable Care Act.
Sarah Kate Ellis, CEO of GLAAD, also condemned Trump’s executive order in a statement as an attempt to sabotage coverage for the more than 20 million people who receive coverage under Obamacare.
“President Trump is working to sabotage the Affordable Care Act in any way possible; showing complete disregard for the health and well-being of millions of Americans, including many in the LGBTQ community, who rely on the ACA for coverage,” Ellis said. “Health care is a human right and now more than ever we must keep fighting to protect our care and demand the inclusive and affordable healthcare that the LGBTQ community, and all Americans, deserve to live and thrive.”