The fiery presidential debate between Donald Trump and Kamala Harris was perhaps a spectacle. But as is historically often been the case when candidates for president square off, there weren’t many substantive policy discussions. Nevertheless, on healthcare Harris reiterated her positions on the Affordable Care Act, the Inflation Reduction Act and abortion, while Trump showed an unwillingness to commit to specific policies.
A May 2024 poll of voters by the Pew Research Center found that healthcare ranked as the third-highest issue priority for voters, behind inflation and the perceived need for more bipartisanship. Survey respondents cited rising healthcare costs, with 57% saying that the increasing expenses are a “very big problem” in the country today.
Yet it took more than 90 minutes into the debate for moderators to finally pose a question about healthcare.
Harris defended the Affordable Care Act and Inflation Reduction Act, noting how under the Biden Administration the ACA was “strengthened” and that the newly enacted IRA “lowers drug prices for seniors … and caps out-of-pocket costs for insulin as well as other [outpatient] drugs.”
Just this week, the ACA reached a milestone of nearly 50 million individuals having received coverage under the law.
The $35 per month cap on insulin out-of-pocket costs she was referring to is in effect and applies to all Medicare recipients. The Trump Administration did issue an executive order in 2020 in which monthly insulin out-of-pocket costs were capped at $35 for a relatively small number of Medicare beneficiaries under a voluntary model. By contrast, the IRA mandates such an out-of-pocket maximum for all Medicare recipients.
The $2,000 annual cap on out-of-pocket costs for outpatient drugs Harris referenced will be implemented starting in 2025. This means that in a given year Medicare beneficiaries will not pay more than $2,000 out-of-pocket on outpatient drugs.
In defending the Biden Administration’s policies on prescription drugs and the ACA Harris reiterated a Democratic plank that “healthcare is a right, not a privilege.”
Trump revealed he doesn’t have a specific proposal to replace the ACA. But he said he had “concepts of a plan.” This may have reminded viewers of something similar he stated about replacing the ACA while he was president. While in office, Trump often proclaimed he would come up with an alternative to the ACA. However, during his time in office he never did.
During the debate, Trump declared “we can do much better than Obamacare,” but that he “would only change it if we come up with something that’s better and less expensive.” He also reiterated points he has made in the past about “saving” the ACA while he was president. Indeed, following unsuccessful efforts to scuttle the ACA, the Trump Administration did issue multiple executive orders to “improve ACA market dynamics.” But overall enrollment in the program declined from 2017 through 2020. And a Brookings article details the ways in which the Trump Administration may have done more to undermine than save the ACA.
Surprisingly, Trump said nothing to parry Harris’s points on reducing Medicare drug prices. He could have noted that his Administration drafted proposals to lower drug prices in Medicare. As president, Trump issued executive orders that would have instituted a “most favored nations” drug pricing policy for the Medicare program. Specifically, MFN would have required pharmaceutical firms to sell certain drugs to Medicare for the lowest price that they offer to peer nations overseas. But notably, the use of international price referencing was staunchly opposed by many fellow Republicans. And the MFN executive order was never implemented.
On abortion rights, the two candidates voiced strongly differing views on a topic that remains critical for about one in eight voters. According to KFF, 12% of the electorate says that abortion is the most important issue for their vote in the 2024 elections.
While Trump said he would not sign a nationwide abortion ban, he hedged by also refusing to commit to vetoing such a ban. Moreover, he maintained that the Supreme Court’s overturning of Roe v. Wade was broadly popular, though that isn’t the case according to state ballot initiatives or public opinion polling. More than 60% of Americans disapprove of the Supreme Court decision.
Harris repeated her strong support for women’s reproductive rights, criticizing Trump for his role in facilitating decreased access to abortion in a growing number of states. However, she declined to say whether she supported restrictions on abortion in the third trimester.
