President Trump’s Executive Order on Health Insurance

Statement of HIVMA Chair Melanie Thompson, MD:

The HIV Medicine Association is deeply concerned about the potential impact on persons living with HIV of the Executive Order signed today by the President. This order could undermine critical health insurance consumer protections in the small group market and lead to the erosion of these protections in the individual market depending on how it is implemented. Under these new options, some people living with HIV and others with chronic medical conditions would be unable to afford health insurance and the life saving medications and healthcare it provides.

While details are yet to be determined, the Executive Order directs the Department of Labor to consider allowing small businesses potentially anywhere in the country to band together to offer health insurance to their employees without certain consumer protections important to preventing plan discrimination and maintaining affordability. Theoretically, these plans could exclude currently required coverage for essential health benefits, including prescription drugs. The Order also directs the Departments of Treasury, Labor, and Health and Human Services to consider expanding Short Term Limited Duration Insurance (STLDI) that would be more broadly exempt from critical Affordable Care Act protections, allowing them to charge more and deny health coverage based on health status, offer limited benefits packages and impose annual and lifetime caps on health coverage.

While the purpose of insurance is to share risk across healthy populations and those needing more medical services at a given time, this plan would segment the non-group insurance market by drawing healthier people to plans with lower premiums and far fewer benefits, leading to higher premiums for the rest of the market. This would destabilize the individual market that people with chronic conditions like HIV will be forced to rely on - if they can afford it - in order to access the care and treatment they need.  Such a move will particularly harm people with HIV and also could worsen the HIV epidemic in America.

We have made remarkable progress in the treatment and prevention of HIV. With reliable access to comprehensive medical care and prescription drugs, persons with HIV can stay healthy and keep the virus under control, thus allowing them to live a near normal lifespan and reducing the risk of transmitting HIV to virtually zero. Restricting their access to health insurance coverage, and therefore HIV medications, will not only leave them sicker, but will likely contribute to an increase in new HIV infections. Both outcomes will cost more in the end and amplify existing health disparities.

This Executive Order could begin to unravel health reforms that leveled the playing field for individuals with HIV and 52 million other Americans living with pre-existing conditions. It will threaten the health of those left uninsured due to unaffordable health care costs and add additional stress to our safety net health systems such as public hospitals, dealing a blow to our attempts to control and eliminate our domestic HIV epidemic, especially in the South.

Instead of undermining health reforms that have improved the lives of tens of thousands of people living with HIV and millions of other Americans, HIVMA calls on the Administration and Congress to collaborate on bi-partisan strategies that will stabilize the non-group health insurance market, including supporting a robust open enrollment period and ensuring sustained federal funding for cost sharing reductions.