Medicare. Medicine cost. The fate of the Affordable Care Act.
In the final weeks of the presidential campaign, the issue of health care and who is best equipped to respond continues to be a hot topic of contention. Polls show Americans put health care costs at the top of national leaders’ agendas.
So it’s not really surprising that both Vice President Kamala Harris and former President Trump have promised to lower prescription drug costs and protect Medicare.
But during an election period in which detailed proposals on health policy were neglected (while other issues tended to take a backseat), “we need to take a closer look at their record,” said KFF’s executive vice president of health policy. Larry Levitt said. , an independent health policy research and news organization.
“If you look at the record, Harris and Trump are polar opposites,” he said, noting that they disagree on the government’s role in health care and trade-offs over spending. He said Trump is focused on cutting government spending, while Harris is focused on expanding coverage and affordability.
The debate is unfolding as the Affordable Care Act, a landmark law passed nearly 15 years ago to reshape health insurance, gains popularity among the public. Harris blamed Trump for his repeated attempts to repeal the law, arguing that if Trump wins a second term, the law’s protections will be at risk. President Trump has said he would only replace it if there is a better alternative, but he provided few details about his plans.
In the aftermath of Roe v. Wade’s reversal, Harris is also focusing on abortion rights. For more information on the candidates’ positions on this issue, see another Times guide. Meanwhile, President Trump has targeted Harris over her support for gender-affirming care and vowed to block “COVID-19 mandates” that influence the political right.
Here’s a breakdown of where the candidates stand on key issues.
Affordable Medical Care Act
Five years ago, when Harris sought the Democratic presidential nomination, she promoted a “Medicare for All” plan. This time, Harris pledged to protect and strengthen the Affordable Care Act.
For example, she wants to permanently extend an enhanced set of premium subsidies for people who purchase health insurance through the Affordable Care Act Marketplace. These subsidies, which reduce insurance premium costs for recipients, are currently scheduled to expire at the end of 2025.
As president, Trump sought to repeal the Affordable Care Act. The administration eliminated financial penalties for individuals who fail to maintain health insurance coverage, a key provision of federal law.
President Trump, who is campaigning for re-election, has said he intends to replace the Affordable Care Act if a better plan is developed, but until then, he intends to “run it as well as we can.” Ta. At the time of the September debate, President Trump had not laid out a detailed plan for what he would do instead.
His running mate, J.D. Vance, said his plan “puts people with similar health conditions into the same risk pool.” Risk pooling is the process of calculating insurance premiums by sharing medical costs. Mark A. Peterson, a professor at the Luskin School of Public Policy at the University of California, Los Angeles, said such plans could lower premiums for young people and healthy people, but lower premiums for older people, especially those with chronic conditions. He said there was a risk of pushing up prices.
The Trump campaign also expressed concern about the premium subsidies that Harris wants to make permanent, telling the Washington Post they “benefits big insurance companies and brokers more than American patients.” said.
Medicine and medical expenses
Levitt said reducing the cost of prescription drugs “seems to be the only consensus in the medical field, but how that translates into concrete policy is a little unclear.”
The Trump administration has cleared the way for states to import prescription drugs from Canada. As president, Mr. Trump tried to tie Medicare reimbursement for certain drugs to prices paid by other countries, an effort that was blocked in court and ultimately reversed under the Biden administration. A Trump campaign spokesperson said they would push forward with the plan again.
President Trump also issued an executive order on price transparency, which requires hospitals to publish information about their standard prices online. (The Biden administration continued rules aimed at tightening enforcement.) And as president, Trump created a demonstration program that capped insulin copays at $35 per month for some Medicare beneficiaries. .
Many of the efforts to reduce health care costs touted by the Biden administration are based on the Inflation Control Act, which Harris voted for. For example, the law extended the $35 per month copay limit for insulin to all Medicare beneficiaries. It also established a $2,000 cap on drug out-of-pocket costs for Medicare drug coverage.
The Inflation Control Act also required the government to negotiate prices for some drugs under Medicare. In August, the federal government announced it had negotiated lower prices for 10 drugs to treat conditions such as heart disease and diabetes.
