Tag Archives: Trump

The GOP’s Comprehensive Plan to Undermine Women’s Health Care

(Published June 20, 2017 in the Huffington Post)

As Senate Republicans continue to craft a healthcare bill behind closed doors, a Trump Administration’s reported plan  would exempt many employers from including contraceptive coverage in health insurance plans. While the Administration has framed their executive order as a protection of “religious freedom,” it is just one part of a frightening new wave of policies that will particularly harm women.

According to the Congressional Budget Office, millions of Americans will lose health insurance under the American Health Care Act (AHCA), already passed by the Republican House of Representatives. Low- and moderate-income Americans will lose the most because the plan decreases insurance subsidies and will eventually eliminate the Medicaid expansion.

This is especially troubling for women. Consistently, year after year, American women earn less than men. And according to the Department of Labor, women are more likely than men to be among the working poor. At the same time, women use more medical services and spend more on health care than men. They make more visits each year to primary care physicians and are more likely to take at least one prescription drug on a daily basis.

Under the House version of the AHCA and the Trump Administration’s order, women’s access to care through their insurance will decline. The bill eliminates the Affordable Care Act’s requirements for insurance plans to cover “essential benefits” like birth control and maternity care. Worse yet, this move will reduce the largest health safety net for women in the country. The Republican House plan singles out Planned Parenthood, prohibiting federal funding for one year after the law goes into effect.

Reduced access to birth control will lead to more unwanted pregnancies. Yet under the Republican House bill, qualified health plans cannot include abortion coverage except for pregnancies that present life-threatening physical risks and pregnancies that resulted from rape or incest. Not only does this reduce access to a needed medical procedure, but it also leaves questions about how to determine if a pregnancy is life-threatening or how to confirm if it’s a result of rape or incest. And it could potentially force women to prove—to the satisfaction of an insurance company—that she indeed was raped. This would certainly delay performing the abortion. Delays, in turn, present health risks to women.

The Republican House bill does allow insurance to pay to treat “any infection, injury, disease or disorder that has been caused or exacerbated by the performance of an abortion.” But legal abortions performed by a qualified medical provider in a suitable medical setting are extremely safe. While it is unlikely that the House’s intent is to encourage illicit abortions, this provision seems to acknowledge that an increase in unsafe abortions may be a consequence of the policy.

The Administration’s order and the Republican House bill will have devastating effects for women’s health in the United States. Our maternal mortality rate is already the highest among all developed countries.  And while this rate is decreasing in nearly every other nation, it continues to rise in the U.S. Our high maternal death rate is in part the result of unplanned pregnancies – more than half of all pregnancies in the U.S. – and a health system that makes accessing care difficult, especially for new mothers. The President’s order, together with Congress’s “repeal and replace” bill, will only lead to more tragedy. Now, the Senate has the chance to take out these harmful provisions and reaffirm the value of women’s health.

The “Price” of Health

 I’ve spent far too much time over these past months trying to understand why the current administration does not seem to understand (or care about?) basic health care facts:
  1. All people get sick and injured over their lives; all people feel pain; human experience is unpredictable and none of us knows when disaster will strike; and all (or at least most) people try hard to manage their pain, disabilities and illnesses so that they can continue to engage in the normal activities of daily life.
  2. All people need the help of medical experts in order to minimize the damage caused by disease and injury. In the twenty-first century, expert help and procedures and remedies involve substantial expenses.
  3. Even with careful planning, most Americans cannot save up enough money to cover these expenses, especially in cases of long-term or chronic health challenges.
  4. Health “insurance” that requires people to guess what care they will need (so-called “more choice for the consumer”) presumes that people can prophesy the future and / or avoid all illness and injury.
  5. When members of our communities cannot access appropriate health care there are consequences for everyone: Infectious diseases spread; people miss work and vital businesses and services become understaffed; production drops; kids fall behind in school; and some people turn to illicit substances (including alcohol) in order to self-medicate.
  6. See point #1.

These points are consistent with what most people observe and experience in their own families and communities and should, one might think, serve as the basis for health care policy. That, however, is not the case. As regarding many other issues, the current administration invokes an alternative set of “facts” regarding the nature of health and health care. These “facts” do not tend to be articulated in a coherent statement, yet they do emerge as a sort of sub-text in a variety of situations.

Ebola Winners and Losers

Last week newspapers reported on Health and Human Services Secretary Tom Price’s first trip overseas to Liberia, the West African country where more than 4,800 people recently died from the spread of the Ebola virus. A new Ebola outbreak seems to be emerging at this time but Secretary Price did not address that. Rather, he made a point of praising survivors of the earlier outbreak, declaring that: “We celebrate their victory over Ebola.” Now, from my perspective as a medical sociologist, it’s hard to see that those who survived Ebola are deserving of any particular praise. Is Price’s (unspoken) implication that these survivors somehow worked harder than those who died? That they were smarter or made better choices? That they were more morally deserving to live? And in praising the survivors was Price implicitly criticizing those who did not survive?

