This piece is part of Rebel Well: a Starter Survival Guide to a Trumped America for Teens and Emerging Adults.
People of all ages across the United States are very concerned about the impact of the Trump administration on access to healthcare, as the federal government provides billions of dollars in funding every year to healthcare programs in every state and territory, and also sets policies that can affect everything from the safety of medications to anti-discrimination protections in healthcare. Reproductive healthcare in particular is at risk, between states moving to restrict access to basic healthcare like abortions and contraception and the federal government undermining nationwide protections for patients who need these services.
Recent moves by the current Trump administration show that the president and his supporters are comfortable violating well-established legal precedent and conventions, which has scary implications for many regulations, laws, and policies, including those around healthcare. The Trump administration and Republican lawmakers have indicated that they plan to push for substantial changes, including potential repeals, to the Affordable Care Act external link, opens in a new tab(“Obamacare”), Medicaidexternal link, opens in a new tab, and Medicareexternal link, opens in a new tab. Their work also includes attacks on administrative agencies such as the Department of Health and Human Services, along with policies such as Section 1557 of the Affordable Care Act, which prohibits some forms of identity-based discrimination in healthcare programs (such as denying transition care).
Because things are moving quickly and chaotically and the administration’s messaging is often contradictory or confusing, it’s easy to feel overwhelmed and lost. Try to keep your focus on the bigger picture, and turn to trusted news sources and organizations — including right here at Scarleteen — for important updates on healthcare policy in the United States. In that spirit, we’re trying to update this section regularly!
INSURANCE
If you don’t know what kind of insurance you have and what it covers (or if you have it at all), ask your parents, or call the member services number on your insurance card to get information. Your insurer should provide you with a brief description of benefits that quickly reviews what is covered and the amount of your copay. You are also entitled to view your actual health insurance contract, which includes a detailed summary of benefits. If you have a specific question (“Which doctor can I use?” “What is my copay for non-specialist doctor’s visits?”) you can ask. Your insurer is currently required to cover a minimum of one preventative care visit a year, and at least one sample of every major birth control method (pills, implants, IUDs, etc.) must be available for free.
Until we know exactly what’s going to happen with health insurance, it’s hard to know how best to prepare, but it is wise to do what you can now in case you lose some or all of your coverage at any point. Get all your routine examinations and currently-needed testing done as soon as you can if you’re not already on top of them. If you are someone who could become pregnant and isn’t 100% sure they’d want to become pregnant, catch up on sexual health appointments. Request “vacation fills” from your care provider so your pharmacy can override medication limits, and if necessary, call around to find a pharmacy that carries your meds in bulk. Additionally, the World Health Organization maintains detailed information about vaccine schedulesexternal link, opens in a new tab so you can keep up with critical vaccines including measlesexternal link, opens in a new tab, mumpsexternal link, opens in a new tab, and rubellaexternal link, opens in a new tab (MMR); tetanusexternal link, opens in a new tab, diphtheriaexternal link, opens in a new tab, and pertussisexternal link, opens in a new tab (TDAP); influenzaexternal link, opens in a new tab; inactivated polio virusexternal link, opens in a new tab (IPV); and COVID-19external link, opens in a new tab. Because others are also racing to do this, it may be that you can only get an appointment weeks or even months from now: make that appointment anyway, and ask them to call you if they get a cancellation before then.
If you’re in school and about to graduate, take advantage of student health while you can! If you aren’t currently insured, explore your options, which may include a state or federal healthcare exchange, private insurance, or joining a parent’s insurance policy if you are under 25.
If at any point you lose health coverage or your plan is drastically modified: Community clinics — including free and low-cost clinics for the public at colleges, teaching hospitals and nursing schools — can be excellent resources for basic healthcare needs. Some public health departments also operate clinics that may offer services you can use. If you are LGBTQ, check clinics before going. Those affiliated with the Catholic Church or other religious groups may be hostile and unwilling to meet your healthcare needs, and other organizations may also have a history of LGBTQ discrimination. (Try Googling for the name of the clinic and “controversy” or “LGBTQ” to see what comes up.) You may also be able to obtain low-cost catastrophic insurance that will cover major accidents, though not preventative care and day-to-day health issues, and it will include a high deductible.
