Keep Calm and Call Your Senators Now: Executive Orders, the Global Gag Rule, and Tom Price’s HHS Hearing Part Two

Firstly, everyone take a moment to settle down and take a deep breath. We made it through the inaugural weekend. We showed up by the droves at the Women’s March. And though the fight that many of us shared to add Hillary Clinton to the list of honorees did not succeed, we honored her howsoever we could, in our dress choices, our posters, our chants. What this should make clear to all of us is that we have the power and strength in numbers to succeed. The march was just the beginning, and now it’s time to step up even more.

So where are we in the world of healthcare? On Friday evening, we learned that Trump issued an executive order that seriously weakened the individual mandate of the Affordable Care Act that requires all people either to purchase health insurance or pay a tax instead. The mandate is utterly critical for the ACA’s stability. People love that the ACA ensures that children can stay on their parents’ plans until age 26 and that it guarantees coverage to people with preexisting conditions. But it depends on the funding from the mandate to do so. I’ve said it before, but I’ll say it again: without the individual mandate, the ACA cannot provide care to “high-risk” populations — or, in English, folks with preexisting conditions, senior citizens, the disabled, and low-income folks. So while the executive order was vague in its parameters and precise intent, it struck at the heart of the ACA, and signified the Trump administration’s serious intent to repeal the life-saving law. And it may only be the beginning of Trump’s actions to cripple the individual mandate that is the ACA’s backbone.

Let’s take a moment to look at the language of the executive order. It permits federal agencies to “waive, defer, grant exemptions from or delay” enforcing elements of the law that financially impact states and individuals. It also limits the breadth of the ACA in unspecified ways and gives states more leeway in terms of how to implement and orchestrate healthcare. Really unclear, right? But that’s precisely what’s so dangerous about it. Lawmakers can interpret it in a variety of ways in their decisions about healthcare funding. Basically, states have permission to play fast and loose with financial aspects of the ACA, which undermines the entire financial basis of the law.

Its impact doesn’t stop there, as if that’s not enough. The executive order also destabilizes the insurance marketplace, since insurers need to decide by this spring if they’ll enter the marketplace for next year’s enrollment. If the money isn’t there, what incentive do insurers have to join the market? And those that do will likely increase their premiums to compensate, which would make healthy people even less likely to purchase insurance — which they’d do with impunity. And in turn, that means again that a lot of people who need healthcare will be unable to afford health insurance, so we’re back at square one.

What exactly would repealing the ACA look like? The Washington Post ran an article spelling it out today. Conservatively, based on the New England Journal of Medicine’s studies about Medicaid’s expansion’s impact on death rates, the Post estimated that repealing the ACA is likely to cause 43,956 deaths every year. To be abundantly clear, this staggering death toll that would result from Republicans’ shameful repeal-and-delay tactic is entirely avoidable. Even if Republicans are determined to replace the ACA with some non-specified healthcare law, they do not need to repeal it first. That’s just an extra step. Republicans’ eagerness to repeal it is, however, illuminating. One, it reveals just how much they hated Obama, with their burning desire to undo his landmark legacy, never mind the cost to their constituents. Two, it enables them to “manufacture a [healthcare] crisis” to try to force Democrats, who are in unison in their efforts to protect the ACA, to play ball. Remember, Republicans can’t replace the ACA on their own, since they need 60 votes to do so. So rather than come up with a consensus plan by working cooperatively with Democrats, they prefer instead to jeopardize the health and lives of millions of Americans, including their own constituents, just to make this law they so despise go away.

But, you may say, Republicans do have plans! Sure, I’ll grant you that, but few of those plans are fleshed out, and none of them would provide anywhere near the level of healthcare coverage that the ACA does. And a lot of that returns to the issue of the mandate. If you don’t have a mandate or something like it, you cannot provide coverage for people with preexisting conditions, senior citizens, and low-income folks. You cannot provide “non-necessary” coverage (which, let’s be real, would probably have reproductive care on the top of the list) to people. You cannot provide preventive care. You cannot provide team-based holistic care that the ACA supports and that has been life-altering for many, especially those with chronic diseases (present company included). Period. End of story.

But that, as bad as it is, isn’t all. Today Trump brought back the global gag rule that forbids US funding to nongovernmental organizations that offer abortion or even discuss it with their patients. If we had any doubt that this administration intended a war on women and on women’s health, well, that doubt should stop right now. But the global gag rule existed before, you may say, and we survived, so what’s the big deal? Given that President Obama provided financial support for women’s reproductive health around the world, we’re not just talking about making abortions significantly more unsafe at home. We’re talking about completely unnecessary deaths of women who will be unable to access vital healthcare worldwide. Both in the United States and abroad, organizations that provide abortion do so as one element of many facets of healthcare. Particularly in developing countries, more and more women will be unable to access all kinds of health care that have nothing to do with abortion or even reproductive health, and all because of the Trump administration’s crusade against abortion.

To use very erudite language, this sucks. It is our duty not only as citizens, but as caring and empathetic human beings, to do whatever we can to stop this ravage in its tracks. So what can we do? For starters, call your representatives and urge them to oppose Tom Price for Health and Human Services Secretary. He’s up for his second hearing tomorrow, January 24th, so time is of the essence. I’ve even got talking points for you. While you’re on the phone with them, urge them to support Democrats’ call for investigations of Price’s potential legal and ethical violations of the STOCK Act via what looks like insider trading. And to keep it thematic, urge them to denounce publicly Trump’s reinstatement of the global gag rule as a cruel vendetta against the health and lives of women and girls worldwide. You can become a Planned Parenthood Defender. Planned Parenthood has listed lots of different ways to get involved, some of which take only minutes a week. Take a few minutes to read up on the devastating impact of the global gag rule. And follow @caring_for_us on Twitter to stay updated on ACA- and healthcare-related news, information, and actions you can take in your daily life.

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