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Key Takeaways
-While healthcare is not a major focus on the campaign trail, it will surely be a key topic after the inauguration and both candidates have differing opinions on everything from reining in costs, to the Affordable Care Act, abortion and contraception, and LBGTQ rights
- Where candidates do align are on pharmacy, transparency and doing something about costs
- A future Harris administration is likely to continue trying to expand and improve upon the ACA, promote ICHRAs, negotiate lower drug prices collectively, protect against price gouging, and improve healthcare transparency
- A future Trump administration is likely to give additional power to state governments for negotiating drug prices and deciding on the legality of reproductive care within their borders, may return to replacing and or repealing Obamacare, and protect against price gouging and improve healthcare transparency, as well
ARTICLE | Health Care In the 2024 Elections and Beyond
The next couple of years are likely to be pivotal in shaping the future of US healthcare for potentially decades to come.
Despite the current presidential and congressional election cycles continuing to heat up on the federal level, there has been relatively little discussion on healthcare policy so far this year relative to recent cycles.
Just because they are not making headlines, however, there of course remain substantial differences between each side of the aisle’s competing vision for both how the healthcare system should operate and for the federal government’s role in facilitating and/or regulating those operations.
Further, while healthcare-related issues may not be currently commanding the national spotlight as they have for the last 14 years as other issues (and non-issues) have taken center stage, healthcare is likely to surge once again to the forefront of people’s minds next year when healthcare expenses are predicted to spike and pressure will grow considerably for a governmental response from whichever politicians win their races this fall.
In short, while there may be an increasing amount of noise, we likely won't hear anything material on healthcare until months or even years after the inauguration of the winning administration.
But, fear not, the healthcare debate will arise again at some point in 2025 and 2026 and the usual healthcare themes of the day will be back in the mix - PBM, transparency, Medicare fee schedules, etc. - but rest assured that there will be impacts to employer sponsored healthcare depending on who wins the election.
Given that we are likely approaching a situation on the medical cost front in the years ahead that is going to demand action from our elected officials, and since we don’t yet know who those elected officials will be, we thought it might be a good idea to discuss a little about each party’s platform and plans going forward with regard to healthcare in order to inform how they might respond when the time comes.
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One good thing about the upcoming presidential election is that both major party candidates have been a part of very recent presidential administrations - as president and vice president respectively - so there are records available to point to when predicting priorities and how their different policy approaches toward health care issues might be expected to play out for whomever is in office next term.
In comparing those records, the Kaiser Family Foundation recently released information covering how each of the last two presidential administrations handled a number of different healthcare topics including the ACA, abortion, contraception, LGBTQ health, prescription drug prices, health care costs, mental health, and the opioid epidemic.
While the nominating convention is not officially until mid-August and therefore no official party platform has yet to be formalized, the draft that was released a couple weeks ago does include a few healthcare related notes.
For one, the platform draft makes a point to note that the Biden-Harris administration has already taken steps that have resulted in significant cost savings in the US healthcare system, including passing the PACT act to expand veteran health care coverage, capping insulin prices at $35 dollars a month for many seniors, and saving Americans an average of $800 dollars a year on their health care premiums.
In terms of plans going forward, a Harris-Walz administration is expected to continue pushing to expand the ACA as well as the use of ICHRAs, for example, while continuing to fix coverage gaps and oversights that exist within the current system, like the “family glitch” correction under the Biden-Harris administration that allowed dependants of people with budget-exceeding employer-sponsored healthcare to receive ACA subsidies.
The party platform also outlines the plan to continue building on the Biden administration’s actions enabling Medicare representatives to negotiate lower drug prices on an additional 50 drugs per year.
Further, Harris has endorsed restoring Roe v. Wade’s national standard of legal abortion up to viability, expanding telehealth coverage, and protecting the viability and accessibility of Medicare for future generations.
A new Trump administration may continue pushing for individual state governments to take on more responsibility for the health of the citizens they serve and the laws that expand or restrict the quality and kind of medical care available to those citizens, including pushing their plan to create new pathways enabling states to import drugs from Canada and to allow state governments to decide the legality of abortion and reproductive-related health care issues.
Earlier this year, former president Trump also declared a renewed interest in repealing Obamacare, which could potentially result in the removal of healthcare coverage for as many as 50 million people currently insured via the ACA exchanges, depending on what if anything replaces Obamacare if/when it is repealed.
For employers and the 55% of people who get their healthcare from their employers, the largest impact of ACA repeal would likely be felt by the tens of millions of people with pre-existing conditions who would experience ‘job lock’ and risk not only losing their insurance if they lose or leave their employer, but they also risk losing the ability to obtain health insurance coverage in the future, whether employer-sponsored or not.
Despite Trump’s declarations, in any case, the GOP nominating convention platform that was released last month made no mention of healthcare policy or any intention to repeal and/or replace the Affordable Care Act, so it is currently unclear if GOP healthcare policy remains consistent with Trump’s statement and the platform positions of recent nominating conventions or if that policy is in flux. The platform also notably did not include a national abortion ban.
A future Trump-Vance administration might also restore rules enacted during the first Trump-Pence administration that have been since repealed by the Biden-Harris Administration, including reinstating additional work requirements and eligibility requirements for Medicaid applicants, restrictions to prevent Title IX funds going to abortion providers, and exemptions to allow employers to deny contraception coverage as required by the ACA.
With the only obvious overlapping agreement between parties being concerns about high drug costs and a lack of price transparency, the lack of specificity about the health-care-related plans and policies they would pursue in office may be one of the greatest similarities between the parties at the moment.
The luxury of keeping plans vague on an issue as broadly important as healthcare only lasts as long as people and pundits have focused their attention elsewhere, which only lasts as long as the immediate negative effects of rising healthcare costs remain indirect.
When people feel more and more of those growing expenses on a personal level as employers, insurers, and providers start making changes to their own policies in order to curb the increasing costs in the coming years, however, these issues won’t remain abstract and of little concern for long.
Faced with increasing costs and worsening outcomes, the need to reform the healthcare system will once again likely become a prominent topic of both discussion and contention, and the calls for change will grow regardless of which party controls the reigns of powers.
The main current questions of relevance are how loud will the calls for change grow, what actions will be taken in response, and by whom - and at this particular point in time, there are no particularly clear answers to any of those questions.
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