President Donald Trump talks to the press outside the White House, July 19, 2019, left, and Democratic presidential nominee and U.S. Vice President Kamala Harris speaks to mark the one-year anniversary of the Oct. 7 Hamas attacks on Israel, at the vice president’s residence at the U.S. Naval Observatory in Washington, Oct. 7, 2024.
Getty Images (L) | Reuters (R)
Prescription drug costs. Abortion rights. The future of Obamacare.
The fast-approaching presidential election between Vice President Kamala Harris and former President Donald Trump could lead to a huge range of outcomes for patients on those issues and others in the sprawling U.S. health system.
Both candidates are pledging to make care more affordable in the U.S., an outlier in the developed world due to its higher health-care spending, worse patient outcomes and barriers to access. But the candidates appear to have different approaches to doing so if elected.
The candidates have not yet released detailed proposals on health policy, which ranks slightly lower than other issues at the top of voters’ minds, such as the economy. But each candidate’s track record provides a glimpse of what drug costs, health care and reproductive rights could look like over the next several years.
“A Trump administration will try to slash federal health spending to pay for tax cuts and reduce the role of the federal government in health,” Drew Altman, CEO and president of health policy research organization KFF, told CNBC. He said a Harris administration “will build on existing programs, increasing federal spending to make health care more affordable for people.”
It wouldn’t be easy for either administration to make sweeping changes: The U.S. has a complicated and entrenched health-care system of doctors, insurers, drug manufacturers and other middlemen, which costs the nation more than $4 trillion a year. Any overhaul of the U.S. health-care system would also depend on which party controls Congress, and on the policies state lawmakers pass.
Despite spending more on health care than any other high-income country, the U.S. has the lowest life expectancy at birth, the highest rate of people with multiple chronic diseases and the highest maternal and infant death rate among those nations, according to a 2023 report published by The Commonwealth Fund, an independent research group.
Around half of American adults say it is difficult to afford health care, which can drive some patients into debt or lead them to put off necessary care, according to a May poll conducted by KFF.
Here’s how Harris and Trump differ in their approaches to key health-care issues.
nearly three times higher than those in other countries, according to the nonprofit research firm RAND.
About 1 in 5 adults say they have not filled a prescription in the last year because of the cost, while roughly 1 in 10 say they have cut pills in half or skipped doses, according to the March KFF survey.
Activists protest the price of prescription drug costs in front of the U.S. Department of Health and Human Services building in Washington, D.C., on Oct. 6, 2022.
Anna Moneymaker | Getty Images
Many of Trump’s efforts to rein in drug prices have either been temporary or not immediately effective, according to some health policy experts. On the campaign trail, the former president has also provided few specifics about his plans for lowering those costs.
Some of Harris’ proposals are not fully fleshed out, but if elected she can build on the Biden administration’s efforts to save patients more money, experts said.
Harris plans to expand certain provisions of President Joe Biden’s Inflation Reduction Act, part of which aims to lower health-care costs for seniors enrolled in Medicare. In 2022, she cast the tie-breaking Senate vote to pass the legislation.
Harris’ campaign says she intends to extend two provisions to all Americans, not just older adults in Medicare: a $35 limit on monthly insulin costs and a $2,000 annual cap on out-of-pocket drug spending.
She also plans to expand and speed up the pace of Medicare drug price negotiations with manufacturers to cover more expensive drugs. The landmark policy, passed as part of the IRA, has faced fierce opposition from the pharmaceutical industry, as some companies have challenged its constitutionality in court.
Trump has not indicated what he intends to do about IRA provisions.
Many Republicans have been vocal critics of the drug pricing negotiations, claiming they harm innovation and will lead to fewer cures, according to Dr. Mariana Socal, a health policy professor at the Johns Hopkins Bloomberg School of Public Health. Trump made a similar argument in 2020 when he opposed a separate Democratic bill that would allow Medicare to negotiate drug prices.
Still, Socal said a Trump administration wouldn’t have much flexibility to dismantle or scale back the law without change from Congress.
Some of Trump’s efforts to lower drug prices during his presidency “didn’t really come into fruition,” Socal added.
In 2020, he signed an executive order to ensure Medicare didn’t pay more than the lowest price that select other developed countries pay for drugs. But the Biden administration ultimately rescinded that policy following a court order that blocked it.
The Trump campaign this month said the former president would not try to renew the plan if reelected.
Also in 2020, Trump issued a rule setting up a path to import prescription drugs from Canada, where medication prices are 44% of those in the U.S. But it took years for the measure to gain momentum. The Biden administration only in January approved Florida’s plan to import some prescription treatments from Canada.
Trump also set a $35-per-month cap on some insulin products for seniors through a temporary program that Medicare prescription drug plans, also known as Part D plans, could choose to join. The program was in effect from 2021 to 2023, and less than half of all Part D plans opted to participate each year, according to KFF.
But that measure was much more limited than the Biden administration’s insulin price cap, which requires all Part D plans to charge no more than $35 per month for all covered insulin products. It also limits cost-sharing for insulin covered by Medicare Part B plans.
Both administrations would likely continue to scrutinize pharmacy benefit managers, the drug supply chain middlemen who negotiate rebates with manufacturers on behalf of insurance plans, according to Dr. Stephen Patrick, chair of the health policy and management department at Emory University.
Lawmakers and the Biden administration have recently ramped up pressure on PBMs, accusing them of raking in profits while inflating prescription medication prices and harming U.S. patients and pharmacies.
she would not back the program as president.
But Harris has supported the Affordable Care Act, also known as Obamacare, since she was a senator, consistently voting against bills to repeal the plan and reasserting her commitment to strengthen it during the presidential debate on Sept. 10.
The ACA was designed to extend health coverage to millions of uninsured Americans and implement reforms to the insurance market. The law expanded Medicaid eligibility, mandated that Americans purchase or otherwise obtain health insurance, and prohibited insurance companies from denying coverage due to preexisting conditions, among other provisions.
The IRA extended enhanced subsidies that made ACA health plans more affordable for millions of households through 2025 — a provision Harris plans to make permanent if elected, her campaign said.
Harris may also work with Congress to try to extend Medicaid coverage in the 10 states that haven’t expanded it under the ACA, some experts said. Medicaid provides coverage for 81 million people, or more than 1 in 5 Americans, according to KFF.
The program is the largest source of federal funding to states. It covers low-income patients and families, as well as those with complex and costly needs, such as people with disabilities and individuals experiencing homelessness.
But if Republicans control even one branch of Congress, boosting Medicaid coverage will “be much tougher, if not impossible to do,” KFF’s Altman said.
Democrats face a difficult path to retaining their slim Senate majority, while Republicans are trying to cling to narrow control of the House.
