By Carla Javier
Fusion, January 27, 2017 —
It’s all happening. As the GOP ramps up its fight to repeal the Affordable Care Act, President Obama’s signature health care law, Donald Trump dealt another blow to the law as one of his first actions as president. Getting rid of the 2010 law could leave more than 18 million people–who are disproportionately poor, unemployed, and people of color–without health coverage.
Immediately after Trump’s election, vulnerable communities–fearful of the uncertain terrain ahead–started coming together to create crowdsourced survival guides like Proactive Steps, which addresses everything from how to navigate the legal system to how to protect the environment. One of the most popular–the Oh Crap! What Now? Survival Guide–began as a Google Doc. It’s important to note that the information contained in these guides was contributed anonymously and is unverified.
Building on the work of so many people to put together these survival guides, we talked to experts, did our research, and created a checklist summary of things that you should do now–depending on your circumstances–to prepare for an uncertain future. Of course, many of the specific provisions of Trump and the Republicans’ plan to repeal the Affordable Care Act have not yet been announced, and no checklist will fit every person’s individual needs.
Still, you’re better safe than sorry. Here some things to think about and ask your medical provider as you plan for a future where you might not have health insurance or the same access to the care you need.
What if I’m on my parents’ insurance?
One of the most important provisions of the Affordable Care Act is the ability to stay on your parents’ insurance until age 26. The “Oh Crap!” guide suggests if you have insurance through your parents, you should use it now while you still can. Until the Affordable Care Act is officially and fully repealed, you get a free annual wellness check-up. If you haven’t used your one for the year, it’s worth using that appointment ASAP before possibly losing it.
For many people on their parents’ insurance, preventative care is currently covered, so if you need the HPV vaccine or want to start using a long-lasting birth control method like an implant or an intrauterine device (also known as an IUD), now’s the time.
What if I need care now but can’t afford it?
If you are sick and your access to health coverage goes away, there are still resources available. The Health Resources and Services Administration maintains a map of health care providers that will provide primary care and pregnancy services along with immunizations and checkups for kids–even if you don’t have insurance. These clinics allow patients to pay what they can afford based on their income. The Free Clinic Directory also aggregates free and affordable health care providers submitted by users.
Planned Parenthood–another provider constantly under siege–offers general health care as well, including physical exams and flu vaccines, along with its reproductive health services.
The “Oh Crap!” guide also crowdsourced a list of providers in specific cities that provide free or low-cost care.
I have a pre-existing condition.
There’s an outside chance that Trump and the GOP will keep the popular Obamacare provision that requires insurers not to charge more or deny coverage because of pre-existing medical conditions. (Recall a pre-Affordable Care Act world when Americans could be denied coverage for everything from depression and asthma to cancer and diabetes.) Still, if you suffer any of the wide range of conditions that disqualified you from getting insurance pre-Obamacare, it’s best to prepare for the worst.
Both private and public organizations fund testing and treatment based on diagnosis. For example, individuals diagnosed with breast cancer–which could be considered a pre-existing condition if Obamacare is repealed–could be eligible for financial assistance for testing, treatments, transportation to treatments, and non-medical expenses.
If you need a prescription medication but can’t afford it, Medicare.gov maintains a list of medications that are eligible for pharmaceutical assistance programs. Needy Meds, a national nonprofit that helps connect people in need with health care resources, also maintains a list of patient assistance programs, which can help you get free or discounted prescription medications if you meet their list of criteria. There are also coupons and rebates available for certain medications. FamilyWize offers a prescription savings card that anyone can use. Some diagnosis-based assistance programs also cover the cost of treatment.
How can I take care of my reproductive health?
Lisa Maldonado, executive director of the Reproductive Health Access Project, told Fusion that the same federal qualified health providers mentioned above should also be able to care for reproductive health.
But she emphasized that some organizations–like crisis pregnancy centers–may be religiously affiliated and not provide all types of care, so you might want to ask some questions to make sure a provider is a good fit for you and your needs. For students, campus health centers might also be able to provide many of the same resources.
Maldonado also recommends using barrier methods like condoms not just as a contraceptive measure, but also to protect yourself from sexually transmitted diseases and infections. If you have questions about STDs, family planning clinics, Planned Parenthood, and community health centers are great resources that can also help you get tested.
