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to Section One | to Arts & Entertainment
posted Friday, May 26, 2017 - Volume 45 Issue 21
Health care catastrophe if Trump gets his way

23 million to lose insurance; deep cuts to HIV services, research
Section One
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Health care catastrophe if Trump gets his way

23 million to lose insurance; deep cuts to HIV services, research

by Mike Andrew - SGN Staff Writer

America is on track for a health care catastrophe if Republicans succeed in replacing the Affordable Care Act (ACA, or Obamacare) with the legislation that passed the US House of Representatives, and the situation will only get worse if Donald Trump's proposed budget passes.

According to a Congressional Budget Office (CBO) projection, 23 million Americans will lose their health insurance if the Republican plan makes it through the Senate. Most of the losses will take place in the first year of the plan, with 14 million people losing coverage in 2018 if the ACA is replaced.

'Premiums would vary significantly according to health status and the types of benefits provided, and less healthy people would face extremely high premiums,' the CBO said in a report released May 24.

Older Americans would also have to contend with much higher premiums, and all but the richest of them would likely be priced out of the insurance market, along with people who have pre-existing conditions - in other words, anyone who's ever been sick.

In a one-two punch aimed at middle- and lower-income Americans, Trump's proposed budget cuts also target the health care system, especially programs that benefit LGBT folks and people of color.

For example, Trump plans to cut Medicaid - the program that helps many low-income people pay for their health insurance under the ACA - by $600 billion over the next 10 years.

Domestic HIV/AIDS programs are also slated for deep cuts. The proposed budget for the Centers for Disease Control and Prevention (CDC) includes a $186 million cut in funding that affects HIV/AIDS prevention.

In the CDC's own budget request justification, public health officials admitted the impact on HIV services.

'At the FY 2018 requested amount, CDC will reduce activities around testing, support services for persons living with HIV, and prevention services,' they wrote.

'In addition, CDC's ability to implement innovative demonstration projects or research examining strategies related to high-impact prevention and new tools supporting HIV prevention will be reduced.'

Americans living with HIV would not be the only victims of Trump's budget. Under the slogan 'Putting America's Health First,' the Trump budget cuts $2 billion in global health assistance, which includes a $225 million reduction in the US contribution to the Global Fund, an international organization fighting HIV, tuberculosis, and malaria.

Disease prevention programs - especially those that serve communities of color - are also targeted under Trump's plan.

His proposed budget cuts $222 million off of 2017 spending on disease prevention and health promotion programs. It eliminates $51 million for 'Racial and Ethnic Approaches to Community Health' programs, $18 million for cancer prevention efforts, and $8 million for an epilepsy program.

Trump also wants to eliminate $136 million for public health preparedness and response programs. Most of that cut is a $107 million reduction for 'Public Health Emergency Preparedness Cooperative Agreements,' a joint federal-state-local project to ensure that local public health departments have the resources to respond to a crisis.

CDC-funded occupational health and safety programs would take a $138 million hit, which the agency says would prevent it from funding 'state and academic partners for conducting, translating, or evaluating research' as it has in years past.

The budget would also eliminate $64.9 million for 'emerging and zoonotic infections,' including activities related to chronic fatigue syndrome and prion disease.

Mental health services would take two hits - a $116 million cut to mental health services block grants, and a $136 million reduction in 'programs of regional and national significance.'

One of the biggest line-item cuts in the entire budget comes from HHS Community Services Block Grants, a $714 million pool of money awarded to communities around the country to address issues of poverty - and often poverty's public health implications. Those grants would be zeroed out entirely in 2018 under the White House's funding request.

Repeal of the ACA and deep budget cuts to health and human services are intended to finance a proposed tax cut for the very rich. The nonpartisan Urban-Brookings Tax Policy Center forecasts that more than half of the tax savings in Trump's plan would eventually accrue to the wealthiest 1% of taxpayers.

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