What Trump or Harris Could Mean for Health Care Access and Affordability

Health care is already complicated, expensive and confusing for many people in the US, and it is one of the biggest issues in the 2024 election. Vice President Kamala Harris and former president Donald Trump has both vowed to take this on if he wins—and to do so with policies ranging from reducing drug costs to ensuring access to care. But there are big differences over how their various plans would affect the economics of the US health care system — and the people who face its mandate every day.

Harris says his administration will strengthen the Affordable Care Act (ACA) and expand the savings provisions of the IRA’s. Trump’s presidential record on health care has been mixed, filled with attacks on the ACA and significant cuts to health insurance programs.

Drug Price

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People in the US pay more for medicine than people in other very wealthy countries. Both presidential candidates have emphasized lowering drug prices prominently in their programs, and each has made related policy moves during their time in the White House.

During President Joe Biden’s administration, Harris cast a strong vote to pass the IRA Act of 2022 that sets new limits on drug price increases. The IRA gave Medicare (the federal insurance program for adults 65 and older) the ability to negotiate lower prices for certain drugs. The biggest talking point in Harris’ campaign is the $35 insulin hike. It also made Medicare-covered vaccines free and expanded subsidies to help low-income people pay for better coverage. And it would put $2,000 out of pocket in annual prescription drug spending under Medicare starting in 2025. Cancer drugs, for example, can now cost patients more than $10,000 a year. But the IRA will lower this to $2,000, explains Stacie B. Dusetzina, a health policy and drug price researcher at Vanderbilt University School of Medicine. “This is a huge increase in benefits coming to seniors,” Dusetzina says.

Ten drugs have already been listed for price negotiations, but people won’t start seeing price changes at the pharmacy until January 2026. Harris says, if elected, he will further strengthen the IRA, lower costs of additional drugs under Medicare-even expansion. providing drug coverage under private insurance and Medicaid, the federal insurance program that covers some people with low incomes, certain disabilities or pre-existing conditions. It is uncertain what the fate of the IRA will be under the Trump administration.

“One of the reasons why drug price negotiations have become such a hot topic is that there is concern among Republicans that companies do not have the incentives to invent and develop new drugs” if they can’t find the potential profit, Dusetzina says. . “Many Republican members of Congress have pushed to stop drug price negotiations, and we know that pharmaceutical companies have … sued the government to stop negotiations on select products.” (Several companies have lost their lawsuits, and other lawsuits are ongoing.) If a second Trump administration were to act quickly, it might try to block or to undo the policy before the new prices take effect in 2026, Dusetzina says.

In Trump’s final months in 2020, he issued two executive orders to help lower the cost of prescription drugs. He tried to prevent pharmacy benefit managers—third-party companies that negotiate prices and discounts between drugmakers and consumers—from collecting reimbursement checks on discounted drugs sold to the public. elderly with Medicare to ensure that these people get full money from drug manufacturers. He also tried to push through the “Most Favored Nation”, which would have put certain prescription drugs under Medicare at low costs, close to those paid in other developed countries.

Critics said the Most Favored Nation model would give other countries more control over drug prices. The Biden administration pulled the plug on the order in 2022. In his campaign, Trump initially supported restoring the Most Favored Nation model, but has recently walked back those statements. Dusetzina says there is bipartisan support for reducing drug patents, which would enable generic drugs to enter the market, thus reducing prices.

Affordable Care

In last month’s presidential debate, Trump falsely said he had “saved” the Obama-era ACA, which provides health insurance to more than 21 million people. During the Trump administration, he has repeatedly tried to delete it. Ultimately, he failed, although he persuaded Congress to repeal the ACA’s individual tax penalty, which encouraged people to enroll in health insurance programs. While Trump has been in office, ACA insurance enrollment has dropped from 12.7 million people to 11.4 million, raising premiums for those who remain.

As president, Trump also proposed funding plans that would have cut $1 trillion from Medicaid if approved. The ACA supports a federal funding program that matches 90 percent of the costs to say they choose to expand Medicaid; this extends access to health care services to people below 138 percent of the poverty line. States that accepted the expansion saw a 41.7 percent increase in insurance enrollment as of 2020. Ten states have not expanded Medicaid, creating coverage gaps that studies have shown disproportionately affect people with colors. People with low-wage jobs may also not qualify for Medicaid because their income is still too high by individual states’ standards.

In an attempt to fill these gaps, Trump allowed states to use work requirements—which force Medicaid recipients to prove they work 20 hours a week, participate in community service or otherwise. are eligible for exemption. But mandatory pilot programs in states without Medicaid expansion, such as Arkansas and Georgia, have seen poor enrollment rates and high government costs, says Stephen W. Patrick, a pediatrician and chair of Emory University’s Department of Health Policy and Management. Patrick notes that polls suggest a majority of Georgians favor Medicaid expansion. While the Trump administration has suppressed such requirements, the Biden administration has moved to roll them back, saying work and employment should not be tied to access to health care.

Trump’s position on the ACA has been inconsistent and ambiguous throughout his campaign. He has said he will keep the ACA and strengthen it. In other words he promised to replace it with something better. During his September 2024 interview with Harris, Trump said he had “planning ideas” but did not provide specifics. Trump’s ally, Senator JD Vance of Ohio, recently proposed major changes to insurance risk pools that would make coverage more affordable for those with less medical needs — and it’s expensive. weight for those with higher. This may undo ACA protections that prevent insurers from discriminating against people with disabilities or pre-existing conditions, including chronic conditions or disabilities, or people who are pregnant.

Trump has tried to deal with the medical bill, a byzantine process – and sometimes collapses – for many in the US – online services. However, it may raise some costs.

The Biden-Harris administration has actively promoted insurance enrollment and advocated for ways to strengthen and protect the ACA, Patrick says. On his campaign trail, Harris also strongly touted a proposal that would use unused COVID relief funds to remove $7 billion in medical debt from people’s credit reports. “No one should be denied access to economic opportunity simply because they have a medical emergency,” Harris said in a June press release.

Pandemic Preparedness

The Trump administration has created a Coronavirus Task Force to oversee public health efforts during the COVID pandemic, and has also pushed Operation Warp Speed ​​to rapidly develop life-saving mRNA COVID vaccines by the end of 2020. Although even so, many experts say that the country was not well prepared for this epidemic. because of some of the moves that Trump has made. At the height of the outbreak, he repeatedly downplayed and dismissed advice from public health officials, banned mask mandates and continued to hold large rallies during his presidential campaign. 2020. Since then he has promoted anti-vaccine sentiment; many experts agree that many of the COVID-19 deaths among Trump supporters could have been avoided.

Biden’s American Rescue Plan, created in 2021, helped mobilize the public health response to this epidemic. Federal funds have provided free COVID vaccines, tests and treatment. The project also aims to reduce the racial injustice that has arisen during this epidemic. In 2023 Biden signed legislation to help the country prepare and plan for future pandemics. It also created the White House pandemic preparedness office, which Trump shut down in 2018, to monitor biological threats and diseases — such as the H5N1 bird flu, which recently infected dairy cattle and poultry. US, along with other people. The next administration will have to face the potential threat of an H5N1 outbreak.