As a black bisexual woman living in the United States, I find that Donald Trump’s America is constantly presenting me with new challenges to overcome. Last week, I woke to meet the reincarnation of two old foes that I naively and wholeheartedly hoped were just lost dreams of the GOP — an executive order attempting to espouse religion as the law of the land and the official Republican-led House passage of the latest iteration of the American Health Care Act, or Trumpcare.
I have many thoughts about the horrors that Trump’s executive order on “Promoting Freedom and Religious Liberty,” presents, but as many legal entities have already noted, this order, much like most of the actions and actors in the Trump administration, is purely rhetorical and ultimately toothless. Even the conservative-leaning news outlet National Review declares that “Trump’s Executive Order on Religious Liberty Is Worse Than Useless.” However, one important thing to note is that the executive order does charge the secretary of Health and Human Services, Tom Price, to issue amending regulations that address the conscience-based objections to the preventive services mandate within the Affordable Care Act.
The contraceptive coverage mandate requires certain employers to provide contraceptive coverage to their employees without cost-sharing. This provision was at the center of the Supreme Court’s Hobby Lobby decision, in which the court decided that even for-profit corporations, if closely held, could seek an accommodation for their religious objections to the mandate. Unsatisfied with this result, similar plaintiffs brought the case Zubik v. Burwell, asserting that the sheer act of seeking the accommodation made them complicit in the wrongdoings of others. The Supreme Court ultimately refused to issue an answer in this case and instead remanded the case to the lower court with the hope that the two competing parties would be able to find a solution among themselves. That nonruling occurred last summer, and the parties have yet to come to any form of agreement.
Undoubtedly, then, the executive order’s directive to Secretary Price to issue new regulations that answer the question that the Supreme Court was unwilling to answer is extremely important. Price has already declared his excitement about drafting an amended rule, but until HHS takes active next steps to do so, the executive order itself is ultimately meaningless.
In contrast, passage in the House of the AHCA actually is a real and present threat to dismantle the Affordable Care Act. If this piece of legislation moves any further, it could have deadly results for many people living in America, especially femme folks, uterus-having folks, immigrants, nonpale people, and LGBTQ people.
In its current form, the American Health Care Act (House Resolution 1628), which passed 217-213 along party lines, would:
- Take away health insurance from at least 24 million people.
- Gut Medicaid funding and end Medicaid expansions, affecting 11 million families, children, people with disabilities, low-income people, and seniors.
- Undermine protections for people living with HIV or other chronic conditions.
- Deny access to affordable contraception and other forms of preventive care.
- Allow insurance companies to charge people with preexisting conditions more for coverage.
- Eliminate the community rating provision that disproportionately affects people who have given birth because it would allow insurers to claim that having had a vaginal birth or a C-section is a preexisting condition. Furthermore, being a survivor of sexual assault could disqualify you for certain insurance policies or cause your insurance to cost more because being a sexual assault survivor could be categorized as a preexisting condition.
- “Defund” Planned Parenthood by blocking people with Medicaid from accessing preventive care at Planned Parenthood health centers — including birth control, cancer screenings, and sexually transmitted disease testing and treatment — which puts 2.5 million Planned Parenthood patients at risk. Planned Parenthood is one of the biggest providers of transition-related care in most areas of the country.
- Take away essential health benefits, including affordable prescription drugs, maternity and newborn care, mental health and substance abuse services, and rehabilitation services.
- Impose a nationwide ban on private insurance coverage of abortion.
- Allow members of Congress and their staff to be exempt from the AHCA.
While we don’t yet know all of the harmful consequences that will result if this bill moves further along the legislative process, we do know it will disproportionately affect LGBTQ people, who are twice as likely to be uninsured as non-LGBTQ people. According to a data from a nationally representative survey of LGBTQ people conducted by the Center for American Progress in January, 25.2 percent of LGBTQ respondents reported experiencing discrimination because of their sexual orientation or gender identity in the past year. The survey found that LGBTQ folks are more likely to avoid doctor’s offices and postpone both preventive and medical care because of their sexual orientation or gender identity. Further, this survey found:
- 23.5 percent of transgender respondents avoided doctors’ offices in the past year, versus 4.4 percent of cisgender LGB respondents.
- 13.7 percent of disabled LGBT respondents avoided doctors’ offices in the past year, versus 4.2 percent of nondisabled LGBT respondents.
- 10.3 percent of LGBT people of color avoided doctors’ offices in the past year, versus 4.2 percent of white LGBT respondents.
We also know that LGBTQ immigrants and refugees encounter even more hurdles to overcome when trying to access healthcare in any form.
So what now? We have to remain awake to today’s realities. And we must fight back. We must hold the House members who voted for the AHCA accountable through digital advocacy and showing up in person at town halls. When these members are up for reelection, we must not forget how they voted and vote them out. We must ensure that the House members who voted against the AHCA continue to see the importance of the Affordable Care Act so that when the next vehicle to dismantle Obamacare comes forth, whether through reconciliation or the appropriations process, they continue to vote to protect our care.
We also must turn to the Senate and urge senators to not take up the AHCA in its current form or in any iteration. The Senate already has gathered a group of white GOP men to begin the ACA repeal-and-replace process in the chamber, and we must stay vigilant and stop them. We must flood their phone lines and fax machines, and crowd their lobbies. We must engage in strategic social media campaigns that spread awareness both to the people who will be most hurt by dismantlement of the ACA and to the members themselves.
Remember, this is our democracy. Our members of Congress work for us. We must work not to get rid of the ACA, but to expand it so that more people have access to lifesaving health care. And when members like Rep. Raúl R. Labrador voice ignorant lies like “Nobody dies because they don’t have access to health care,” we must speak truth to power and respond with facts, including that 24 million people could die as a result of this abomination.