Harris and Trump Plans on Health Care Compared
The United States is the only one of 32 developed nations without universal health for all citizens. The Affordable Care Act, which was designed to offer affordable coverage for all Americans, has four major components: 1) a requirement that insurers may not exclude or discriminate in pricing their coverage for those with pre-existing conditions, 2) refundable tax credits and a purchasing pool (the Exchanges) for affordable coverage for the uninsured and individually insured, 3) Medicaid expansion for those uninsured with incomes under 138% of the federal poverty level (FPL), and 4) a requirement that large employers (50+ employees) offer basic coverage for their full time workers. It also allows young adults (under age 26) to have coverage through their parents and contains many other beneficial improvements in care and coverage to all Americans. About 45 million Americans are now insured through the Exchanges and the Medicaid expansion. https://aspe.hhs.gov/reports/aca-related-enrollment-february-2024#:~:text=Based%20on%202023%20and%20early,the%20highest%20total%20on%20record.
During his first term, Trump sought to repeal and undermine the Affordable Care Act in every means possible. He failed in Congress and in the courts. His Administration eliminated outreach to explain the programs, stopped payments on federal subsidies to reduce consumer’s copays and deductibles (cost sharing). He sought to block grant Medicaid to the states, and approved federal waivers to allow states to deny Medicaid coverage to the unemployed uninsured. He approved new insurance plan options without the ACA’s required protections for those with pre-existing conditions. Speaker Johnson just reiterated GOP plans to repeal the ACA in a second Trump term. https://www.cnn.com/2024/10/30/politics/johnson-obamacare-trump/index.html
During the Biden Harris Administration, they increased premium subsidies in the Exchanges to make coverage more affordable for many more of the uninsured and individually insured. They eliminated premiums for those with incomes less than 150% of the Federal Poverty Level, reduced premiums for those with incomes between 150 and 400% of FPL, and they removed the 400% cap on premium assistance so that more of the middle income, middle aged could qualify for premium assistance for their individual coverage. They increased federal matching assistance to those states that chose to enact the Medicaid expansion, and North Carolina has done so. The enhanced premium assistance in the Exchanges expires in 2025; Harris supports making these improvements permanent.
While states’ voters have resorted to the ballot box to adopt the Medicaid expansion in a series of ballot initiatives, the remaining 10 non expansion states either do not allow for citizen initiatives or have adopted high hurdles (like the 60% majority rule in Florida) to prevent citizen initiatives. https://www.kff.org/affordable-care-act/issue-brief/status-of-state-medicaid-expansion-decisions-interactive-map/ and https://www.healthaffairs.org/content/forefront/ballot-initiatives-have-brought-medicaid-eligibility-many-but-cannot-solve-coverage-gap As a result the uninsured rate is nearly 17% in a hold out state like Texas, and 2.4% in a pioneering state like Massachusetts. https://www.statista.com/statistics/986620/health-uninsured-population-share-by-us-state/
Reproductive rights for women, men, and their families were overturned by the Trump appointees to the Supreme Court in the Dobbs decision. Fourteen states have now banned abortions entirely. https://www.guttmacher.org/state-policy/explore/state-policies-abortion-bans Eight additional states restrict abortion during the period before viability, most typically with six-week gestational limits like Florida, Georgia and South Carolina. Some have exceptions for rape, and incest; others do not.
Ballot initiatives have been passed by voters seeking to protect a woman’s reproductive rights under state constitutions, and this year there are five designed to overturn their states’ bans or tight restrictions. https://www.kff.org/womens-health-policy/issue-brief/opportunities-realities-citizen-abortion-ballot-measures/ Because of past successes, state legislatures, GOP state Attorney Generals and Secretaries of State have been pulling out all the stops to prevent the ballot initiatives from reaching decisions by their states’ voters this year. https://www.brennancenter.org/our-work/research-reports/abortion-rights-ballot-2024 In total, ten measures will be on this year’s ballots. https://www.kff.org/womens-health-policy/dashboard/ballot-tracker-status-of-abortion-related-state-constitutional-amendment-measures/
Trump appointed the three Supreme Court judges who over-ruled 50 years of federal constitutional precedents protecting women’s reproductive rights. He says he supports state decision-making outlawing abortions, but not a nationwide ban. He is planning to vote against the Florida ballot initiative restoring women’s reproductive rights. He has not spoken out against the GOP efforts to keep these vital decisions off state ballots.
Harris wholeheartedly supports women’s reproductive rights and has been a strong and consistent leader in the struggle to defend women’s reproductive freedoms. She has promised to sign legislation over-ruling Dobbs and restoring Roe v. Wade, but the sixty votes needed in the Senate are not there.
The Biden Administration has been consistent in support of abortion medications, mail order deliveries, interstate travel, and abortions in pregnancy related emergencies.
