Heading into the 2024 general election, health care remains one of the top concerns for American voters, with former President Trump and Vice President Harris having starkly different approaches and track records on the issue. In this Client Alert, part of our 2024 Election series, we analyze the candidates’ health care priorities, or at least what we know about them. Despite growing concerns about health care among voters, both candidates have been criticized for not providing enough detail about their respective plans.
Still, VP Harris has said more about her health care plan than former President Trump so far. One of Trump’s most memorable lines from a recent debate came when he said he had a plan in mind while discussing health care, though he offered few specifics. One thing both candidates have in common is that they both say they want to focus on reducing health care costs for Americans. Both sides are expected to reveal more details in the coming weeks.
Harris Health Policy Focused on Cost Reduction
Much of VP Harris’ health care policy is contained in her plan to reduce health care costs for American families, including proposals to expand private health insurance coverage under the Affordable Care Act (ACA), reduce drug costs through out-of-pocket caps and expanded Medicare price negotiations, focus on reducing medical debt, and support the Department of Justice (DOJ) and Federal Trade Commission (FTC) efforts on health care competition.
Health Insurance Coverage: Under the American Rescue Plan (ARP) and the Inflation Control Act (IRA), Congress and the Biden-Harris Administration temporarily increased the amount and availability of the Advance Premium Tax Credit (APTC) under the ACA. The enhanced APTC reduced individual premium payments by an estimated 44% and increased marketplace enrollment from 12 million in 2021 to more than 21 million in 2024. The premium tax credit increase expires at the end of 2025, at the same time as many provisions of the Tax Cuts and Jobs Act. Failure to extend the enhanced premium tax credit could increase enrollment costs, cause individuals to drop out of the marketplace, and cause instability for health care providers and insurance plans. Vice President Harris has proposed making the health insurance subsidy increase permanent, and Democrats may request this during the tax extension negotiations.
Drug Costs: The IRA allows Medicare to negotiate the prices of some prescription drugs for the first time in history. In the first round of negotiations, the law allows for price negotiations on 10 drugs, with the new prices taking effect in 2026. The list will grow to 15 in 2027, 15 in 2028, and 20 each year from 2029 onwards. Democrats propose to increase this number to add at least 50 drugs per year to the list and to expand the reach of the program to Medicare beneficiaries. The IRA also put a $2,000 cap on out-of-pocket drug costs for seniors on Medicare and a $35 cap on insulin prescriptions. In addition, prescription drug companies that raise prices faster than the rate of inflation must reimburse Medicare for the difference between the increase and the inflation-adjusted price. Vice President Harris supports extending these provisions beyond Medicare to all Americans.
Medical Debt Relief: Even before running for president, VP Harris was a key figure in the Biden-Harris Administration’s efforts to remove medical debt from credit reports, touting how more than a dozen states and localities have used funds provided in the ARP to reduce and forgive $7 billion in medical debt for 3 million Americans. As a presidential candidate, Harris has said she would continue to work with states to forgive medical debt, but it is not clear whether she would seek additional legislative authority or resources beyond those provided in the ARP.
Healthcare Competition: The Biden-Harris Administration, through the FTC and DOJ, has focused on healthcare mergers through enforcement actions, new merger guidelines, and investigations of healthcare consolidation, including private equity involvement in the industry. The FTC has also recently pursued actions against pharmacy benefit manufacturers (PBMs) for anticompetitive conduct, and VP Harris has vowed to continue this action if elected. Pharmaceutical manufacturers have also come under FTC scrutiny, facing allegations that pharmaceutical companies improperly or inaccurately list patents for their products in the Orange Book, limiting market entry for generic competitors. VP Harris and the Democratic platform have vowed to continue action in this area.
Reproductive rights and maternal health have been longtime priorities for Harris.
Vice President Harris has also made reproductive rights a central part of her campaign, pledging to continue her focus on reducing maternal mortality and morbidity, as well as protecting access to in vitro fertilization (IVF).
Reproductive rights: Since the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization overturned Roe v. Wade and ruled that there is no right to abortion in the federal constitution, 22 states have banned abortions or limited them to earlier in pregnancy than Roe allowed. Vice President Harris has placed the blame for Dobbs on former President Trump, who appointed three of the six justices in the majority on the ruling and has campaigned in favor of federal legislation allowing abortion care nationwide. Additionally, Democrats have made access to IVF a campaign issue after the Alabama Supreme Court ruled that frozen embryos created through IVF should be considered “fetuses,” putting access to the treatment in the state in jeopardy. Reproductive rights will be a hot topic in the 2022 midterm elections, and with abortion rights debates continuing on state ballots this year, abortion and IVF access are expected to remain issues for the foreseeable future.
