Obamacare’s uncertain future has some social workers on edge

Jordan Mickman walked into a room of crying nurses the other day.

These nurses are the civil aid attorney’s teammates at HELP (Health, Education and Legal Assistance Project), a medical-legal partnership that serves the “poorest of the poor” in Philadelphia — mostly women with high-risk pregnancies, young children, disabilities and/or abusive partners.

Many are protected by Philadelphia’s Sanctuary City status and most have Medicaid — two reasons why Mickman said his clients “fear” President-Elect Donald Trump’s plans to deport undocumented immigrants and repeal the Affordable Care Act, a.k.a. Obamacare.

“I’ve been doing this job for four years under President [Barack] Obama. Trump will make this difficult. The people who are eligible for our services aren’t going to disappear,” said Mickman. “It’s really upsetting as far as the work goes. We had a lot of forward momentum. This is a major setback.”

"The people who are eligible for our services aren't going to disappear."

In a few different ways. For example, one of Hillary Clinton‘s campaign platforms was expanding federal funding for the Maternal, Infant, Early Childhood Home Visiting (MIECHV) program, which provides home visits by a social worker or nurse during and directly after pregnancy. It’s an evidence-based program proven to produce positive health and development outcomes.

HELP relies on those MIECHV dollars. There was a “reasonable expectation,” Mickman said, that the partnership could expand programming under Clinton.

“We knew what the next steps for advocacy were,” he said. “We still had concerns under Obama.”

Obamacare is “an imperfect plan” to begin with, said Jane Shull, executive director of AIDS service organization Philadelphia FIGHT. Unlike Mickman and his colleagues, Shull is not overly concerned about the future of Obamacare. People are still suffering, she said, from a compromise made “way too far toward the benefit” of insurance companies and corporations.

“These plans were really not structured in a way to help people. It’s important that we don’t forget that,” said Shull. “What we got is meaningful non-economic insurance reform.”

Non-economic insurance reform with a smattering of equality protections such as guaranteed coverage for pre-existing conditions and rules that prohibit discrimination based on race, ethnicity, sex, gender, age or disability. Following his meeting with President Obama earlier this month, Trump said he would consider keeping those protections — after two years of campaigning on a promise to repeal Obamacare altogether.

Vice President-Elect Mike Pence revisited the new administration’s intent to repeal as recently as yesterday.

“If Obamacare and all the protections they built in go away,” said Shull, “then there’s really going to be a problem.”

"If Obamacare and all the protections they built in go away, then there's really going to be a problem."

Wavering on monumental policy reform doesn’t exactly assuage anxiety.

“This uncertainty, I think, is probably what has us bent,” said Michelle Taylor, program manager at the Center for Hunger-Free Communities’ Witnesses to Hunger (but you might know her as activist Feminista Jones). “It’s not knowing what the impact of a repeal would do, particularly for poor people who rely on [Obamacare].”

Obamacare, Taylor said, has made healthcare accessible to millions of people who otherwise could not afford health insurance.

“One of thing about poor people, particularly people of color, is we already have concerns about getting health treatment at all because of a history of racist practices,” said Taylor. “We have to think about the people who are already disenfranchised from obtaining mental health services.”

And the consequences of not having those services covered. Without coverage, Taylor said, people may stop seeing specialists or taking medications.

“Almost one in two people have a mental health diagnosis in the homeless population,” she said. (Project HOME reports 94.1 percent of the national homeless population has “behavioral health challenges.”) Constrained access to mental health services could mean jeopardizing opportunities for employment and housing. “It’s about what comes along with not being able to get [coverage]. I need to know someone who is living with anxiety and agoraphobia can get the medication they need to leave the house and come to one of our advocacy events.”

But it’s all still up in the air. Maybe Trump’s tinkering with Obamacare will improve the lives of his clients, said Mickman with a healthy dose of snide. But but right now?

“Nobody knows what to tell the clients,” he said. “We’re brainstorming.”