Health care has become a difficult, expensive and frustrating issue for many in the US, and it is one of the main issues in the 2024 election. Vice President Kamala Harris and former President Donald Trump have both vowed to do so if they win—and do so through legislation starting with cost reductions. doctor to make sure he gets treatment. But there’s a big difference in how their plans will affect the US health care economy — and the people who deal with them every day.
Harris says his administration will strengthen the Affordable Care Act (ACA) and expand the Inflation Reduction Act’s (IRA’s) savings plan. President Trump’s record on health care is mixed, filled with attacks on the ACA and major cuts to health insurance programs.
Drug Prices
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People in the US pay more for medicine than those in other wealthy countries. Both presidential candidates have made lowering drug prices part of their agenda, and each has done so in the past during their run for the White House.
During President Joe Biden’s administration, Harris voted to pass the 2022 IRA-law that would have put limits on drug price increases. The IRA gave Medicare (the insurance program for adults 65 and older) the ability to negotiate lower prices for certain drugs. The most talked about feature of Harris’s campaign is the $35 cap on insulin. It also made Medicare vaccinations unfunded and increased spending on low-income people to pay for quality care. And it will put up to $2,000 a year for drugs covered by Medicare starting in 2025. Cancer drugs, for example, can cost patients more than $10,000 a year. But an IRA will drop that to $2,000, explains Stacie B. Dusetzina, a health policy and drug cost researcher at Vanderbilt University School of Medicine. “This is a huge expansion of the benefits coming to the elderly,” says Dusetzina.
Ten drugs have already been listed in the price negotiations, but people won’t start seeing price changes at the pharmacy until January 2026. Harris says, if elected, he will also strengthen the IRA, lower the cost of many drugs under Medicare – and even expand them. the provision of drugs under private insurance and Medicaid, a government insurance program that covers certain people with low incomes, disabilities or pre-existing conditions. It is unclear what the future of the IRA will be under the Trump administration.
“One of the reasons that drug price negotiations are so difficult is that there is concern among the Republican Party that companies have no incentive to innovate and develop new drugs” if they can’t make a profit, Dusetzina says. . “Many Republican members of Congress have pushed for a ban on drug price negotiations, and we know that the pharmaceutical companies … (Many of these companies have lost their lawsuits, and some lawsuits are still pending.) If the second Trump administration were to act quickly, they could try to ban or ending the process before the new prices start in 2026, Dusetzina says.
In the final months of Trump’s presidency in 2020, he issued two orders to help reduce the cost of medicine. He tried to stop pharmacy benefit managers—the third-party companies that negotiate prices and discounts between drugmakers and consumers—from removing rebate checks on low-cost drugs sold to seniors with Medicare to ensure that those people get the full amount. from drug manufacturers. He also tried to push for “Most Favored Nation” pricing, which would set certain prescription drugs under Medicare at very low prices, close to those paid in other developed countries.
Critics say the Most Favored Nation model will ultimately give other states more power over drug prices. The Biden administration pulled the plug in 2022. During his campaign, Trump initially supported reintroducing the Most Popular brand, but has recently abandoned that term. Dusetzina says there is a two-pronged approach to reducing drug licensing, which would make it easier for any drug to enter the market and lower prices.
Care Affordable Care
During last month’s presidential debate, Trump claimed to have “saved” the Obama-era ACA, which provides health insurance to more than 21 million people. During Trump’s administration, he tried repeatedly to get rid of it. In the end, he failed, although he forced Congress to remove the tax penalty of the ACA, which encouraged people to sign up for the health insurance program. While Trump was in office, ACA insurance enrollment dropped from 12.7 million people to 11.4 million, raising prices for those who remained.
As president, Trump also proposed a budget that would have cut $1 trillion from Medicaid if enacted. The ACA supports a federal funding program that matches 90 percent of the funds it chooses to expand Medicaid; this increases eligibility for health care to people who are at or below 138 percent of the poverty level. States that adopted this expansion saw a 41.7 percent increase in insurance enrollment as of 2020. Ten states did not expand Medicaid, creating a disparity that studies have shown has a greater impact on people of color. People with low-income jobs may also be ineligible for Medicaid because their incomes are still too high according to state requirements.
In an attempt to fill these gaps, Trump allowed states to use work requirements—which force people on Medicaid to prove they work 20 hours a week, participate in social activities or qualify for exemptions. But pilot programs in states that have not expanded Medicaid, such as Arkansas and Georgia, have seen higher insurance rates and more government spending, said Stephen W. Patrick, a pediatrician and chairman of the Department of Health Policy and Management at Emory University. Patrick says polls show a majority of Georgians favor Medicaid expansion. While the Trump administration has pushed back on this, the Biden administration has reversed this, saying jobs and services should not be tied to access to health care.
Trump’s position on the ACA has been inconsistent and ambiguous throughout. He said he would keep the ACA and make it stronger. In other words, he has promised to change and become better things. During his September 2024 debate with Harris, Trump said he had “ideals” but did not elaborate. A Trump aide, Senator J.D. Vance of Ohio, recently approved sweeping changes to insurance risk pools that would make care less expensive for those with the least medical needs — and more expensive for those with the highest. This would eliminate ACA protections that prevent insurers from discriminating against people with disabilities or pre-existing conditions, including chronic illnesses or disabilities, or people who are pregnant.
Trump has tried to crack down on medical bills, a byzantine—and sometimes taxing—process for many in the U.S. — Internet services. It can, however, raise other costs.
The Biden-Harris administration has encouraged people to sign up for insurance and to promote measures to strengthen and protect the ACA, Patrick said. During his campaign tour, Harris also strongly reviewed a proposal that would use unused COVID funds to remove $7 billion in medical debt from people’s credit reports. “No one should be denied access to income because of a medical condition,” Harris said in a press release in June.
Pandemic Preparedness
The Trump administration created the Coronavirus Task Force to oversee public health operations during the COVID pandemic, and it also pushed Operation Warp Speed ​​to develop a life-saving mRNA COVID vaccine by the end of 2020. due to other moves Trump made. At the height of the pandemic, he repeatedly flouted and rejected advice from government officials, canceled mask positions and continued to hold rallies during his 2020 presidential campaign. He has since promoted anti-vaccination sentiment; several experts agree that many of the COVID-19 deaths among Trump supporters could have been prevented.
Biden’s American Rescue Plan, which was launched in 2021, helped mobilize people to fight the epidemic. Federal funds provided free COVID vaccines, tests and treatment. The plan also aimed to reduce the racial inequality that arose during the pandemic. In 2023, Mr. Biden signed legislation to help the country better prepare and prepare for future pandemics. It also established an office of pandemic preparedness at the White House, which Trump suspended in 2018, to monitor threats and emerging diseases, such as the H5N1 bird flu, which has recently infected US dairy cows and chickens, as well as other people. The next government must deal with the potential threat of a human H5N1 pandemic.
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