But there are concerns that requiring Medicare plans to be more generous with drug benefits could significantly increase premiums. The Biden administration has leveraged subsidies to insurance companies and, on average, avoided them next year, but the Trump campaign has criticized the anti-inflation law over that and other issues.
Harris promised to expand the $2,000 copay cap and $35 a month insulin copay cap to cover everyone, not just seniors. He also vowed to accelerate negotiations to lower Medicare drug prices.
Harris is also focused on ending medical debt. As vice president, she worked to remove medical debt from credit reports and promoted the use of American Rescue Plan funds, which allow state and local governments to buy and forgive debt. Harris said she would expand such efforts as president.
Medicare and Medicaid
Both candidates have vowed to protect Medicare, but that hasn’t stopped Medicare from becoming a campaign issue.
The Republican platform under Trump promises to protect Medicare, the federal insurance program for Americans 65 and older, “without any cuts.” President Trump has said in the past that he has made statements suggesting he is open to reducing entitlements, but they have been taken out of context.
Harris, who has vowed to protect Medicare, has repeatedly pointed to Project 2025, Trump’s conservative strategy for a second term, saying Trump and his allies pose a threat to the plan. did. Project 2025 says Medicare Advantage, a private service under Medicare, should be the default option for enrollees.
President Trump has repeatedly sought to distance himself from Project 2025. Daniel Alvarez, a senior adviser to the Trump campaign, said Harris was “fear-mongering” and said the former president was only supporting the Republican platform and her “core promises.” He did not say whether he supports making Medicare Advantage the default option.
Then there’s Medicaid, which covers low-income Americans. The Trump administration has approved work requirements as a condition of Medicaid eligibility in some states. He has also proposed major changes to the way Medicaid is funded, which could limit federal funding.
The Biden administration has repealed work requirements in state Medicaid programs and encouraged states to expand coverage. As vice president, Harris urged states to extend Medicaid postpartum coverage from two months to a year, promoting Medicaid as a way to combat maternal mortality.
Gender-affirming care
President Trump denounced the use of puberty blockers and other forms of gender-affirming care for transgender youth and called hospitals “involved in the chemical or physical mutilation of underage youth” on Medicaid and Medicare. He said he would request that it be stopped. The Republican platform also includes a ban on taxpayer funding for gender transition surgeries.
While running in the Democratic primary five years ago, Harris told the ACLU that she supported policies that would ensure inmates dependent on state care received “medically necessary care for gender reassignment.” . Courts have since considered the issue, and Harris-Waltz’s campaign communications director recently told Fox News that it is currently “not what she is proposing.”
Harris said she supports the Equality Act, a bill that would ban discrimination based on sexual orientation or gender identity in public accommodations, as a way to protect LGBTQ+ patients from discrimination in health care.
During his time as vice president, the Biden administration introduced federal regulations that broadly protect against discrimination based on gender identity by health care providers that receive federal funding. The rules prohibit refusing gender-affirming care if similar care is provided for other medical purposes, but the gender identity provision is currently on hold following a legal challenge. .
public health
President Trump helped accelerate the development of a coronavirus vaccine through Operation Warp Speed. Even as he touts the results, President Trump has occasionally expressed skepticism about vaccines.
He said he would “suspend all COVID-19 mandates” and cut federal funding from schools that require vaccinations and mask-wearing. His campaign said he was specifically referring to coronavirus vaccination requirements, which Trump has repeatedly said without specifying them.
He also pledged to establish a commission to investigate the rise in chronic diseases among children. This is the same concern raised by former presidential candidate Robert F. Kennedy Jr., who spread debunked claims about vaccines and supported Trump even after withdrawing his candidacy.
Harris called vaccination “the single best defense against COVID-19.” Early in the pandemic, the Biden administration introduced broad rules mandating coronavirus vaccinations for federal employees and contractors, which have since been phased out.
The Biden administration also launched a new office in the White House focused on pandemic preparedness and response. President Trump said the office would “probably be dissolved.”
