Implications of Harris’ health care plans and Trump’s drafts of a plan

Healthcare remains an important issue for voters, second only to the economyaccording to Pew Research. But the president of the United States probably has less control over the economy than he does over health care. After all, the economy is subject to the whims of market forces, both national and international, which are often beyond the purview of any given government. Yet the federal government can have a direct impact on health care through the programs it funds, such as Medicare and Medicaid, as well as through laws it implements, such as the Affordable Care and Inflation Reduction Acts. Major policy differences have emerged between the campaigns of Vice President Kamala Harris and former President Donald Trump, which could impact patients’ access to health care.

A recent one New England Journal of Medicine article suggests that the November election could have been important implications for patient access to health care, whether through changes to the ACA and other laws, expansion of Medicaid — the government’s health insurance program for people with limited income and resources — or the addition of benefits for seniors and disabled people who are enrolled in Medicare.

The Harris campaign has announced a series of proposals to expand government programs such as Medicare and Medicaid and extend the reach of certain benefits that currently apply only to the public domain to the private insurance sector. The Trump campaign was not as promising. It’s hard to know much about the “concepts of a plan” Trump mentioned during the presidential debate, beyond the rough outlines of what the former president’s intentions might be regarding health care.

If Harris wins, it will likely result in a continuation of policies led by the Biden administration, including strengthening the ACA through the American Rescue Plan and the Inflation Reduction Acts. Or a Trump victory could trigger policy reversals, including possible disruptions to the ACA, as indicated by Trump and his running mate, J.D. Vance.

During the campaign, Harris has spoken about the need to expand Medicare to include dental, vision and hearing benefits. She also touts the Biden administration’s record of reducing the number of uninsured to the lowest level in history and lowering Medicare beneficiaries’ out-of-pocket costs for prescription drugs through provisions included in the Inflation Reduction Act. For example, starting next year, Medicare beneficiaries will have a $2,000 annual limit on out-of-pocket prescription drug costs. And the cost of insulin has already been incurred limited to $35 per month for Medicare recipients, which Harris now wants all Americans with insurance to benefit from.

The Centers for Medicare and Medicaid Services also negotiated the prices of ten best-selling prescription drugs. At the end of August, the agency released the so-called maximum fair prices for the therapies, which are due to be introduced in January 2026. In addition, CMS will select fifteen additional drugs for negotiation in February 2025. Harris plans to build on the Medicare bargaining policy to include more drugs. drugs if she becomes president, although this would likely face hurdles from Congress.

Harris also outlined a plan to expand Medicare coverage of home health care for seniors, including specific ways to potentially fund the new program from expected savings the government could achieve by negotiating lower drug prices.

In addition, the Democratic presidential candidate has talked about tackling medical debt by building on existing federal efforts to help some of the 100 million people struggling with this financial burden. Additionally, Harris sees expanded insurance coverage that lowers patients’ out-of-pocket costs as the best defense against taking on debt in the future.

And Harris has stated that she is trying curb drug patent abuse and alleged anticompetitive practices by both pharmaceutical manufacturers and pharmacy benefit managers, who managed prescription drug benefits for clients such as Medicare and Medicaid. Her views echo those of Federal Trade Commission Chair Lina Khan, an appointee of the Biden administration.

Trump’s ‘concepts of a plan’

Since running for a second term as president, Trump has wavered on a number of health care-related issues. In January, for example, Trump reiterated his pledge to withdraw the ACA before backtracking, claiming in a post on Truth Social that he wanted to make the ACA “better” instead. In fact, now he and other Republicans say they want to improve the care program.

Trump has not announced any details about how he plans to handle this, but his running mate has dropped a few hints. Vance says there is a plan to “fix health care,” specifically regarding the ACA. He has argued that the health insurance market should be deregulated and talked about placing people with chronic conditions in separate insurance pools. But this could lead to insurers charging higher premiums for those with pre-existing conditions.

It’s curious that the Trump campaign has largely retreated from outlining healthcare initiatives that would impact patient access, because Trump certainly had more than just a draft of a plan as president. His government was actively involved in efforts to reshape healthcare.

As president, Trump did not attempt to expand standard Medicare benefits to include vision, dental and hearing. However, the Trump administration private options promoted for beneficiaries through Medicare Advantage plans, which often include additional benefits such as vision, dental and hearing.

The Trump administration also opposed the expansion of Medicaid. Instead, it chose to rely on Section 1115 Medicaid demonstration waivers, which provide an opportunity for states to test new approaches that differ from what is required by federal law. Under Trump, CMS approved a series of demonstrations including eligibility restrictions and work requirements for Medicaid beneficiaries.

And under the former president’s watch, the Department of Health and Human Services proposed government-led measures aimed at reducing Medicare beneficiaries’ out-of-pocket costs for prescription drugs at the pharmacy counter. To illustrate, Trump issued executive orders directly targeting PBMs in an effort to force the middlemen to pass on rebates to Medicare recipients at the point of sale. These efforts could not be implemented.

Trump also signed executive orders that would have established a “most favored nation” drug pricing policy, which would have required pharmaceutical companies to sell certain drugs to Medicare at the lowest price they offer to a number of comparable countries in terms of gross per capita. domestic product. These actions by Trump also led nowhere.

The use of such international price references for prescription drugs was firmly against by many fellow Republicans. After repeated his pursuit of a most-favored-nation policy during a second term earlier this year, Trump has now apparently done rejected this proposal.

Expanding the scope of health care to include the issue of reproductive rights, at Trump’s direction, the Republican platform in 2024 to leave a federal abortion ban plank, instead ceding restrictions to the states, which is in line with the decision to overturn Roe v. Wade. Trump has taken it personally many different positions over timemaking it unclear for voters to assess where he currently stands. On the other hand, Harris promises to codify Roe v. Wade through an act of Congress, which would aim to guarantee abortion rights nationwide.

What can be gleaned from campaign speeches and policy statements, party platforms, and what happened during the Trump administration have revealed sharply defined differences in policy positions between Harris and Trump that would impact patients’ access to health care. The Harris campaign has issued a series of detailed proposals to expand government programs such as Medicare and Medicaid and to expand the scope of certain measures that currently apply only in the public sphere to the private insurance sector. On the other hand, Trump’s campaign messages on health care were more ambiguous or completely lacking in action. All that is known is that under Trump, disruptions to the ACA are possible, as well as experimentation in Medicaid through state-based pilot projects that strictly limit participant eligibility.