Both presidential candidates agree that Americans are paying too much for drugs, despite health care access and affordability receiving limited attention during the 2024 campaigns. The two biggest issues in health care, according to experts, are affordability and access to care, which neither candidate is addressing adequately.
The United States spends significantly on health care but lags behind other developed nations in key health outcomes. Life expectancy is lower, and a majority of American adults live with chronic health conditions. Vice President Kamala Harris focused on supporting seniors through long-term home care services, while former President Donald Trump expressed support for reducing chronic diseases and improving food safety.
Both campaigns agree on the need to reduce drug costs, with some differences in approach to health insurance. Trump implemented measures like capping insulin costs and tying Medicare payments for drugs to lower prices paid in other countries. Biden’s administration expanded on some of these policies, including making the $35 insulin cap permanent and introducing an out-of-pocket cap for Medicare Part D spending.
There are concerns about the impact of these policies on premiums and coverage, with some experts expressing doubts about the feasibility of universal price caps. Additionally, changes to catastrophic coverage in Medicare Part D could lead to increased premiums for beneficiaries.
The ACA, introduced in 2010, provides health insurance coverage for millions of Americans without Medicare or employer-sponsored insurance. While it has increased access to care, some criticize its above-average out-of-pocket costs for sick individuals. Efforts to repeal the ACA have failed, with the Trump administration shifting focus to stabilizing enrollment and ensuring insurer participation in the market.
Overall, the future of health care policy in the U.S. remains uncertain, with both candidates offering differing approaches to address the challenges in the system. Katy Talento, an epidemiologist and former veteran health policy advisor to the Trump administration, stated that she believes repealing the Affordable Care Act (ACA) is a futile effort.
During his first term, Trump promoted the sale of short-term insurance plans that did not comply with the ACA in an attempt to lower costs. He also eliminated the penalty for not enrolling in the ACA. These actions led to a decrease in ACA enrollment during his term.
The Biden administration reversed most of these changes, with Vice President Harris likely to continue this trend if elected. She has pledged to expand and strengthen the ACA, making the temporary tax credits introduced in 2021 permanent. These credits lowered health care premiums and increased ACA enrollments by over 2 million.
Regarding Medicare, both Trump and Harris have promised not to alter its funding structure but have not provided detailed plans on how they would regulate the system. Harris has campaigned to add long-term home-care benefits to Medicare, while Trump has announced support for tax credits for caregivers without affecting Medicare services.
Harris also supports adding vision and hearing services for Medicare beneficiaries. Medicaid could see changes under the election, with Harris proposing to expand access and Trump introducing work requirements for Medicaid during his first term.
On the topic of chronic diseases, Trump has proposed collaborating with Kennedy to address public health reforms and food safety. Kennedy has advocated for banning certain substances and reconsidering vaccine safety.
The candidates differ on abortion, with the Biden administration expanding abortion access and counseling services. Harris vows never to allow a national abortion ban and supports securing abortion access nationwide. Trump believes abortion policy should be decided by the states.
According to Talento, he is not actively seeking to make significant changes on the issue of abortion because he feels it should be determined by the voters and individual states.
However, Talento noted that the Biden administration has expanded abortion access using federal authority. If Trump is re-elected, he may consider reversing some of Biden’s executive orders that facilitated women’s access to abortion through federal programs.
