Changes to Affordable Care Act Will Leave Low-Income Families at Serious Risk

It is well understood that the economy of a country becomes more robust as the health and well being of its citizens improves. It is also clear that improving the health of a nation’s citizens can directly result in economic growth, partly because more people are more productive in the labor force.

But word that President-elect Donald Trump wants to cut or modify the Affordable Care Act could undermine the progress we’ve made as a nation. One of the biggest impacts will be on the fate of minorities and low-income women. The lack of affordable health insurance among these vulnerable Americans poses a particularly serious threat to the nation’s economy.

When workers are able to save for retirement through public or private savings portfolios, it reduces the risk of financial hardship in later life. Healthy workers can also stretch out their productivity years, which also allow assets to grow and increase Social Security benefits. A 2016 study by the National Retirement Institute found that pension benefits have a positive impact on the economy, generating an output of $1.2 trillion.

The growing importance of health to an economy cannot be underestimated. As national health- care expenditures grow toward 20 percent of GDP, efforts to control costs are inevitable. If Medicaid continues to pay less than other forms of insurance, providers may not participate unless they are forced to do so. Medicare enrollment growth is anticipated to be the major force driving public healthcare spending in the future, and Medicaid expenditures will be fueled largely by a new prescription drug benefit and the rapid growth of baby boomers in retirement.

Repealing or making any changes in the new law will disproportionately affect low-income families, many of whom belong to racial and ethnic minority groups.

That action could result in 22 million Americans losing their health coverage or scaling it back. According to the White House Council of Economic Advisers, although the gender gap has narrowed, that figure includes about 14 percent, or 3.7 million women near retirement age who are already uninsured. In a separate study appearing in the Journal of Women’s Health Issues, three states — Texas, Florida and Virginia — have a total of more than 1.8 million near-retirement women, more than 468,000 of whom are uninsured.

Obamacare provided new incentives to improve the quality of transitional care and reduce costs, which now may be abolished. Transitional care follows patients across multiple settings (institution, community and home) and is especially salient for women and family caregivers. Recent analyses of the Health and Retirement Study demonstrates that women over age 50 are more likely than men to be discharged from a nursing home and to need home care. This fact means that the program could reduce hospital readmissions for high-risk Medicare beneficiaries and increase Medicare savings.

Furthermore, the long-term financial implications of an aging population are becoming increasingly clear. With advances in medical care, the potential cost of the final few years of life could bankrupt the nation. Difficult issues related to the rationing of care and the control of health-care budgets must be addressed by the new administration. Again, in an economic and political environment in which rationing becomes necessary, politically weak groups will be vulnerable. For many low-income Americans and “dual-eligible” elders, (those participating in both Medicare and Medicaid), a severe lack of resources and serious health limitations introduce major uncertainties into their own and their families’ futures.

The movement away from traditional family and residential arrangements that results from neoliberal market reforms and international migration means that norms and practices related to intergenerational relations and exchanges will change.

Trump appears open to keeping two of the most widely recognized and popular provisions of the ACA: coverage for individuals with pre-existing conditions and allowing young adults to stay on their parents’ insurance plans until they reach age 26. What he should also consider is keeping the requirement that caps enrollees’ annual out-of-pocket expenses. All of these issues merit serious deliberations.

The health of the nation is on the line.

Jacqueline Angel is a professor of sociology at the University of Texas at Austin.