Executive order on Affordable Care Act raises concerns for UCF students

UCF students walk by the 60,000-square-foot Health Center, which saw more than 68,000 patient visits in the last year.

Staying true to his promises, one of President Trump’s first actions in office was to issue an executive order scaling back the Affordable Care Act.

The one page order signed by Trump on the day of his inauguration intends to scale back as many aspects of the Affordable Care Act, or ACA, as possible.

President Trump gave no specifics about which components of the law the order was targeting, leaving students concerned for what parts of the act will be affected.

“I worry about the public if something sufficient isn’t put in place of the ACA,” said Emily Marshall, a senior communication sciences and disorders major. 

The aspiring speech pathologist benefits from one of the aspects of the ACA - she can stay on her parents’ health care while in school until she is 26 years old.

“I’m very blessed and I know that other people are not as fortunate as me,” Marshall said.

“I’ve had my own range of issues throughout my lifetime; I’ve seen the cost of healthcare but I have the relief of knowing so much of that cost is alleviated by my health insurance," Marshall said. “To be billed that full amount is absolutely horrifying.”

Marshall isn’t the only concerned student. Richecar Polinice, 20, a junior health science major at UCF, grew up in the foster care system. Since she was young, Polinice never had to worry about her health care and has always qualified to be covered by Medicaid, but is now worrying about her options.

According to Polinice, on a recent run to the pharmacy for her monthly birth control a pharmacist informed her that her Medicaid had been cut off.

As part of the Medicaid expansion provision in the ACA, a revision was put in place that would postpone the loss of coverage from age 19 to age 26 for former foster youth.

But, Medicaid expansion to low-income adults was made a state option by a June 2012 Supreme Court ruling. Only 32 states, as of 2016, have adopted the expansion meaning 19, including Florida did not, according to the Kaiser Family foundation.    

This leaves some now having to pay for services out of pocket until a solution is found. 

For Polinice, it means having to be off oral birth control and relying instead on other forms of contraception like condoms.

“I don’t want to be like other college students, that you know end up pregnant,” said Polinice. “I like knowing that I am protected and knowing that I have a plan B.”

According to Polinice, her main method of birth control, taking the pill every day, would cost the struggling college student $56 without insurance.

Condoms are said to only be 82 percent effective, meaning about 18 out of every 100 women who use condoms as their only birth control method will get pregnant each year, according to the Planned Parenthood website.

Under the ACA, 18 types of birth control must be covered by health insurance plans, but the provision has been a consistent talking point across party lines. The issue at one point was brought before the Supreme Court but was put on hold because of the vacant seat and relegated to a lower court.

In light of a new Supreme Court appointee the mandate may be revisited, which has people like Polinice and Marshall worried.

“Birth control is very integral to my relationship with my boyfriend, and the possibility for that to go away is very scary," said Marshall. “It would completely change my sex life, and I would try my best to pursue affordable forms of birth control.”

According to the Kaiser Family Foundation, contraceptives make up an estimated 30-44 percent of out-of-pocket health care spending for women. Since the ACA’s inception, by the year 2013 most woman have had no out-of-pocket costs for their contraception.

If the Trump administration modifies or eliminates the ACA contraceptive coverage rule woman must look to insurance companies or employers who will make choices about coverage and cost-sharing, ultimately limiting or leaving the most cost-effective method just out of reach.

For Arelys Rosario, 26, a senior engineering major, woman’s issues where not on her mind and she felt a complete ACA repeal was due. 

“I think it should be a competitive system. I think people should pay for what they value,” said Rosario. “[A competitive system] is more diverse, it doesn’t limit you into what brackets you fit in.”

Rosario, having quit her job as a youth pastor in North Carolina, decided to go back to school just two years ago. She chose to not pay for insurance.

Feeling healthy and not wanting to place a financial burden on her mother, Rosario didn’t feel like she needed to be covered and that it would be a lot to pay for while still in school.

“I am a student right now, so it’s a very short window, just two years. After [I graduate] I’ll have a career and then I’ll have health insurance that I’ll pay for, hopefully,” said Rosario. “One that I choose for myself. I am not saying that [not having insurance is] long term and that I want to live like that the rest of my life.”

Under the ACA, people must have qualifying health coverage or risk paying a penalty in their next federal tax return. For Rosario, it means paying 2.5 percent of household income or $695 per adult, whichever of the two is higher.

At UCF, students are able to purchase insurance plans through the Children's Health Insurance Program, or CHIP, at a more affordable rate than on the ACA market place.

Director of Student Health Services, Dr. Michael Deichen is an advocate for the CHIP insurance provided by UCF for students. He is not nervous about any changes occurring to students’ access to the CHIP. Instead, Dr. Deichen is more worried about students losing the ability to stay on their parents’ health plans until age 26 and of exclusion due to pre-existing conditions.

According to Dr. Deichen, “UCF five years ago had 1 in 5 students who were not insured; as of November this year that number has shrunk to 6 percent from 20 percent.”

“I think that [the lowered percentage] has been ACA’s greatest influence,” said Dr. Deichen.

The 6 percent are those students that fall in the insurance coverage gap when Florida decided not expand Medicaid coverage.

Meredith Robertson, UCF Health Management and Informatics instructor, emphasized that “all of the ideas that have come [from the Trump administration] are not new ideas.”

The Trump administration wants to give more regulatory oversight to states and wants states to be able to sell across state lines, but Robertson says she doesn’t see that being feasible.

A state by state plan was originally proposed for the ACA but insurers were reluctant to participate. Insurers all have local provider networks but not national level networks.

“Everything being proposed we’ve heard before,” said Robertson. 

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