Harris and Trump on Health Care: What to Watch

Health care issues remain among American voters’ top concerns heading into the 2024 general election, and former President Trump and Vice President Harris have starkly different approaches and records on the issue. In this client alert, part of our Election 2024 series, we analyze the candidates’ priorities in health care, or at least what we know of them. For all of the concern about health care in the electorate, both candidates have been criticized for not revealing enough detail about their respective plans.

Focus on Lowering Costs Frames Harris Health Care Agenda

The bulk of Vice President Harris’s health care agenda falls within her plans to reduce costs for American families. This includes proposals to expand private health insurance coverage through the Affordable Care Act (ACA), reduce drug costs through caps on out-of-pocket expenses and an expansion of Medicare drug price negotiation, a focus on medical debt relief, and support for the Department of Justice (DOJ) and the Federal Trade Commission (FTC)’s efforts related to health care competition.

Health Insurance Coverage: Under the American Rescue Plan (ARP) and the Inflation Reduction Act (IRA), Congress and the Biden-Harris Administration temporarily increased the amount and availability of advanced premium tax credits (APTCs) under the ACA. Enhanced APTCs reduced individual premium payments by an estimated 44% and increased the number of marketplace enrollees from 12 million in 2021 to over 21 million in 2024. The boost to premium tax credits sunsets at the end of 2025, at the same time as many provisions under the Tax Cuts and Jobs Act. Failure to extend the enhanced premium tax credits will lead to increased costs to enrollees, and may lead to individuals dropping out of the market and instability for health providers and insurance plans. Vice President Harris has proposed to make the increased health insurance subsidies permanent, and Democrats may make this an ask in the course of tax policy extension negotiations.

Drug Costs: The IRA allowed Medicare to negotiate the price of some prescription drugs for the first time in history. In the first round of negotiations, the law allowed for prices on 10 drugs to be negotiated, with new prices going into effect in 2026. That list will grow by 15 more drugs in 2027, 15 more in 2028, and finally 20 drugs in 2029 and each year following. Democrats have proposed to increase these numbers to add at least 50 drugs per year to the list, expanding the reach of this program for Medicare beneficiaries. The IRA also instituted a $2,000 cap on out-of-pocket drug spending for seniors in Medicare, and a $35 cap on insulin prescriptions. Additionally, prescription drug companies that raise prices faster than the rate of inflation must pay a rebate reflecting the difference of the increased price above the inflation-adjusted price back to Medicare. Vice President Harris has supported expanding these provisions beyond Medicare to all Americans.

Medical Debt Relief: Since before entering the race for President, Vice President Harris has been front and center on the Biden-Harris Administration’s efforts to remove medical debt from credit reports and touting that more than a dozen states and localities are leveraging funding provided in the ARP to buy down and cancel $7 billion in medical debt for 3 million Americans. As a presidential candidate, Harris has said that she will work with states to continue to cancel medical debt, though it is not clear if she will seek additional legislative authority or resources beyond those provided in the ARP.

Health Industry Competition: The Biden-Harris Administration, through the FTC and the DOJ, have focused attention on mergers in the health industry through enforcement action, new merger guidelines, and investigations into health industry consolidation, including with private equity involvement in the industry. The FTC has also recently pursued action against pharmacy benefit manufacturers (PBM) for anticompetitive practices, which Vice President Harris has vowed to continue if elected.  Drug manufacturers have also faced scrutiny from FTC, facing claims that pharmaceutical companies improperly or inaccurately listing patents for their products in the Orange Book, which can restrict market entry for generic competitors. Vice President Harris and the Democratic Party platform have vowed to continue pursuing action in this area.

Reproductive Rights, Maternal Health Longtime Priorities for Harris

Vice President Harris has also made reproductive rights a centerpiece of her campaign, continuing to focus on reducing maternal mortality and morbidity and has also pledged to protect access to in vitro fertilization (IVF).

Reproductive Rights: Since the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, which overturned Roe v. Wade and found there is no federal constitutional right to abortion, 22 states have banned the procedure or restricted it to time periods earlier in pregnancy than were allowed under Roe. Vice President Harris has assigned responsibility for Dobbs to former President Trump, who appointed three justices in the six-justice majority on the decision, and has campaigned in support of a federal law to allow abortion care nationwide. Additionally, after the Alabama Supreme Court ruled that frozen embryos created through IVF should be considered “unborn children,” jeopardizing access to the treatment in the state, Democrats have made access to IVF a campaign issue. After the salience of reproductive rights as an issue in the 2022 midterm election, and continued debate on abortion rights on state ballots this year, expect access to abortion and IVF to be an issue going forward for the foreseeable future.

