The year 2017 was a tumultuous year with regard to health care reforms in the United States. In July 2017, the seven-year Republican endeavor to repeal the Affordable Care Act (Obamacare) failed in the Senate due to lack of a suitable replacement. Many termed this effort a “skinny repeal.” After numerous failed attempts, in September 2017, the Senate decided not to vote on the Graham-Cassidy bill to repeal and replace Obamacare.
Despite these legislative setbacks, President Donald Trump took the executive order route to make health care policy announcements and change the existing rules, especially related to health care insurance. In a Dec. 26, 2017 tweet, President Trump was optimistic that the Democrats and Republicans would work together to develop a new, bipartisan health care plan that would be beneficial for all.
The opioid crisis has been a key focus of the Trump administration. The U.S. Department of Justice (DOJ), along with the Drug Enforcement Administration (DEA), announced a series of measures in 2017 to combat the crisis:
- New initiatives: Three new initiatives were announced by Attorney General Jeff Sessions in November 2017. U.S. state and local law enforcement agencies would be given grants of over $12 million to prevent the trafficking and distribution of illicit drugs like heroin, cocaine and methamphetamines. AG Sessions also announced the setting up of a new Field Division in Louisville, Kentucky to focus on drug-control efforts in the Appalachian region. Further, he mandated all U.S. attorney offices to designate opioid coordinators to lead the anti-opioid efforts in their communities.
- Public health emergency: In October 2017, President Trump declared the opioid crisis a public health emergency to address the spiraling drug epidemic. However, no new funding was requested as part of the declaration. Since taking office, President Trump has allocated more than $1 billion in funding to address drug addiction and the opioid crisis. In fact, the President has also pledged $100,000, his third-quarter salary, to the Department of Health and Human Services (HHS) to fight the opioid crisis.
- Opioid Fraud and Abuse Detection Unit: Established in August 2017, this data analytics program targets individuals, illegal manufacturers, transnational criminal organizations and illegal marketplaces involved in opioid-related health care fraud. As part of the program, the DOJ seized the largest illegal online marketplace and separately indicted two Chinese nationals proposing to distribute significant quantities of fentanyl in the U.S. Apart from this, officers from the U.S. Customs and Border Protection (CBP) have intercepted tons of drugs being smuggled into the country via its borders.
Tax Cuts and Jobs Act (TCJA):
When the attempt to rescind the Obamacare failed, President Trump passed the tax reform bill. The bill passed in December 2017, will affect health care spending in two ways:
- Firstly, it would repeal the individual mandate provision of Obamacare which required individuals to take health insurance or be liable to a penalty. According to the Congressional Budget Office (CBO) estimates, this would increase the number of uninsured Americans by 13 million.
- Secondly, it would lower the threshold limit of personal health care expenses as a percentage of individual income – from 10 percent to 7.5 percent – to qualify for deduction. A previous version of the bill had sought to repeal this deduction, which would have significantly impacted individuals with high medical costs.
Changes to Obamacare
President Trump signed an executive order in October 2017 which aimed to provide affordable health care insurance to millions of additional Americans by giving them more choice and increasing competition, thereby lowering premiums. Key provisions of the order included:
- Making it easier for small businesses, and maybe individuals, to collaborate and buy health insurance through national association health plans.
- Allowing customers to buy short-term policies which would not need to comply with protections related to pre-existing conditions under Obamacare.
Broadly, the order directed federal agencies to consider easing the rules associated with the issuance of various health plans. These changes would not entail any additional costs to the federal government. Experts, however, expressed concerns about the potential destabilization of insurance markets and higher costs for the elderly and sick Americans due to younger and healthier people exiting plans under Obamacare exchanges.
Discontinuation of health care subsidies
In a follow-up announcement to the October 2017 executive order, President Trump announced the end of reimbursements to Obamacare insurers who were subsidizing payments for low-income individuals. The CBO estimated that premium costs in 2020 would be 25 percent higher due to the discontinuation of these reimbursements. Anticipating this, premiums for 2018 had already increased sharply due to previous hints by President Trump signaling his intention to do away with the reimbursements.
Moreover, the Trump administration did not shy away from blocking important information from the official website of Obamacare, using infographics to portray it in poor light, posting critical YouTube videos, announcing a 40 percent cut in the funds needed to advertise the health plan, not sending officials to the enrolment programs and shutting down the website for 12 hours on Sundays, specifically during the run up to the enrolment period.
Further, the President also reduced the time for open enrollment to less than a month in order to discourage people from joining the health care plan. But, contrary to expectations, the first 18 days of the open period saw nearly 2.3 million people enlisting for Obamacare.
Prescription drug prices
President Trump has also singled out pharmaceutical companies for the high prices of prescription drugs. “Prescription drug prices are out of control,” the President had said in a Cabinet meeting in October 2017. However, no action has so far been taken on this.
Alternatively, the Drug Enforcement Administration (DEA) hosts two National Prescription Drug Take Back Days in April and October every year. This year, more than 900 tons of prescription drugs were collected across the country on these days.
Addressing opioid addiction
According to the 2016 National Survey on Drug Use and Health (NSDUH), 19 million adults suffered from a substance use disorder (SUD). Treatment for any addiction entails a medically assisted detox program. Detox helps in flushing out the accumulated toxins, from years of substance abuse, from the body, preparing the individual for addiction treatment.
The leading detox treatment center in California, Sovereign Health can handle complex cases of substance use disorders with ease. Our multidisciplinary team provides a full diagnostic assessment, designs customized treatment plans and ensures utmost care during the recovery process. If you or a loved one is struggling with an addiction to a substance, call our 24/7 helpline or chat online to know about our evidence-based treatment for detox in California.