Project 2025, developed by the Trump aligned Heritage Foundation, seeks to use the century old Comstock Act to ban mail order deliveries of abortion pills and to use federal rule making authority to ban mifepristone and misoprostol for abortions. Project 2025 also seeks to rewrite/reinterpret the EMTALA rules regulations so that emergency abortions are no longer protected. EMTALA is a federal law requiring hospitals to offer emergency medical care when a patient’s life or health were in serious jeopardy. Idaho sought to limit medical care (in this case a medical abortion) to only those situations where the pregnant woman’s life was in serious and imminent jeopardy — a step too far for the federal judiciary. https://www.supremecourt.gov/opinions/23pdf/23-726_6jgm.pdf
In his concurring opinion in Dobbs, Supreme Court Justice Clarence Thomas opined that Griswold v. Connecticut and Eisenstadt v. Baird, guaranteeing an individual’s fundamental freedoms to purchase contraception, were wrongly decided and should be over-ruled.
Trump approved a Texas Medicaid waiver blocking Planned Parenthood family planning clinics from receiving Medicaid funds. Trump blocked Planned Parenthood from receiving Title X family planning funds for their contraceptive services.
The Biden Administration restored funding for Planned Parenthood clinics, approved the first over the counter oral contraceptives, and supported the required coverage of contraceptives under the Affordable Care Act before the Supreme Court.
Public health
The multiple important preventive roles of public health were underappreciated and largely invisible before the Covid pandemic. https://www.apha.org/what-is-public-health They include: Tracking disease outbreaks and vaccinating communities to avoid the spread of disease; Setting safety standards to protect workers and consumers. https://phaboard.org/wp-content/uploads/10-EPHS-One-Pager.pdf The Centers for Disease Control (CDC) was considered one of the most effective public health agencies in the world, yet during the Covid pandemic under the Trump Administration, it largely failed to do its jobs effectively. https://abcnews.go.com/Politics/cdc-covid-guidance-confusing-overwhelming-organization-overhaul/story?id=88502792 Denialism of COVID and the efficacy of vaccines and treatments was rampant. Over a million Americans lost their lives; children lost valued learning time; American’s mental health suffered badly, and domestic abuse spiked.
Trump downplayed the Covid pandemic, encouraged the use of quack cures like hydroxychloroquine and bleach injections, interfered with the CDC’s issuance of guidance and data, and discouraged the use of masks and vaccines. His administration did develop the Covid vaccines in record time, then sadly aligned with those discouraging their use, such as RFK Jr., and Trump proposed severe budget cuts to the CDC. He proposes a major role in health programs for RFK Jr. in his next administration. https://www.cnn.com/2024/10/29/politics/rfk-trump-control-hhs-usda/index.html
The Biden Administration increased funding to the CDC and the states to fight the Covid pandemic, supported public health responses to the Covid pandemic, and started new initiatives to dispel the misinformation campaigns about Covid and other vaccines spread by RFK Jr. and other Trump allies. It has started the process of revamping and revitalizing the CDC. https://www.bmj.com/content/378/bmj.o2074
Medicare
Medicare is a health care program for seniors and the disabled, run by the federal government. About 66 million Americans are enrolled. It costs the federal government about $832 billion. It also costs subscribers a share of the premiums. Payroll taxes (the Medicare Trust Fund) from employers and employee pay for about 36% of the program’s cost; subscribers pay for 15% through their share of program premiums, and the federal General Fund pays for about 43%. https://www.pgpf.org/budget-basics/medicare
The Medicare Trust Fund, which pays for most hospital care, is scheduled to run out of money by 2036 due to the rising costs of health care combined with the growing numbers of the nation’s elderly. The prescription drug benefit, Part D, which was passed in 2006 but with no funding stream, is the largest single contributor to the financial challenges of Medicare. https://www.pgpf.org/budget-basics/medicare
Trump has promised to protect Medicare and Social Security. Nevertheless, he proposes to eliminate and reduce taxes (like the tax on Social Security benefits and payroll taxes) whose revenues are dedicated to the Medicare and Social Security Trust funds. He proposes to round up and deport immigrant workers who contribute to the Trust funds through their payroll taxes and yet are ineligible to ever claim benefits. He repealed the Board (IPAB) dedicated to slowing the growth in Medicare health spending.
Harris proposes to extend the solvency of the Medicare Trust Fund by raising Medicare taxes on high earners and closing their tax loopholes. She proposes to expand Medicare home care services and add a vision and hearing benefit to Medicare by expanding Medicare drug price negotiations. She cast the tie breaking Senate vote to authorize negotiated drug prices and to cap the costs of insulin at $35 a month.
References:
https://www.kff.org/compare-2024-candidates-health-care-policy/
https://www.pbs.org/newshour/show/a-look-at-harris-and-trumps-positions-on-healthcare-policy
https://www.cbsnews.com/news/trump-harris-health-care-2024/