The 2016 presidential election ended in a result that few who are passionate about public health, human rights, and race, gender and sexual orientation equality could have ever wanted. However, as we face the reality of this reality, we who work to improve health outcomes must steel our resolve and continue to address the critical needs of public health and human rights domestically and abroad, and ponder strategies to still champion our causes in the face of potentially increased adversity.
I find some comfort in thinking that health is one of those few issues that can be easily agreed upon by those of otherwise starkly differing political and ideological views. It is in this mindset that I would like the incoming administration to think when considering health and policy changes that affect the health of Americans. Here are some of the most significant threats to the access to health care for Hepatitis C patients posed by the changes proffered by Republicans and the President-elect.
Hepatitis C and ACA repeal
In the Hepatitis C realm, the threat of repeal or major curtailment of the Affordable Care Act could have catastrophic consequences to those infected with virus and dealing with the associated health issues. The pre-existing condition clause of the ACA, which bans insurers from barring coverage to persons because of an existing health condition, is a key element of the law that allowed may with Hepatitis C to secure health coverage since it was passed. The popularity of this clause is likely to allow it to survive ACA modifications, or to have it emerge in some form in whatever ACA alternative proposed by legislators.
Medicaid expansion is unpopular in Republican states, and many have declined undertaking expansion. Many of these same states, however, house the exact types of Americans that this provision was created to cover. Low-income workers and agricultural/seasonal workers are those who benefit from this extension of coverage. In states that have tried to take steps to reverse their initial support of ACA provisions such as the expansion have found themselves in a moral and political impasse of trying to justify taking health coverage from hundreds of thousands of their citizens. Kentucky is one of these states. Their current governor successfully ran on a campaign that promised to curtail the state’s participation in the ACA, including the Medicaid expansion. This promise has proven to be less likely to come to fruition as he faces the reality of cutting coverage to 400,00 of his citizens if he sees it through. It should be noted that Kentucky is a state that saw a huge Hepatitis C outbreak in recent years, and many of those affected by this outbreak are the very same low-income citizens covered by the state’s Medicaid expansion. Drastic changes to the ACA and Medicaid funding generally could mean the loss of coverage to theses existing patients, and no recourse for obtaining coverage for newly-identified patients. The real-world challenges of attempting a state-level repeal in Kentucky offer some hope that Medicaid expansion can survive in some form, even after an ACA overhaul. However, public awareness and continued pressure on legislature to present comparable alternatives are essential to maintaining access to health care for the millions that could be affected by these changes.
Block Granting Medicaid: Reducing funding to an already cash-strapped program
One of the leading threats to health care coverage for the poor in this country is the Republican push to change Medicaid to a block grant program. This means that states would get a set amount of money to run their program each year, rather than the current process of the federal government providing 60 percent of the funding, and requiring states to cover certain groups of people, such as pregnant women and children. Currently, Medicaid is an entitlement program, which means all who qualify for it must receive coverage. A block grant system would allow states to cap the number of persons it enrolls, and to cut the covered services that the states provide. Block grants would give states more control over how they run their programs and who are covered, but that also means that there is no guarantee that those currently covered will retain their health care. Analysts project that such a plan would leave millions of Americans uninsured.
One of the bigger costs to states under Medicaid is pharmaceutical expenses. I have already droned on ad nauseum in previous blog posts about the cost of Hepatitis C drug treatments. Drug costs will be one of the biggest expenses on the chopping block under the block grant scheme, and Hepatitis C patients, who are already facing hardships getting their drugs covered through Medicaid under its current funding system, will likely face an even greater challenge to getting the drug and clinical care they need to survive.
Government has a DUTY to preserve the health of the people
As the new administration and Congress takes control, I urge them to remember the tenet that they have a responsibility to make laws and policies in the best interest of ALL AMERICANS. Health care is chief on that list, because the government is charged to provide care to those least equipped to afford it, such as the poor, disabled, and elderly through programs like Medicaid. The new administration and the Congress MUST transcend political discourse when considering changes to the public health schemes, and focus on implementing common sense policies that will protect access to health for the most vulnerable.
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The views reflected in this blog are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.