Fuente: Chicago Tribune
Ubicación: United States

For months, officials in Republican-controlled Iowa had sought federal permission to revitalize their ailing health-insurance marketplace. Then President Donald Trump read about the request in a newspaper story and called the federal director weighing the application.

Trump’s message in late August was clear, according to individuals who spoke on the condition of anonymity to discuss private conversations: Tell Iowa no.

Supporters of the Affordable Care Act see the president’s opposition even to changes sought by conservative states as part of a broader campaign by his administration to undermine the 2010 health-care law. In addition to trying to cut funding for the ACA, the Trump administration also is hampering state efforts to control premiums. In the case of Iowa, that involved a highly unusual intervention by the president himself.

And with the fifth enrollment season set to begin Nov. 1, advocates say the Health and Human Services Department has done more to suppress the number of people signing up than to boost it. HHS has slashed grants to groups that help consumers get insurance coverage, for example. It also has cut the enrollment period in half, reduced the advertising budget by 90 percent and announced an outage schedule that would make the HealthCare.gov website less available than last year.

The White House also has yet to commit to funding the cost-sharing reductions that help about 7 million lower-income Americans afford out-of-pocket expenses on their ACA health plans. Trump has regularly threatened to block them and, according to an administration official who was not authorized to speak publicly, officials are considering action to end the payments in November.


Sector Seguridad-Justicia

The Trump administration is effectively undermining the Health services, which translates in a lack of resources to cover the health needs of the population. In the particular case of Iowa, there is an opioid crisis that reclaims attention to fight addiction and help the sick people to recover, if not the security conditions could get worse because, if law enforcement is able to block the access to drugs but it is not able to provide medical attention to the addicts, these people could start taking more violent actions in order to get addictive substances. Also, the local government would have to supply the remaining budget in order to guarantee access to health care services, which could affect the state´s performance in other areas, including security. Also, there could be problems among citizens due to the lack of access to health services, which could cause a change in their behavior and ultimately, in some cases, could push some individuals into illegal activities in order to be able to provide said services for their families.

Sector Político-Social

This news comes amid the debate caused by the potential substitution of the Affordable Care Act which has caused a lot of controversy all over the country. Since the bill pretends to transfer the regulation of health care to each of the states, this could likely have a negative impact in the social security perception of citizens, because several states are facing financial problems, as they have had to take care of emergencies situations such as the impact of hurricanes in the East Coast and the incidence of wildfires in the West Coast. In the particular case of Iowa a possible blocking of fundings of the health department could aggravate further the social discomfort, as citizens feel helpless because they are been denied the access to proper health care. It also would decrease the perception on the performance of the Executive Branch, as citizens could feel that the government is intervening more in their lives

Sector Económico-Financiero

As Iowa's aimed to foster more competition and better prices in insurance exchange markets, a move that could have served as an example for other states with struggling with rising insurance rates, the President Trump’s acting has been perceived as sabotage, injuring millions in the making. The GOP efforts to repeal and replace the Affordable Care Act have, for now, failed, and the Trump administration, one that has repeatedly claimed the unsustainability of the Obama-era healthcare program, seems to be now focusing on changing provisions and state markets. The obstacles to add flexibility to local insurance markets, the delay in a commitment to fund cost-sharing reductions that help about 7 million lower-income citizens afford expenses on their ACA health plans, the plan to allow small businesses and individuals to unite to buy health insurance plans exempted from some Obamacare requirement, among some other budget cuts have increased uncertainty in insurance markets, forcing entities out of the markets and pushing premiums for 2018 higher than in previous years, injuring household income and likely reverberating in less people insured.