Human papillomavirus (HPV) vaccine
While it’s still covered by many private insurers and all plans through the health insurance marketplace, it’s worth talking to your health care provider about the HPV vaccine, which can help prevent certain cervical cancers, if you’re a woman under the age of 26. If you are uninsured or lose coverage, Merck–the pharmaceutical company that makes the HPV vaccine Gardasil–has a patient assistance program that will provide the HPV vaccine free of charge to qualifying patients who couldn’t afford it otherwise.
Contraception and birth control
It’s more important than ever to be proactive about your reproductive health. If you have a uterus, are having sex, and don’t want to become pregnant, you could see the cost for birth control rapidly increase if you lose your insurance.
“If the ACA is dissolved and women don’t have private insurance, contraception prices can go up,” Kristyn Brandi, a family planning specialist at Boston Medical Center, told Fusion last year. “If you’re paying out of pocket for it, it’s going to be expensive, especially for low income women who don’t fall under Medicaid.”
Insurance will cover your birth control until (if and when) Congress repeals the Affordable Care Act. Maldonado suggests talking to your provider about what will be the best option for you and noted that Title X family planning clinics provide birth control for free. The Office of Population Affairs has a tool to help you find the closest Title X clinic—just scroll down until you see “Find a Family Planning Clinic.”
You could consider getting an IUD, which can prevent pregnancy for five to 12 years, or talk to your provider about stocking up on other methods of contraception, like birth control pills, while you’re able to get them without a copay. There are patient assistance programs available for uninsured patients or other eligible patients who may want a long-lasting form of birth control, like an IUD, but might not be able to afford it out of pocket. For people who prefer the pill, Maldonado suggests asking your provider to write a prescription for a year.
If getting to a provider is an obstacle for you, in certain states–including California, New York, and DC, among others–there are online and mobile startups like Nurx and Lemonaid that connect you with a doctor who can help you to find affordable contraceptive options on the internet or over the phone.
Maldonado also recommends stocking up on emergency contraception (also known by the brand name Plan B) if you currently have the means to do so or insurance that will cover it. If a provider writes you a prescription for the morning after pill, many insurance plans will cover part or all of the cost. Plan B or its cheaper generic can also be purchased over-the-counter at drugstores without a prescription.
If you identify as low-income and become pregnant, you may qualify for Medicaid. Depending on where you live, your state might be able to provide additional assistance. A local Women, Infants, and Children office can help guide you through the process of finding health care you can afford, as well as other resources like nutritional assistance. Many community health centers also provide prenatal care, Maldonado said, and Title X family planning offices can help you with pregnancy testing and referrals to the care you need.
If you want to get an abortion, it’s likely that your right to do so anywhere in the U.S. is being threatened. While Trump and the new administration might not overturn Roe v. Wade, they’re likely to continue the trend of imposing further restrictions on both providers and patients.
Right now, there are established funds that help those who cannot afford abortions pay for the procedure or related costs, even in states with strict abortion laws like Indiana. The National Network of Abortion Funds keeps a mapped database of these programs. Some states also allow Medicaid to cover the cost of abortions.
Planned Parenthood has vowed to continue providing reproductive health services–including STD testing, HIV treatment, contraception, breast exams, pap tests, and abortion–to its patients, despite threats from the GOP to “defund” the provider by hacking away at grants and reimbursements for services rendered.
The National Abortion Federation and the Abortion Care Network both provide searchable lists of providers that have been vetted and meet strict clinical standards. Local abortion funds can also connect you to quality providers within your community, according to Maldonado.
How can I take care of my mental health?
Between the lasting stigma of mental health issues and the fact that many diagnoses could go back to being considered disqualifying pre-existing conditions, it is more important than ever to create a support system if you or someone you love suffers from mental health issues.
Mental Health America also offers step-by-step guides to finding help for yourself or for someone you are concerned about. If you or someone you know is in crisis, Pamela Greenberg, the president and CEO of Association for Behavioral Health and Wellness, said you should connect them with a hotline that can help them immediately.
