How health care could change in Connecticut under Trump presidency

CT Post – Monday, November 11, 2024
By Cris Villalonga-Vivoni

A Trump presidency could dramatically shake up the world of health care locally and across the country under a second Donald Trump presidency. Many state health experts and elected officials say they are concerned about what changes may come under a Trump administration, but for now, they remain “ambiguous and murky,” according to at least one expert.

“There’s a lot of TBD [to be determined] this morning,” Angela Mattie, professor of management and medical sciences in the schools of business and medicine at Quinnipiac University, said this past week.

Many experts are looking at past health care policies set by the Trump administration and statements made throughout the 2024 campaign to surmise what changes will come at the federal level – from reproductive rights to health care affordability to vaccine requirements. Connecticut has a fairly liberal set of policies, but the impact of the federal policies on the state health care system is to be determined, Mattie said.

Throughout his campaign, Trump has indicated that politician Robert F. Kennedy Jr., politician and nephew of President John F. Kennedy, will play an unknown but major role in his administration.

Kennedy, 70, has worked as an activist, author and environmental lawyer. Over his career, however, he started to explore and promote conspiracies and contradict scientific consensus, most notably on vaccines.

Mattie said Kennedy has often made health claims without evidence or while ignoring scientific data that proves otherwise. For example, Kennedy recently tweeted of his intentions to look into banning the use of fluoride in drinking water first day in office, which has long been used to help prevent disease and cavities, claiming that it causes cancers. Trump told NBC News last week that he had not spoken to Kennedy about fluoride yet, “but it sounds OK to me. You know, it’s possible.”

“We have a lot of good research on several health care and public health topics,” Mattie said. “Research should inform policy, not rhetoric.”

Vaccines

Dr. Jason L. Schwartz, an associate professor of health policy at Yale School of Public Health, said Trump teased Kennedy would play a role in his administration in his initial 2016 campaign. He said Trump signaled that Kennedy would lead a vaccine safety commission but ultimately hired people who “turned out to be relatively mainstream, reasonable public health voices who also were firmly in support of vaccines.”

However, Schwartz said there’s a far greater doubt about the safety and value of recommended vaccines from the incoming administration than anyone has seen in generations. For example, NBC News recently reported that Trump said he would talk to Kennedy and others about banning certain vaccines.

Major moves like banning fluoride in water and vaccines are policies made at state and local levels, so the federal government can’t pull the trigger on those directly, Schwartz said. However, he said appointed health officials can set recommendations and guidelines and use statements influencing public opinion.

“It doesn’t require Congress to support, it doesn’t require particular budget programs, but it will very much shape the conversation about how we think about health and disease in ways that are hard to predict,” he said. “But it will be incredibly influential to sort out how the public thinks and acts about their own health and the health of their communities.”

Reproductive health care

Looking back at what Trump has done in his previous term regarding reproductive rights is a way to anticipate what he may do once he takes office in January, said Amanda Skinner, president and CEO of Planned Parenthood Votes! Connecticut, the advocacy and social welfare arm of Planned Parenthood of Southern New England in the state.

In his last term, she said Trump appointed several conservative judges to the Supreme Court that eventually helped overturn Roe v. Wade. He also proposed and passed a change to Title X, a long-standing federal program that allows family planning clinics to apply for grants to offer services on a sliding, income-based scale. His new rule forbade Title X providers from referring patients to abortion services unless the patient asked for the referral and allowed the provider to refuse to offer services on moral grounds, according to Population Connection Action Fund, a national advocacy reproductive rights advocacy group. It also removed requirements that providers offer all methods of birth control, encouraged them to prioritize natural family planning methods and required staff to involve family members in the contraceptive decision of minors.

When it comes to a national ban on abortion, Trump and Vice President-elect JD Vance have both publicly gone back and forth on whether they would pass it. However, Skinner said there’s absolute concern that a national ban is still on the table, as shown by the campaign trail and the details of Project 2025, a multi-pronged initiative to promote conservative policies under a Republican presidency.

These restrictions may look like reduced funding, creating legal structures that make it harder for people to overcome barriers and changes to health insurance or the Affordable Care Act, Skinner said.

“There is language being used that implies that what they’re not talking about is a ban,” Skinner said. “Any effort to restrict access to abortion as a healthcare procedure, any effort to insert politicians or politics into making decisions about when or whether people can build their families. Those are bans. They have the impact and effect of bans.”