Maternal Mortality and Morbidity: Although there was a drop in maternal mortality rates in the most recent year in which data is available, maternal mortality remains high in the United States, especially among Black and Native American women. As U.S. Senator, Harris was the lead sponsor on the Black Maternal Health Momnibus, a package of policy proposals to help reduce the maternal mortality crisis and improve care for mothers and newborn children. Vice President Harris has continued to talk about maternal mortality while in office and on the campaign trail. If elected, expect her administration to focus resources on addressing the issue.

Trump’s Approach to Lowering Health Care Costs

To some extent, Trump’s lack of specificity on health care may reflect a lack of consensus on how Republicans should approach health care policy. Since Republicans failed to repeal and replace the ACA, the influence of small-government Tea Party-types has waned. Some new Republican members of Congress have more of a populist approach that makes them more comfortable with federal government health care initiatives and less likely to overturn the ACA. That appears consistent with Trump’s approach to the ACA. At the recent debate with Vice President Harris, Trump said that he would not necessarily try to repeal the ACA. He said “I would only change it [if] we came up with something that’s better and less expensive.”

Vance’s Comments on Overhauling Insurance Markets: On September 18, Trump's running mate, Senator JD Vance, said “[w]e want to make sure everybody is covered, but the best way to do that is to actually promote more choice in our health-care system and not have a one-size-fits all approach that puts a lot of the same people into the same insurance pools, into the same risk pools, that actually makes it harder for people to make the right choices for their families.” Vance said further that the Trump campaign wants to “allow people with similar health situations to be in the same risk pools.” On Meet the Press on September 15, Vance said that Trump’s plan would also make sure that preexisting conditions are covered. These two policies seem to be in some tension. Some have pointed out that putting people into different risk pools could make it more expensive for people to get insurance who have preexisting conditions. More details from the Trump Campaign are needed to evaluate the merits of this emerging policy proposal. As described so far, the proposal has some similarities to the 2017 Republican bill called the American Health Care Act which passed the Republican-led House of Representatives, but failed in the Senate.  

Possible Approaches to Lowering Prescription Drug Costs: Former President Trump has not yet laid out detailed policy proposals for lowering drug prices during his current campaign, but it was a policy area he was highly interested in during his first administration. During his administration, President Trump worked to reduce prescription drug prices, especially for seniors. For example, he created a temporary program that capped insulin costs for individuals in participating Medicare Part D and Medicare Advantage plans at $35 per month. He also issued executive orders designed to make it easier to import cheaper prescription drugs from other countries like Canada and that required discounts from drug companies currently captured by PBMs to be passed on to consumers. Trump might support additional executive orders or legislation backing similar ideas in a second administration. In 2016, Trump campaigned on letting Medicare negotiate drug prices for seniors, but he opposed the idea during his administration in favor of other proposals. Here it is worth noting that JD Vance favored Medicare price negotiation during his 2022 Senate campaign. It’s unclear how Trump would approach the issue in a second term, but he might be hesitant to roll back Medicare price negotiations given his previous support of the policy. Other ideas on drug pricing Trump is expected to consider include increasing generic and biosimilar competition, and lowering prices for drugs in the Medicare 340B program. That program requires drug manufacturers to provide some drugs at reduced prices to lower-income and uninsured patients. Other right-leaning thought leaders and think tanks have proposed other ideas on lowering drug prices from patent reform to PBM reform to capping Medicare drug price increases to inflation.    

Trump Will Defer to the States on Abortion, Has Proposed IVF Treatments Subsidized by the Federal Government

Abortion and IVF: One of the biggest differences between the two presidential candidates is on abortion. Trump said in the debate that he would veto a federal law banning abortion. He would also oppose a national law codifying access to abortion. Unlike Harris, who supports a national law, Trump thinks that each individual state should set their own laws on abortion. On the issue of IVF treatments, Trump has proposed having the government or insurance companies cover IVF costs. This could be a significant benefit to individuals and families dealing with infertility though several Republicans, including Senator Lindsey Graham (R-SC), have expressed concerns about the costs of this idea, which could be significant.

Maternal Mortality and Morbidity: In 2018, then-President Trump signed into law the Preventing Maternal Deaths Act. This act reauthorized federal support for state-based committees that review pregnancy-related deaths to identify causes and make recommendations to prevent future mortalities. Maternal mortality remains high, so this could be a place where a Trump administration is active, but Trump is more likely to back efforts to support what the states are doing to address the maternal health crisis.  

Summary

Both presidential campaigns have criticized the other for not offering more policy details. But some insights can be gleaned from recent statements by the campaigns and how both candidates approached the issue during the Trump and Biden administrations. More details will no doubt follow over the coming weeks as election day approaches. Both parties share the goal of reducing health care costs, but differ broadly in how best to go about it.