Understanding Healthcare Policy Changes: How to Stay Informed & Protected

February 14, 2025- Over the last few weeks, since the Trump Administration took office, uncertainty has arisen about healthcare access and coverage in the United States. Also, changes to government websites that have historically provided healthcare information are also driving confusion and concern.

One of our aims at Tia is to be a trusted healthcare advisor for women, supporting women in understanding the facts and making informed decisions for themselves. To that end, we are outlining the impacts of some changes that have already been made and potential impacts to contemplated changes. We also recognize that creating fear and panic about what could happen is not helpful. So what you will find here is factual information rather than speculation.

This policy environment is fast-moving. We will aim to keep this page updated as the administration makes new decisions or other impacts become clear. Please feel free to reach out with any questions, we’ll do our best to provide guidance.

Care Access

Access to abortion care:

In 2022, the United States Supreme Court decided a landmark case, Dobbs v. Jackson Women's Health Organization (1). While this case effectively removed the federal constitutional right to bodily autonomy for pregnant women, it did not ban abortions nationwide. Rather, the court’s decision gave individual states (not the federal government) increased rights to determine abortion laws in their respective states. Certain states used this decision as a basis to limit or even outlaw abortions, but other states have remained steadfast in their protection of abortion rights. While there is no guarantee that California (2), New York (3), or Arizona (4) (states in which Tia currently provides service) will continue to protect abortion rights in perpetuity, there is strong support through each respective state’s constitutions and statutory law to continue to protect the right to abortion for the foreseeable future.

Simplified: Reproductive rights are controlled by the states, not the federal government, since the over turning of Dobbs in 2022. The Trump administration has not indicated a plan to change this.

Care for LGBTQIA and individuals subjected to gender-based violence:

The new administration has scrubbed government and federal agency websites of content that protects the LGBTQIA community. These actions follow executive orders ending federal funding for gender-affirming care, which would include terminating government-sponsored healthcare for gender affirming programs under Medicaid and Medicare. While private/commercial payors have not yet announced similar policies, historically, we have seen commercial payors (eg Aetna, Cigna, United Healthcare, Blue Cross, Anthem etc) follow the same coverage guidelines used by Medicare & Medicaid Services.

Simplified: the rights for LGBTQIA people to access gender affirming care no longer broadly exists in this country, and we are watching changes to private/commercial coverage decisions closely

We expect many will challenge these executive orders on legal bases. However, these legal challenges will take time to reach the high courts, and if payers deny coverage, the private sector will be left with little recourse until a higher court hears the legal challenges.

Coverage under the Affordable Care Act (ACA):

The Affordable Care Act (ACA)(5) is an Obama-era policy that instituted enhanced access and coverage for key healthcare services. The ACA is known most significantly for federally mandating that individuals obtain healthcare coverage, and instituting the exchange (marketplace) for individuals to buy insurance policies.

Healthcare exchange or marketplace plans (terms used interchangeably) are services available in every state that help individuals, families, and small businesses shop for, and enroll in, affordable medical insurance that meet ACA guidelines.

In most states, the federal government runs the Marketplace or exchange plans available at HealthCare.gov, although some states run their own Marketplaces at different websites. These plans are also accessible through call centers and in-person assistance. If you have an individual plan *not* purchased for you by your employer, you likely have a marketplace plan.

The prior Trump administration rolled back the federal mandate (requiring all in the US to obtain healthcare coverage) in 2017, as part of Tax Cuts and Jobs Act (6). Now, only certain states (Massachusetts, New Jersey, Rhode Island, Vermont, and Washington, D.C) have individual coverage mandates.

Policies that impact ACA access:

The Trump administration has proposed policies that may shift coverage options in the coming years. Specifically, the new administration is taking measures to:

• Rescind Biden-era policies aimed at increasing coverage and access for individuals. The policies facing roll-back include mid-year enrollment and affordability of coverage or financial assistance for coverage.
• Eliminate policies designed to reduce paperwork burdens for ACA marketplace plan enrollment and lower maximum out-of-pocket costs.
• Halt Biden-era practices which historically made it easier to enroll, understand benefits, improve access to providers, improve coverage comprehensiveness, expand eligibility, and lower coverage costs through executive orders.

Simplified: for those who access plans through the exchange, it is likely that the administrative burden to get individual coverage will increase.

Many healthcare policy analysts are warning the changes already made may be a harbinger of forthcoming attacks on policies and practices that promote access to marketplace plans.

Subsidies (aka – how much an ‘exchange’ plan costs):

Currently, Americans enjoy enhanced subsidies on marketplace plans – making these plans more affordable. However, these subsidies are set to expire at the end of 2025, and the new administration has not indicated intent to renew these subsidies.