There continues to be public support for abortion rights across the country. Seven ballot measures addressing abortion access were approved by voters across the U.S, according to Associated Press.

In Connecticut, several state legislators and officials affirmed their commitment to safeguard access to reproductive care and safe abortions in the state on last week during a post-election press conference. Skinner said that now is the time to act to protect access to care in Connecticut when possible, and states will be pivotal in defending reproductive rights.

However, if passed, the national ban would preempt Connecticut state law, said Sen. Richard Blumenthal at a post-Election Day press conference. He and many other legislators said they were prepared to fight the ban at the highest level. He said they will have some allies among Republicans as well and believes they can work together to stop a national abortion ban if proposed.

State Attorney General William Tong said he’s “extraordinarily concerned” about what could happen with a national ban but emphasized that abortion and abortion pills medication remain safe, legal and accessible in Connecticut.

A slippery slope for fertility care

To many health officials, abortion bans are just the tip of the iceberg that can lead to a slippery slope that restricts other reproductive health care like contraceptives and in-vitro fertilization, better known as IVF.

Although President-elect Trump has previously stated that he supports access to IVF, what that means on a practical level is not completely clear, said Dr. Alexander Kucherov, a reproductive endocrinologist at Illume Fertility, a Norwalk-based fertility clinic.

Kucherov said the concerns regarding fertility treatment on the national level include rollbacks or reductions of access to care. However, he hopes the legislators will not restrict access since some congressional Republicans have supported increased access.

He said there are also more significant concerns regarding possible embryo personhood bills, which aim to determine when a human fetus is considered a person with legal rights by law.

“Embryo personhood bills specifically can have major repercussions for carrying out appropriate fertility care and limiting the ability of a patient to do IVF in an appropriate and efficient way,” Kucherov said in an email.

Kucherov said there could be an increase in people coming to Connecticut for care if they feel their local state is not supportive of fertility care.

Affordable Care Act and prescription price costs

Although there’s no specific plan spelled out that she’s found, Mattie said there are a few changes that may come to the Affordable Care Act, like offering block grants to states that cap federal funding for Medicaid.

She also said that Trump may allow states to relax rules that protect people with pre-existing conditions. She said this plan, in particular, will affect many people’s ability to get proper medical care, worsening their conditions and raising the cost of care for individuals and the system as a whole.

Similarly, Schwartz said it needs to be clarified what the plan is moving forward with creating a more affordable health care system. He said passed legislation, like the Affordable Care Act, is complex to undo but can be tweaked, which Republicans have promised to overturn or modify for years.

He said it’s hard to imagine what it means to have the ACA pull out from underneath the feet of millions of community members in one fell swoop. However, financing subsidies and regulatory details are coming up that may lead to some modifications and changes.

Gov. Ned Lamont similarly said he worries about health care and that there’s been a lot of “loose talk” about Obamacare and its future. At a recent press conference, he said to look at what changes may be coming over the next year that could drive up the cost of healthcare for working families in the state and find ways to mitigate that.

Regarding drug prices, Mattie said she’s unsure that Trump will take on prescription drug prices this time. She said she hasn’t seen a step-by-step plan that outlines how he plans to tackle drug prices and said pharmaceutical companies “have lots of money and lots of lobbyists.”

Health care for immigrants

Connecticut has made many recent strides to expand Medicaid options to children under 15 and pregnant mothers regardless of immigration status. In addition, a recent final rule from the Biden-Harris administration expanded Medicaid access to Deferred Action for Childhood Arrivals recipients starting Nov 1.

However, Mattie said she imagines that health care access for undocumented immigrants will be restricted under a Trump administration considering his rhetoric throughout the campaign trail.

Husky 4 Immigrants, a statewide advocacy group working to expand Medicaid coverage to all, was quick to call on state legislators to implement safeguards to ensure the safety of all community members and access to health care.

Carolina Bortolleto, Husky 4 Immigrants Coalition Member, said Trump’s policies are a threat to everything the communities are building for everyone, documented and undocumented alike.

“Trump has vowed to carry out the ‘largest mass deportation in American history.’ Our message to all elected officials is simple: Stand with our immigrant communities against hateful, racist policies that will swiftly emerge from the federal government, putting the lives of undocumented individuals in our state at risk,” Bortolleto said in a press release.

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