In the case of a mental health crisis, there are a number of hotlines staffed to help you find a way forward, including the 24/7 National Suicide Prevention Lifeline (1-800-273-8255). You can also text the Lifeline Crisis Chat. If you’re transgender, Trans Lifeline is a crisis line staffed by trans folks, for trans folks. You can find a full list of crisis hotlines here.
Therapy and counseling
The Oh Crap! Guide suggests looking into online resources and counseling, which might be more affordable. But Greenberg said as with all health professionals, you should make sure these resources are accredited and a good fit for your needs. If you can’t afford therapy, Give an Hour connects volunteer providers with patients in need of services.
The Substance Abuse and Mental Health Administration also maintains a database of behavioral health treatment centers that serve individuals in need of substance abuse and addiction treatment along with mental health services like therapy. Their tool allows you to search for providers who provide services on a sliding scale.
If you enter your zip code in the locator tool, then go to the map and check the box that says “mental health,” a window will pop up. There, you can scroll down and check a box that allows you to select “sliding fee scale” and “patient assistance available.” It’s a little confusing to navigate, but if you call the SAMHSA hotline (1-800-662-HELP), a representative can walk you through it and help find a therapist you can afford.
Many providers may offer an employee assistance programs which can help connect employees to short-term counseling, Greenberg explained.
The National Alliance on Mental Health can also connect you to a resource group for your particular condition or diagnosis. For example, the Depression and Bipolar Support Alliance–an organization Greenberg recommends–has tools to find support groups and treatment.
If you need medication to manage a mental illness but can’t afford it, Needy Meds has a list of Patient Assistance Programs that can help you find free or discounted prescription medications. You can also look up your condition and see if there are diagnosis-based assistance programs to help you get access to testing, treatment, and support groups. Greenberg recommends asking both your medical provider and your insurance provider directly if there’s an affordable option, like a generic drug, that could work for you and your needs–or that is eligible for a discount with the FamilyWize prescription savings card.
What if I have a physical or mental disability?
The National Disability Rights Network is made up of member agencies in every state that can help get your medications paid for, help you access the care you need, and acquire resources like wheelchairs or mobility devices that can help you be more independent.
The Proactive Steps guide suggests reaching out to independent living centers, which also have staff to help you navigate health care, food stamps, and using other assistance programs.
There are a number of private and government programs that can help pay for costs related to your disability, including service animals, adaptive equipment, telecommunications equipment, and medical care.
I’m transgender and need health care.
Diane Bruessow, a physician assistant at Healthy Transitions, a health care provider that serves the transgender and genderqueer communities, emphasized the importance of finding a provider that not only uses the correct pronouns, but one that can meet your needs and provide quality care.
GLBT Near Me maintains a database of LGBT-friendly providers, although costs vary by provider. RAD Remedy and MyTransHealth also allow you to search for clinics that accept payment on a sliding scale. Bruessow also said providers will often have coupons to help uninsured patients with costs related to their care, like lab work, so she suggests asking your provider about those options.
Bruessow also recommends seeking out support groups or therapy for any gender diverse people who want to talk through any challenges they’re facing. PFLAG–which was formerly known as Parents, Families and Friends of Lesbians and Gays before expanding to be more inclusive of trans and queer individuals–has resources if you’re looking for yourself or to support someone you know.
If you need them, some Planned Parenthood locations now offer hormones. If you live in New York City and find yourself without health insurance (or your insurance will not cover hormone replacement therapy) Planned Parenthood has said they will counsel patients to help find a payment option that works for them.
Bruessow suggests asking your provider about using a compounding pharmacy–where practitioners on site are able to personalize medications to fit your particular needs–to fill prescriptions. These pharmacies may be able to provide hormones at drastically reduced prices, she said.
The Trans Assistance Project also crowdfunds donations for trans people to cover medical and other expenses related to getting the appropriate gender on identification documents. The Jim Collins Foundation, which Bruessow recommends, also can help provide funding for applicants who meet certain criteria.
GLBT Near Me allows users to search for local and national resources to help with financial costs of transitioning, including gender-affirming surgery. Human Rights Campaign also tracks state laws by issue, like transgender health care, to help you see if you live in a state that bans insurance exclusions for being transgender or mandates that employers offer trans-inclusive health care.