“Waging war” is not the solution this country needs

At the time of the first outbreak, I critiqued the U.S. rhetoric of “waging war” on Ebola. I voiced concern that we have come to rely on our military as the only governmental agency capable of responding to any sort of crisis. And I pointed out that our America inclination to frame social problems in terms of war underpins our troubled history of crusades to stamp out vices and diseases (the two words often are used interchangeably) ranging from alcoholism to obesity to cancer. Declaring war on disease sends the message that the sufferer is somehow at fault and wars on disease too easily turn into wars on those who embody the disease. Our racially driven “war on drugs,” more aptly described as a “war on drug users,” and has led to local police departments being armed with military equipment (including tanks) and to the highest rate of incarceration in the world.

Bleak Binary Terms 

In the era of Trump and Price the rhetoric of “victory” takes on whole new levels of significance. From the start, the Trump campaign framed the world, and the people of the world, in bleak binary terms of “winners” and “losers.” Famous Trump remarks include “Believe me. You’ll never get bored with winning. You’ll never get bored!” and “Work hard, be smart and always remember, winning takes care of everything!” Candidate Trump’s comment that best sums up the winners vs. losers world view concerned Senator John McCain: “I supported him, he lost, he let us down. But you know, he lost, so I’ve never liked him as much after that, because I don’t like losers…He’s not a war hero…He’s a war hero because he was captured. I like people who weren’t captured.”

The Price of Winning and Losing

In the world of health and health care, this paradigm is dangerous. It comes close to the rhetoric of the eugenics movement (developed in the United States and most famously and energetically adopted by the Nazis) – the idea that some people are inherently better than others (the winners) and that those people deserve social praise, resources, and encouragement to reproduce themselves. Losers, in contrast, should be marginalized and discouraged from reproducing.

Today, the Trump Administration unveiled its first budget – a budget that rewards strength and punishes weakness. According to the New York Times, “The document, grandly titled ‘A New Foundation for American Greatness,’ encapsulates much of the ‘America first’ message that powered Mr. Trump’s campaign. It calls for an increase in military spending of 10 percent … [It also] calls for slashing more than $800 billion from Medicaid, the federal health program for the poor, while slicing $192 billion from nutritional assistance and $272 billion over all from welfare programs [over the next decade].”

Winners and losers, indeed.

 

See  the following for more on winner/loser paradigm, the health care system, and the rhetoric of war on the Ebola outbreak:

Pink Ribbon Extravaganza

Health Insurance Roulette: The House Always Wins

Why Can’t the US Help Solve Ebola Outbreak without “Waging War” and “Sending Troops.”

Uninsured in Texas, Then and Now

In previous posts, I shared stories of Americans who had been uninsured when I first met them a decade ago and who, in the wake of the ACA, now are insured. These stories were inspiring, encouraging and – in a few cases – disappointing in that health insurance alone cannot make up for a lifetime of sub-par living conditions, harmful working conditions, and the cumulative ill effects of inadequate health care.

As the president-elect and Republican congressional leaders are reiterating promises to repeal the Affordable Care Act, it’s crucial to remember what it’s like for Americans to try to scrape by without dependable access to health care. The experiences of people living in states that elected NOT to expand Medicaid eligibility under the ACA serve as a wake-up call for what things were like during the bad-old-days. In this article published in Health Affairs I share the story of Texas parents valiantly struggling to care for a child with disabilities, even while their own health deteriorates due to lack of medical attention.

I ended that article with a section I called “Playing Prophet.”

For the time being, at least, it seems unlikely that the Texas health care landscape will change. The barrage of anti-Obamacare radio, television, and billboard ads I heard and saw when I visited Texas during my research represent a well-financed campaign that, unfortunately, has convinced even those people who would benefit the most from the ACA.

Luis and Daniela’s situation probably won’t change much, either. Luis will get older, still working long shifts driving trucks and loading and unloading them. Daniela will age, too, still lifting Alexa. Alexa will never be able to care for herself. And her brother, now a teenager, will age out of CHIP and either become one of the lucky few in the Rio Grande Valley who finds a job that offers insurance or hope and pray that he remains healthy enough not to need much medical care. It’s likely that the next time I visit them, either Luis or Daniela, or possibly both of them, will have become too disabled to continue working and finally will have health care coverage through Disability—which will come at the price of a substantial drop in family income as well as a blow to their self-esteem as providers. It’s hardly an ideal solution for their family or for Americans overall.

Post-election, this prophecy actually feels overly optimistic. In light of Republican promises to privatize Medicare — as well as the president-elect’s mocking impromptu performance and history of unethical practices regarding people with disabilities — I fear that the family’s worry that Daniela will end up in a horrid, underfunded institutional will happen sooner rather than later.