Women’s health and mental health are “under attack” from the proposed changes to the Affordable Care Act, said Ben Domingo, director of Syracuse University’s Health Services.

The possibility of mental and women’s health care no longer being part of the required coverage under the ACA due to President-elect Donald Trump’s proposed amendment of the legislation is a cause for concern, Domingo said.

Domingo said the reduction of coverage for women’s health care and mental health care is one of the potential changes to the ACA that would affect college students the most. He added that both women’s health and mental health are major parts of the primary care needed for college students.

“People have to be concerned about coverage for women’s health care,” Domingo said. “You have a lot of people who have different ideas in office now about women’s reproductive rights, whether that’s covering birth control or other things that is now mandated under the Affordable Care Act.”

Beginning this semester, all Syracuse University students were required to either sign up for the university’s ACA-compliant health insurance plan or have their own health insurance meet certain requirements, which included being compliant with the ACA.

Throughout his campaign, Trump repeatedly said if he was elected he would repeal and replace the ACA.

However, Trump recently pivoted from his long-held stance on the ACA by saying he may want to amend the health care law instead of fully repealing it. The president-elect said he came to this conclusion after meeting with President Barack Obama in the Oval Office on Nov. 10.

The specific parts of the legislation that Trump said he would like to keep are the ones that prevent insurers from refusing coverage for preexisting conditions and allow children to stay on their parents’ health care plans until age 26.

In the past, when Republicans in Congress have tried to repeal the ACA — moves which were ultimately vetoed by Obama each time — they kept in these two provisions, said John Palmer, a University Professor at SU who specializes in health care financing and federal budget policy.

One part of the ACA that may be repealed is the mandate that everyone in the U.S. has to have health care insurance, Domingo said.

If there was no mandate saying people had to have health insurance, only those who need health care insurance — typically higher risk customers — would buy it, Palmer said. Younger, healthier people would either not buy health insurance at all or they would sign up for a “bare-bones” plan, he added.

This would create a dichotomy within the health care consumer pool between heavy users driving up the cost of insurance and light users, who may not need as much coverage, paying the same price as heavy users. To ensure there is affordable health care for everyone, Palmer said people have to be required to buy it.

If the mandate is eliminated or other changes are made to the ACA, Domingo said it would make SU’s student health care insurance requirement “a lot trickier.”

“We’re going to have to navigate and figure out what we decide are minimum requirements for the university in order to determine students are in our opinion ‘adequately insured’ — that’s always very subjective,” Domingo said.

Before Domingo came to SU in June 2011, the university did not require students to have health insurance, which was he said was an anomaly. Just a year before, the ACA had been passed and was still being implemented when Domingo started working at Health Services.

He added that it was an anomaly because every major private research institution — with the exception of SU and Baylor University — had a health insurance requirement for students.

As soon as the ACA was passed and implemented, SU had to drop its voluntary health insurance plan and work on making it required for students.

Another change that may happen to the ACA is the allowance of people to enter health care exchanges from different states. Currently, U.S. citizens are required to buy health care insurance only from companies in their state of residence.

Actual regulation of insurance occurs at the state level, so right now an insurance company that’s based in Pennsylvania, for example, can’t offer their policies in New York, Palmer said, unless that company meets both Pennsylvania and New York state standards.

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“The problem is some states, particularly out West and in the South, have very low standards for what they require and if you start allowing them to market those in New York, people in New York won’t understand,” Palmer said.

The number of health insurance policies people are used to looking at in their home state may increase exponentially — from three or four to about 50 — if the state level health insurance regulation is removed, Palmer said. And it may be difficult for people to understand the differences in all of these policies, he added.

Republicans feel that opening up the health care exchange for people to buy from any state would increase competition and drive down the cost of health insurance, Palmer said. But then people would have to deal with the added difficulty of choosing from numerous companies and policies, he added.

There are ways to amend and change what is currently included in the ACA, but “none of (the changes) are going to be very satisfactory,” Palmer said.

“That’s why it sort of leads you back to something that is like Obamacare,” Palmer said. “… It’s gonna be hard if they want to offer affordable insurance to all those people who aren’t getting it through an employer or who aren’t poor enough to get it through Medicaid, to do something that’s very different than what we’ve got now.”

Virtually all legislation that could be passed — including these proposed changes to the ACA — require a Senate supermajority of 60 votes or more because the threat of a filibuster can prevent bills from getting to the floor for a vote, Palmer said.

After the election, the Republicans are projected to hold only 52 seats in the Senate — enough for a majority, but not a supermajority. Democrats in the Senate have the ability to block legislation they are unhappy with and make Republicans compromise with them.

Palmer said he’s not sure how these potential amendments will play out, but any changes that are made would not go into effect for a few years because the government would have to phase out the current ACA policies to introduce the new ones.

Domingo said he does not think there will be a repeal of the ACA without some sort of plan for its replacement because that would be “political suicide.”

SU is not currently discussing plans for the future if changes are made to the ACA, Domingo said, but as soon as amendments are announced the student health insurance committee will hold weekly meetings to decide what the university should do moving forward.

Published on November 17, 2016 at 2:41 am

Contact Sara: smswann@syr.edu | @saramswann