President Donald Trump spoke to the media outside the White House on July 19, 2019, while Democratic presidential nominee and U.S. Vice President Kamala Harris addressed a gathering marking the one-year anniversary of the October 7 Hamas attacks on Israel at her residence in the U.S. Naval Observatory, Washington, D.C., on October 7, 2024. The approaching presidential election between Vice President Kamala Harris and former President Donald Trump presents the possibility of varied outcomes for patients in the expansive U.S. health system regarding issues such as prescription drug costs, abortion rights, and the future of Obamacare.
Both Harris and Trump have committed to making healthcare more affordable in the United States, which stands out among developed nations for higher healthcare spending, poorer patient outcomes, and access barriers. However, their methods for achieving this goal diverge significantly. While neither candidate has disclosed detailed health policy proposals, each one’s track record offers insights into potential future changes in drug prices, healthcare, and reproductive rights.
Drew Altman, CEO, and president of health policy research organization KFF stated that a Trump administration might attempt to reduce federal health spending to fund tax cuts and minimize federal involvement in health. In contrast, a Harris administration would likely build on existing programs, increasing federal spending to make healthcare more affordable.
Restructuring the U.S. healthcare system, which involves various stakeholders such as doctors, insurers, and drug manufacturers, poses significant challenges. Any major reform also depends on congressional control and state legislation.
Despite being the highest spender on healthcare among wealthy nations, the U.S. records the lowest life expectancy at birth, the highest incidence of chronic diseases, and the highest rates of maternal and infant mortality, according to a 2023 report by The Commonwealth Fund.
Approximately half of American adults report difficulties affording healthcare, leading some into debt or causing them to delay necessary care, according to a KFF poll from May.
Both Harris and Trump have pledged to lower prescription drug costs in a country where medication expenses are nearly threefold that of other nations, as stated by RAND. Around one in five adults have not filled a prescription within the past year due to cost, with one in ten resorting to cutting pills in half or skipping doses.
During his presidency, Trump’s efforts to control drug prices had limited, temporary impacts, and his current campaign lacks detailed plans on this issue. Harris, if elected, would aim to extend certain provisions of the Inflation Reduction Act to benefit all Americans, not just Medicare enrollees, including a $35 monthly insulin cost cap and a $2,000 annual out-of-pocket spending limit.
Under Harris, Medicare drug price negotiations would expand and accelerate to include more expensive drugs, despite opposition from the pharmaceutical industry. Trump has not specified his stance on these provisions.
While Republicans have criticized drug pricing negotiations for hindering innovation, experts like Dr. Mariana Socal from Johns Hopkins University argue that a Trump administration would need congressional change to modify these laws substantially.
Both candidates are scrutinizing pharmacy benefit managers, intermediaries in the drug supply chain, amid accusations of inflating medication prices and impacting U.S. patients and pharmacies. Recent pressure from lawmakers and the Biden administration highlights increasing scrutiny on these entities.
Addressing healthcare coverage, Harris and Trump propose differing methods. Harris supports the Affordable Care Act (ACA) and plans to make permanent the enhanced subsidies for ACA health plans extended by the Inflation Reduction Act. She may work with Congress to expand Medicaid coverage in the remaining 10 states yet to do so under the ACA.
Conversely, Trump previously sought to repeal the ACA, though he has now indicated a preference to improve it without offering specific plans. Republican promises to repeal it have waned as the law’s popularity grows.
The impact of either administration on Medicaid could be significant. Trump’s previous presidency saw attempts to limit spending and transform federal funding to states into a “block grant” program. Harris would likely further the expansion of Medicaid coverage and address health disparities. Any sweeping Medicaid changes under Trump would face Democratic opposition if they control either house of Congress.
Reproductive rights, especially abortion, remain pivotal in the upcoming election. Since the U.S. Supreme Court overturned Roe v. Wade, many states have increased abortion restrictions. Harris, supporting abortion rights, seeks to codify these protections into federal law and has advocated for maintaining access to the abortion pill mifepristone.
In contrast, Trump has had shifting stances on abortion and could potentially consider more restrictive policies, though he has recently expressed opposition to a federal abortion ban. Both candidates support the availability of in vitro fertilization as part of their reproductive rights platforms.