Healthcare policy analysts have pointed out that as individual access to ACA marketplace options decreases, demand for employer sponsored plans will increase – resulting in higher costs to employers and employees in these plans who have commercial insurance

Simplified: it is likely that most of us on commercial insurance will see plan premiums rise.

What should I do?

Understandably, if you are covered under an ACA marketplace plan or through employer-sponsored coverage, you may be wondering how these upcoming changes could affect you.

First – note these changes have not yet happened. So, it is critical to continue to watch. We don’t know if / when these proposals will be finalized; however, it is likely that the Administration will strive to put them into effect by Nov 2025, when enrollment for 2026 starts.

Second – even though we don’t have full information, you can start planning now. Here are a few ways for you to stay proactive to protect your coverage and care options through Tia:

Budget for higher premiums.

Although the solution of “spend more money” is not ideal, the reality is that premiums under marketplace and employer-sponsored plans will likely increase. As you are choosing a (new) plan, it is important to carefully consider what features of a particular plan are most important to you and where you may be able to decrease coverage in certain areas to increase affordability. While exchange-based plans are most at risk for rising costs, as noted above, employer-based plan premiums could also rise. Again – not that it is not likely these changes will “hit” ahead of the next open enrollment cycle (especially if you are already enrolled in an annual plan), which starts in November 2025.

Research employer-sponsored options.

If you are not currently covered under your employer or eligible partner’s employer-sponsored plan, we recommend that you research coverage options available through those plans. If you get coverage through your employer, your Human Resources team may start to learn about adjusted costs as soon as Q2 – so you could reach out to them to start to understand coverage shifts and changes. Oftentimes, employers are able to negotiate more favorable rates and premiums due to a volume based model. Many employers offer a multitude of plans and we suggest that you carefully consider the components of each plan to ensure that you are optimizing the coverage options vs. the premiums and out of pocket costs based on your individual circumstances.

Tia’s commitment

Tia has an unwavering commitment to providing women with the high-quality care they deserve. Full stop. We remain steadfast in our efforts to provide safe, compassionate, and comprehensive care, no matter what, including creating a safe space that enables you to show up exactly as you are. Whether in our clinics, through virtual care, or in our community, Tia is here to ensure you are seen, heard, and supported.

Despite this commitment, there are realities we must accept and that we strive to build around, including:

• The noise is real and can be overwhelming, especially during uncertain and volatile times. We are committed to being a source of clarity and truth during these times and always. We hope you feel you can turn to us as you need.
• Care is not always covered, or fully covered, and the insurance landscape is confusing and hard to navigate (one may think this is on purpose). We strive to provide support navigating insurance coverage with our care coordination team, and when certain visits or procedures are not covered, cost transparency.
• Cost is a limiting agent to many seeking healthcare, and the lack of clarity about how much something will cost or when it will “hit” is nerve wracking. We have launched a predictable payments product to assuage these concerns.

Thank you for your trust in Tia. We are committed to doing all we can to support our patients and our larger community through times of uncertainty - now more than ever. Please find us in clinic, virtually or through chat - if we can help you navigate any specific concerns.

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1 - Dobbs v. Jackson Women's Health Organization, 597 U.S. 215 (2022)
2- CAL. HEALTH & SAFETY CODE § 123468, CAL. HEALTH & SAFETY CODE § 123462, CAL. HEALTH & SAFETY CODE § 123466, CAL. HEALTH & SAFETY CODE § 123462;

CAL. CONST. Art. I, § 1 (Added 1974); Comm. to Defend Reprod. Rights v. Myers, 625 P.2d 779 (Cal. 1981) (striking down limits on Medicaid coverage for abortions, finding that all women possess a fundamental constitutional right to choose abortion under the California constitutional privacy provision); Am. Acad. of Pediatrics v. Lungren, 940 P.2d 797 (Cal. 1997) (invalidating parental-consent requirement).

A res. to propose to the people of the State of Cal. an amend. to the Const. of the State, by adding Section 1.1 to Article I thereof, relating to fundamental rights, Sen. Const. Amend. No. 10, 2022, https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220SCA10. NYTimes, California Proposition 1 Election Results: Constitutional Right to Reproductive Freedom, https://www.nytimes.com/interactive/2022/11/08/us/elections/results-california-proposition-1-constitutional-right-to-reproductive-freedom.html (Last accessed Nov. 9, 2022).

3- NY Pub Health L § 2599-BB (2023)

4- On November 5, 2024, Arizona voters approved Proposition 139, the “Arizona Abortion Access Act.”

5- Public Law 111–148, 124 Stat. 119 (2010).

6- Public Law 115-97 (2017)