Health care has become more difficult, expensive and stressful for many in the US, and this is one of the biggest issues in the 2024 election. Vice President Kamala Harris and former president Donald Trump have already vowed to do this if they win—and to do it through policies ranging from cutting drug prices to ensuring access to care. But there are many differences in how each of their plans will affect the US health economy – and the people who deal with its management every day.
Harris said his administration will strengthen the Affordable Care Act (ACA) and expand the Inflation Reduction Act’s (IRA’s) cost-savings provisions. Trump’s presidential record on health care is mixed, full of attacks on the ACA and major cuts to federal health insurance programs.
Drug prices
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People in the US pay more for medicine than people in many other comparatively wealthy countries. Both candidates have prominently highlighted lowering drug prices on their agendas, and they have previously implemented such policies during their positions in the White House.
During the administration of President Joe Biden, Harris made the breaking vote to pass the 2022 IRA-legislation to put new limits on drug prices. The IRA gave Medicare (the government insurance program for adults 65 and older) the ability to negotiate lower prices for certain drugs. The most talked-about feature of Harris’ campaign is the $35 cap on insulin. It also made Medicare vaccinations free and expanded subsidies to help low-income people pay for better coverage. And it would provide $2,000 in annual out-of-pocket spending on prescription drugs under Medicare starting in 2025. Cancer drugs, for example In other words, patients can now pay upwards of $10,000 a year. But the IRA will drop this to $2,000, said Stacie B. Dusetzina, a health policy and drug cost researcher at Vanderbilt University School of Medicine. “This is a great addition to the benefits that are coming for seniors,” Dusetzina said.
Ten prescription drugs have already been listed for price negotiations, but people won’t start seeing price changes at the pharmacy until January 2026. Harris said, if elected, he would further strengthen the IRAs, reduce the cost of many drugs under Medicare – and expand them. drug coverage under private insurance and Medicaid, the federal insurance program that covers certain people with low incomes, special disabilities or pre-existing conditions. It is not certain what the fate of the IRA will be under the Trump administration.
“One of the reasons drug pricing is a hot topic is because there is concern in the Republican Party that companies don’t have incentives to innovate and produce new drugs” if they can’t they reap the profits, Dusetzina said. . “Many Republican members of Congress have pushed to stop negotiating drug prices, and we know that pharmaceutical companies … are suing the government to stop negotiating for selected products.” (Many of these companies have lost their cases, and other cases are ongoing.) If the second Trump administration were to act quickly, it could try to block or repeal the policy before it can. enforce new prices in 2026, said Dusetzina.
In Trump’s final months in office in 2020, he issued two executive orders to help lower the cost of prescription drugs. He tried to stop pharmacy benefit managers—third-party companies that negotiate prices and deals between drugmakers and consumers—from collecting reimbursement checks for prescription drugs. to seniors with Medicare to ensure that all of these people receive savings from drug manufacturers. He also tried to strengthen the price model of the “Most Favored Nation”, which will set some drugs prescribed by doctors under Medicare at low prices, close to those paid in other developed countries.
Critics say the Most Favored Nation model will end up giving other countries power over drug prices. The Biden administration pulled the order in 2022. In his campaign, Trump initially supported the return of the Great Government model, but he walked back those statements. Dusetzina said there is collective support for limiting prescription drug patents, which could facilitate the entry of generic drugs into the market and four reduce costs.
Maintenance Maintenance
In last month’s presidential debate, Trump falsely said he “saved” the Obama-era ACA, which provides health insurance to more than 21 million people. During the Trump administration, he kept trying to repeal it. Ultimately, he failed, even though he persuaded Congress to repeal the ACA tax exemption, which forced people to enroll in a health insurance program. While Trump was in office, ACA enrollment dropped from 12.7 million people to 11.4 million, increasing rates for those remaining.
As president, Trump also proposed budget proposals that could cut $1 trillion in Medicaid if passed. The ACA supports a federal funding program that matches 90 percent of costs in states that opt ​​in to Medicaid expansion; it increases the program’s ability to provide health care to people below 138 percent of the poverty line. States that implemented this expansion saw a 41.7 percent increase in coverage by 2020. Ten states did not expand Medicaid, resulting in a disparity that studies have shown disproportionately affects people of color. . People with low-wage jobs may also be ineligible for Medicaid because their incomes are too high according to each state’s standards.
In an effort to fill these gaps, the Trump administration allowed states to use work requirements – which force people on Medicaid to prove that they work 20 hours a week, participate in the organization or qualify for an exception. But mandatory pilot programs in states without Medicaid expansion, such as Arkansas and Georgia, have seen worse enrollment and higher government costs, the report said. by Stephen W. Patrick, a physician and chairman of the Department of Health and Management at Emory University. Patrick said the polls show a majority of Georgians favor Medicaid expansion. While the Trump administration pushed for these requirements, the Biden administration has moved to roll them back, saying that jobs and careers should not be tied to health care.
Trump’s position on the ACA has been inconsistent and ambiguous throughout his campaign. He has indicated that he will keep the ACA and enforce it. In other words he promised to change it to something better. During his September 2024 debate with Harris, Trump said he “thinks it’s a plan” but gave no details. Trump’s ally, Senator JD Vance of Ohio, recently approved major changes to insurance pools that could make insurance cheaper for those with fewer medical needs—and more expensive for those with higher. ACA protections that prevent insurers from discriminating against people with special needs or pre-existing conditions, including chronic diseases or perfect, or pregnant people.
Trump has tried to tackle medical bills, a byzantine—and sometimes bankrupt—movement for many in the U.S. In 2020, Congress passed Trump’s No Surprises Act, a law that clearly advocates from a study that has prevented millions of unexpected medical bills from abroad. – communication services. However, other costs may increase.
The Biden-Harris administration has strongly encouraged insurance enrollment and suggested ways to strengthen and protect the ACA, Patrick said. On his campaign trail, Harris has also strongly emphasized a proposal to use unspent COVID relief funds to remove $7 billion in medical debt from people’s credit reports. “No one should be denied access to economic opportunities because they experienced an emergency,” Harris said in the June announcement.
Prepare for Disease
The Trump administration created the Coronavirus Task Force to oversee public health efforts during the COVID pandemic, and it also launched Operation Warp Speed ​​to quickly develop mRNA vaccines against COVID at the end of 2020. due to other actions taken by Trump. At the height of the epidemic, he undermined and dismissed advice from public health officials, blocked mask orders and continued to hold large rallies during his 2020 presidential campaign. Since then to develop strong anti-vaccination sentiments; Most experts agree that many of the COVID deaths could have been avoided among Trump supporters.
Biden’s American Rescue Plan, enacted in 2021, helped strengthen the public health response to the pandemic. Federal funds provided free COVID vaccinations, testing and treatment. The plan was also intended to reduce the racial inequality that emerged during the pandemic. In 2023, Biden signed a law to help the country better prepare and plan for future pandemics. It also re-established a White House pandemic preparedness office, which Trump shut down in 2018, to monitor biological and disease threats — such as the H5N1 bird flu, which recently affected American dairy cows. and chickens, as well as some people. Another administration will face the threat of the human H5N1 virus.
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