How Will Trump Administration Impact HIV Health Policy?

In the nearly seven years since the Patient Protection and Affordable Care Act (ACA) was signed into law in March 2010, there have been many unsuccessful attempts led by House Republicans to repeal the ACA entirely, change or eliminate some of its main provisions, or restrict the funding necessary to implement the law.

With the inauguration of President Donald Trump and the election of Republican majorities in the House and Senate, proposals to repeal and replace the ACA are now being pursued with renewed energy. However, these efforts are also being met with strong opposition from supporters of the ACA who fear that many people, especially persons with low incomes or chronic conditions, may lose health coverage or be burdened with higher health care costs.

This issue, completed during the first week of the Trump Administration, is devoted largely to recent news about health policy changes expected under President Trump and the 115th Congress. We have also included coverage of the hopes and concerns of proponents and opponents to the proposed changes in U.S. health care -- with an emphasis on the impacts of these changes on the care and treatment of HIV and viral hepatitis.

President Trump's First Executive Order Directs Agencies to Scale Back Parts of the ACA

On January 20, President Trump issued his first executive order, which explicitly states his Administration's intention to promptly repeal the ACA and directs the heads of federal agencies and executive departments to scale back implementation of the law.

In particular, the order states that, "To the maximum extent permitted by law, the Secretary of Health and Human Services (Secretary) and the heads of all other executive departments and agencies (agencies) with authorities and responsibilities under the Act shall exercise all authority and discretion available to them to waive, defer, grant exemptions from, or delay the implementation of any provision or requirement of the Act that would impose a fiscal burden on any State or a cost, fee, tax, penalty, or regulatory burden on individuals, families, healthcare providers, health insurers, patients, recipients of healthcare services, purchasers of health insurance, or makers of medical devices, products, or medications."

News summaries of the executive order published by Health Affairs, Kaiser Health News, the Associated Press, and elsewhere indicate, however, that its immediate impact may be limited.

Since the current healthcare rules under the ACA have already been incorporated into insurance company contracts for 2017, the order may have little effect on coverage this year.

In addition, as of this writing, no high-level political appointees had yet been installed at the Departments of Health and Human Services (HHS), Labor, and Treasury, which have primary authority over the law. President Trump had nominated secretaries for each of these departments -- U.S. House Budget Committee Chairman Tom Price (R-GA) for HHS, CKE Restaurants CEO Andrew Puzder for Labor, and Dune Capital Management CEO Steven Mnuchin for Treasury -- but none had yet been confirmed. Once the heads of these agencies are confirmed, the agencies will need time to develop policies implementing the executive order.

Republican members of Congress broadly support President Trump's intention to repeal the ACA. However, their views on which parts of the ACA should be replaced, modified, or retained vary widely, as evidenced by the differing provisions of the healthcare proposals that Republicans have floated before and after the 2016 election.

Negotiating, reaching consensus, and passing comprehensive healthcare legislation to replace the ACA will likely take considerable time. ACA advocates are expected to fight hard to retain the law or, failing that, some of its key provisions, such as coverage for pre-existing conditions and premium subsidies for low- and middle-income persons.

Finally, assuming a new healthcare law is passed, new regulations implementing the legislation cannot be issued immediately. They must follow an established process that requires a period of public notice and the opportunity for interested parties to comment on the proposed regulations before they become law.

In fact, one of the provisions of Trump's executive order explicitly acknowledges this: "To the extent that carrying out the directives in this order would require revision of regulations issued through notice-and-comment rulemaking, the heads of agencies shall comply with the Administrative Procedure Act and other applicable statutes in considering or promulgating such regulatory revisions."

Eric Brus writes about HIV policy. His HIV/AIDS Disparities Report is produced by the New England AIDS Education and Training Center Minority AIDS Initiative Project. The full version is available here.