Talk to your doctor’s office now about what will happen if you lose your insurance or your insurer refuses to cover some services. Paying cash can be expensive, but some doctors’ offices offer discounts to cash patients or are willing to help with payment plans.
SEXUAL HEALTHCARE
Get current with your STI screenings and general sexual healthcare and ask any current sexual partners to do so as well. These services may become more costly or otherwise harder to access. In addition, if you or a partner have an STI, treatment as soon as possible not only is always a good idea, it’s ever more important when healthcare may become more difficult to access, particularly for serious or chronic infections such as HIV. Get up to date with your vaccinations now, too, including for HPV; Hepatitis A and B; and mpox.
With sexual healthcare services — including STI diagnostics and treatment — potentially becoming harder to access or less affordable, safer sex is all the more important. If you and your partners don’t already use barriers to reduce the risk of STIs, now is a very good time to take that more seriously and start.
If you or your sexual partners can become pregnant and you do NOT want to parent, or know you are or will be unable to parent in some way (such as being unable to afford it):
Our How Not to Get Pregnant guide provides important information on preventing pregnancy, from setting healthy relationship boundaries to choosing the right kind of contraception for you.
Long-acting methods of contraception, such as IUDs or the implant, are currently covered by all insurance providers under the stipulations of the Affordable Care Act, whether you have private, group, or subsidized insurance, so if you do not want to become pregnant, and parent, in the next four years, at a minimum, now is the time to go and get those methods. They soon may not be covered, and abortion access has already become very limited before now. It is very likely to become even harder to access soon. If you do not want to use methods like IUDs or implants, but want to get a method now you may be able to use for a few years, ask your healthcare provider about cervical barriers.
Emergency contraception pills have a shelf life of around three years, and are also covered by most health plans and much public health. Stock up if you can, for yourself and/or others.
Both emergency contraception and birth control pills are available over the counter in some states. The National Conference of State Legislatures maintains a regularly-updated guide to basic state-by-state contraception policiesexternal link, opens in a new tab, so you can learn more about options where you live. In these cases, it’s also possible to pay cash and purchase these products without a record attached to your health insurance — remember not to use a customer loyalty card such as CVS’ ExtraCare to make sure your purchase can’t be linked to you.
Find out the names of the abortion providers and funds closest to you currently, and start with independent providers (those affiliated with hospital chains or large organizations such as Planned Parenthood may cut services or raise costs sooner). In the event abortion services shut down or become even more limited, knowing those names can give you a place to start in seeking that healthcare or help.
A NOTE ON PRIVACY
While the contents of medical records are currently protected by law, there are cases in which your doctor can disclose information, as for example when an insurance company requests details about a treatment. In some areas, doctors may be required to report certain medical events, such as STIs or abortions, to the state or local agencies. It’s possible that these laws may change, and likely not in your favor. If you have privacy concerns about a specific diagnosis or treatment, ask about them ahead of time, when you’re discussing diagnostic testing and other evaluations. You may also want to talk to your doctor about information in your medical record that could be used against you, like a diagnosis of gender dysphoria, a psychiatric condition, or details on a pre-existing condition. It may be possible for your provider to code a diagnosis differently, take sparse notes in your official record, or take other steps to protect you.
If you are a minor, your parent or guardian may have legal access to all or some of your medical record, and information about your insurance claims is also available to them. In some states, parental consent is required to receive treatment, like if you want prescription contraception, vaccines, or an abortion. Teen Health Law, a project of the National Center for Youth Law, has guidance on various issues related to healthcare access and privacy for youthexternal link, opens in a new tab, broken down by state.
If you have privacy questions, ask your healthcare provider about what information they may be required or allowed to share, and what kinds of treatments, if any, your parent or guardian may need to consent to. You can also check out laws in neighboring states to explore more private or autonomous options.
If you’re an adult, but you’re on your parents’ health insurance, your parents will still be able to view a history of your claims, including those related to reproductive healthcare. If this is a concern for you, discuss the situation with your care providers and their administrative offices: It may be possible to pay cash for an appointment, to access help with funding some of your care through community resources, or to get this care through a community clinic or another third party.
