Healthcare remains an important issue to voters, second only to the economy, according to Pew Research. But arguably, the President of the United States has less control over the economy than healthcare. After all, the economy is subject to the vagaries of market forces, both domestically and internationally, that are often outside the purview of any given Administration. Yet the federal government can have direct impact on healthcare through the programs it finances, such as Medicare and Medicaid, but also laws it implements like the Affordable Care and Inflation Reduction Acts. Stark differences in policy have emerged between the campaigns of Vice President Kamala Harris and former President Donald Trump that would impact patient’s access to healthcare.
A recent New England Journal of Medicine article suggests that the November election could have important implications for patients’ access to healthcare, whether it be through changes to the ACA and other laws, expansion of Medicaid—the government health insurance program for people with limited income and resources—or the addition of benefits for seniors and disabled folks enrolled in Medicare.
The Harris campaign has announced a series of proposals to expand government programs such as Medicare and Medicaid and extend the reach of certain provisions currently only applicable in the public realm to the private insurance sector. The Trump campaign hasn’t been as forthcoming. It’s hard to glean much about “concepts of a plan,” which Trump mentioned at the presidential debate, other than rough contours of what could be the former president’s intentions regarding healthcare.
If Harris wins, it’s likely to result in a continuation of policies led by the Biden Administration, including the bolstering of the ACA through the American Rescue Plan and Inflation Reduction Acts. Or, a Trump victory could produce policy reversals, including possible disruptions to the ACA, as hinted at by Trump and his running mate, JD Vance.
On the campaign trail, Harris has spoken of the need to expand Medicare to cover dental, vision and hearing benefits. She also trumpets the Biden Administration’s record on reducing levels of uninsured to their lowest in history and decreasing Medicare beneficiary out-of-pocket costs for prescription medications through provisions included in the Inflation Reduction Act. Beginning next year, for example, Medicare beneficiaries will have a $2,000 annual cap on out-of-pocket costs for outpatient prescription drugs. And the cost of insulin has already been capped at $35 per month for Medicare recipients, which Harris now wants all Americans with insurance to benefit from.
Also, the Centers for Medicare and Medicaid Services negotiated the prices of ten top-selling prescription drugs. In late August, the agency released what it calls maximum fair prices for the therapeutics, to be implemented in January 2026. Furthermore, CMS will select 15 more pharmaceuticals for negotiation in February 2025. Harris intends to build on the Medicare negotiation policy to include more drugs if she becomes president, though this would likely encounter Congressional hurdles.
Harris has also outlined a plan to expand Medicare coverage of home healthcare for seniors, including specific ways to potentially fund the new program from projected savings the government could achieve from negotiating lower drug prices.
In addition, the Democratic presidential candidate has spoken of tackling medical debt by building on existing federal efforts to assist some of the 100 million people struggling with this financial burden. Moreover, Harris views more comprehensive insurance coverage that reduces patients’ out-of-pocket costs as providing the best defense against going into debt in future.
And Harris has stated that she seeks to rein in drug patent abuses and alleged anti-competitive practices by both pharmaceutical manufacturers and pharmacy benefit managers, who managed prescription drug benefits for clients that include Medicare and Medicaid. Her positions are consistent with the Federal Trade Commission Chair, Lina Khan, a Biden Administration appointee.
Trump’s “Concepts Of A Plan”
Since running for a second term as president Trump has wavered on a number of healthcare-related issues. In January, for example, Trump repeated his pledge to repeal the ACA before backtracking, asserting in a post on Truth Social that instead he wanted to make the ACA “better.” Indeed, now he and other Republicans claim they want to improve the healthcare program.
Trump hasn’t divulged details on how he wants to go about this, but his running mate has provided a few hints. Vance says there is a plan to “fix healthcare,” specifically with respect to the ACA. He has argued that the health insurance market needs to be deregulated and spoke of placing people with chronic conditions into separate insurance pools. But this could lead to insurers charging higher premiums for individuals with pre-existing conditions.
It’s curious that the Trump campaign has mostly backed away from outlining healthcare initiatives that would impact patient access, because as president Trump certainly had more than just a concept of a plan. His Administration was actively involved in trying to reshape healthcare.
As president, Trump didn’t seek to expand Medicare’s standard benefits to include vision, dental and hearing. However, the Trump Administration promoted private options for beneficiaries through Medicare Advantage plans, which often include extra benefits such as vision, dental and hearing.
Also, the Trump Administration was opposed to Medicaid expansion. Instead, it opted to rely on Section 1115 Medicaid demonstration waivers which offer states a pathway to test new approaches that differ from what is required by federal statute. Under Trump, CMS approved a range of demonstrations that included eligibility restrictions and work requirements for Medicaid beneficiaries.
And under the former president’s watch, the Department of Health and Human Services proposed government-led measures aimed at reducing Medicare beneficiary out-of-pocket costs for prescription drugs at the pharmacy counter. To illustrate, Trump issued executive orders aimed squarely at PBMs, attempting to force the intermediaries to pass through rebates to Medicare recipients at the point of sale. These efforts failed to get implemented.
Trump also signed executive orders that would have instituted a “most favored nations” drug pricing policy, which would have required pharmaceutical firms to sell certain drugs to Medicare for the lowest price that they offer to a number of comparable nations in terms of per capita gross domestic product. These actions by Trump also didn’t go anywhere.
The use of such international price referencing for prescription drugs was staunchly opposed by many fellow Republicans. After reiterating his pursuit of a most favored nations policy in a second term earlier this year, Trump has now apparently backed off this proposal.
Expanding the scope of healthcare to include the reproductive rights issue, at the direction of Trump the Republican platform in 2024 abandoned a federal abortion ban plank, instead ceding restrictions to the states which is in line with the decision to overturn Roe v. Wade. Trump has personally taken many different positions over time, making it unclear for voters to judge where he currently stands. On the other hand, Harris vows to codify Roe v. Wade through a Congressional act, which would aim to guarantee abortion rights nationwide.
From what can be gathered from campaign speeches and policy statements, Party platforms and what occurred during the Trump Administration, sharply delineated differences in policy positions have come to light between Harris and Trump that would impact patient access to healthcare. The Harris campaign has promulgated a set of detailed proposals to expand government programs such as Medicare and Medicaid and extend the reach of certain measures presently only applicable in the public realm to the private insurance sector. On the other hand, the Trump campaign messages on healthcare have been more ambiguous or completely missing in action. The only thing that’s known is that under Trump disruptions to the ACA are possible, as is experimentation in Medicaid through state-based pilot projects that strictly limit enrollee eligibility.