Maternal Mortality and Morbidity: Although maternal mortality rates have declined in the most recent years for which data are available, maternal mortality remains high in the United States, particularly among Black and Native American women. As a U.S. Senator, Ms. Harris was the lead sponsor of the Black Maternal Health MoMnibus, a package of policy proposals to reduce the maternal mortality crisis and improve care for mothers and newborns. Vice President Harris has spoken out about maternal mortality throughout her time in office and on the campaign trail. If elected, her administration is expected to focus resources on solving the issue.
President Trump’s approach to reducing health care costs
Trump’s lack of specificity on health care may partly reflect a lack of consensus on how the Republican Party should approach health care policy. Since the Republican Party failed to repeal and replace the ACA, the influence of Tea Party advocates of small government has waned. Some new Republican lawmakers have taken a more populist approach that is less resistant to federal health care policy and less likely to overturn the ACA. This seems consistent with Trump’s approach to the ACA. In a recent debate with Vice President Harris, Trump said he would not necessarily seek to repeal the ACA. “I would only change the ACA if I could come up with something that’s better and cheaper,” he said.
Vance’s comments on insurance market reform: On September 18, Senator JD Vance shared details about one of Trump’s health insurance plan ideas. He said, “We want to make sure that everyone has insurance, and the best way to do that is to actually promote more choice in the health care system and not have a one-size-fits-all approach where we put the same people in the same insurance pool, the same risk pool, which makes it harder to make the right choice for your family.” Additionally, Vance said the Trump campaign “want to make sure that people with similar health conditions are put in the same risk pool.” On “Meet the Press” on September 15, Vance said that Trump’s plan would ensure that pre-existing conditions are covered. The two policies appear to be in some tension. Some have pointed out that putting people in different risk pools could make it more expensive for people with pre-existing conditions to get insurance. More information from the Trump campaign is needed to evaluate the merits of this new policy proposal. As we’ve explained, the proposal shares some similarities with the 2017 Republican bill, the American Health Care Act, which passed the Republican-led House of Representatives but died in the Senate.
Possible Approaches to Lowering Prescription Drug Costs: Former President Trump has yet to offer detailed policy proposals to lower drug prices during his current campaign, but this was a policy area he was very interested in during his first administration. During his administration, President Trump worked to lower prescription drug prices, especially for seniors. For example, he created a temporary program to cap insulin costs at $35 per month for individuals participating in Medicare Part D and Medicare Advantage plans. He also issued executive orders to make it easier to import cheaper prescription drugs from other countries, such as Canada, and to mandate that discounts from pharmaceutical companies currently obtained by PBMs be passed on to consumers. Trump may support additional executive orders or legislation supporting similar ideas in his second administration. In 2016, Trump campaigned on allowing Medicare to negotiate drug prices for seniors, but opposed the idea in favor of other proposals during his administration. It is worth noting here that J.D. Vance supported Medicare price negotiations during his 2022 Senate campaign. It is unclear how Trump will approach this issue in a second term, but he may be hesitant to back away from Medicare price negotiations given his previous support for the policy. Other drug pricing ideas Trump is likely to consider include encouraging more generic and biosimilar competition and lowering drug prices in the Medicare 340B program, which requires pharmaceutical companies to offer some drugs at a discount to low-income and uninsured patients. Other right-wing thought leaders and think tanks have proposed other ideas for lowering drug prices, ranging from patent reform to PBM reform to inflation caps on Medicare drug price increases.
Trump proposes leaving abortion up to the states and subsidizing IVF treatments through the federal government
Abortion and IVF: One of the biggest differences between the two presidential candidates is on abortion. Trump said during the debate that he would reject any federal law banning abortion. He also opposes any national legislation that would legalize access to abortion. Unlike Harris, who supports a national law, Trump believes that each state should make its own laws regarding abortion. On the issue of IVF treatment, Trump has proposed that the government or insurance companies cover the cost of IVF treatment. If implemented, this would be the most expensive federally mandated health care benefit in history. Several Republicans, including Senator Lindsey Graham (R-SC), are skeptical of the affordability of Trump’s proposal.
Maternal Mortality and Morbidity: In 2018, then-President Trump signed the Prevent Maternal Mortality Act into law. The act reauthorized federal support for state commissions that investigate pregnancy-related deaths to determine causes and make recommendations to prevent future deaths. Maternal mortality remains high and may be an area of activity for the Trump Administration, but President Trump is likely to support efforts to support the efforts states are making to address the maternal health crisis.
summary
Both presidential campaigns have criticized the other for not providing details on their policies, but recent statements from both campaigns and how the candidates have addressed the issue under the Trump and Biden administrations offer some insight. More details are likely to emerge in the coming weeks as Election Day approaches. While the two parties share the goal of reducing health care costs, they differ significantly about the best way to do so.
