Nov. 5, 2024, is here. Voters will head to the polls to cast their ballots in the presidential election, shaping the course of health policy for the next four years.
Vice President Kamala Harris has promised to largely continue the Biden administration’s priorities by further bolstering the Affordable Care Act (ACA) and supporting the drug price negotiation program. However, she has retreated from old positions she previously approved of in 2020, when she endorsed single-payer healthcare.
Former President Donald Trump would likely continue price transparency initiatives, but he has faced criticism over his views on reproductive rights, disdain toward the ACA, association to the Heritage Foundation-led Project 2025 and close ties to Robert F. Kennedy Jr.
Here’s how the two contenders may approach the ACA, reproductive rights and drug price negotiations.
Affordable Care Act
Harris repeatedly highlights the strength of Obamacare and says she will make sure to protect the law. Democrats will likely push for the extension of enhanced subsidies set to expire at the end of 2025. Insurers publicly say Republicans may extend the tax credits as well, but the prospect is generally less likely.
The former president lambasted the ACA throughout his presidency and criticized the late Sen. John McCain for being the decisive vote against repealing the program in 2017. In the only general election debate of the 2024 cycle, when asked whether Trump finally had a plan to replace the ACA, Trump responded he has “concepts of a plan.”
Trump’s vice presidential running mate J.D. Vance said some high-risk individuals could be moved to different risk pools, a pre-ACA concept that results in higher premiums for sicker patients, experts say. Harris says Trump’s contempt for the ACA shows he won’t protect voters from preexisting conditions, an issue that no longer plagues ACA recipients.
Harris also said she is in favor of Medicare covering home health care, vision and hearing for eligible members.
Reproductive rights
Abortion and reproductive could prove to be the defining issue in this tightly contested election, even ahead of immigration, the economy and democracy itself.
In what is turning out to be an electorate divided by gender, women may overwhelmingly vote for Harris. She has promised to restore Roe v. Wade by eliminating the filibuster and protect access to in vitro fertilization and mifepristone.
Trump says his policies will protect women and that abortion is now up to the states. He previously stated IVF treatments would be covered by the government and private insurers if elected, though that would fly in the face of Project 2025’s goals. Many former Trump officials are closely tied to the master plan. He has also made conflicting statements on mifepristone and contraceptives.
Roe v. Wade was overturned in June 2022. Trump selected two judges to sit on the court that both voted in favor of abolishing the legal precedent.
Prescription drugs
Harris cast the tie-breaking vote in the Senate to pass the Inflation Reduction Act, allowing the Centers for Medicare & Medicaid Services to negotiate with manufacturers to lower the cost of prescription drugs.
The issue is divided among party line, with Democrats pointing to the savings Medicare and patients will see and Republicans claiming the savings are overstated and innovation will be stifled.
On pharmacy benefit manager reform, Harris said she would protect small pharmacies by cracking down on “abusive practices” by middlemen, seemingly referring to controversial practices from major PBMs. Trump has not stated how he would handle PBM reform.
Both candidates have tried to win credit for $35 insulin copay caps.