How Trump and Harris Aim to Address Your Health Care – NerdWallet

Health care has largely taken a back seat during the presidential campaign and the lack of focus has left the public wanting more.

Two in three Americans (67%) surveyed by Gallup and West Health (Sept. 9-16) say that health care is getting too little focus in the 2024 presidential election. Democrats are more likely (78%) than Republicans (53%) to say health care hasn’t received enough attention.

That response is likely because the candidates have been light on the details when it comes to most topics concerning health care in America:

• Harris has focused on lowering prescription drug prices; expanding Medicare coverage for long-term care; working with states to cancel medical debt; and supporting the restoration of federal abortion rights.  

• Trump says he supports IVF coverage, but abortion should be left to the states. And during the Sept. 10 debate he said that he has only a “concept” of a plan to replace the Affordable Care Act. 

Both candidates promise to protect Medicare.

According to a September poll by Kaiser Family Foundation (KFF), the health care-related issues that voters most care about include abortion (7%); Medicare and Social Security (7%) and health care costs, including prescription drug costs (5%).

Most of the candidates’ proposals would only move forward with support from Congress. NerdWallet spoke with three health care policy experts to get their take on what Trump and Harris have in store for health care.

• Harris has said she wants to lower prescription drug prices. Under 2022’s Inflation Reduction Act, a provision allows Medicare to negotiate drug prices with pharmaceutical companies. It also added a $2,000 cap on all out-of-pocket drug expenses. In addition, the Biden-Harris administration capped insulin at $35 for seniors. Harris wants to extend these cost-saving measures to all Americans. 

• She also wants to expedite Medicare prescription drug negotiations. 

• And she proposed to “increase competition and demand transparency in the health care industry,” according to her packet of economic policy proposals. The details on this are unclear. 

• In 2016, Trump campaigned on reducing drug prices. During his time in office, he supported several measures including capping insulin costs for certain Medicare recipients, and issued an executive order to make it easier to import inexpensive prescription drugs. But he also opposed letting Medicare negotiate drug prices for seniors. 

• During this campaign, Trump said little about prescription drug costs. However, he did reverse his position on a promise he once made to link some Part B medications drug prices to what peer nations pay. 

Josh Bivens, chief economist at the Economic Policy Institute: He says Harris’ plans seem realistic, especially expanding the insulin cap to more Americans. There’s just some question of how her plans could be implemented.

Richard Frank, director of the Center on Health Policy at Brookings Institution: Frank says there are two main areas where Harris can improve prescription drug costs. “The first has to do with clearing out impediments to generic competition,” he says. “There are a variety of regulatory and industry strategies that serve to create frictions for generics drugs entering the market. And what that does is it effectively extends the exclusivity period and keeps prices high for prescription drugs that have been on the market for quite a while.”

“The second part of that, the second competition piece has to do with biosimilars,” he says. “And generic drugs apply mostly to what are known as small molecule drugs — those are drugs that usually come in the form of pills that we’ve been taking for most of our lives. The other type of drug are biologic products, and they are regulated differently. The Affordable Care Act created a pathway for biosimilars to enter the market and compete that is kind of like what we do for generics, but not exactly. And the regulations have been very slow to develop and they’ve been what turns out to be excessively cautious. And so what [Harris] might do is try to streamline the regulations and to use a sort of pro-competitive policy to try to reinvigorate the biosimilar market and create more competition for biological drugs that have been on the market for quite a while.”

Colleen Grogan, professor and co-director of the Center for Health Administration Studies at the University of Chicago: “There are now 10 drugs that the federal government is able to negotiate over,” she says. “Now it only applies to Medicare, so that impacts the elderly and disabled who who are on Medicare. But Medicare is important because it often sets the stage for private insurance plans to follow and so if Medicare is able to negotiate good prices, then private insurers say, ‘Hey, you know, we want those prices, too.’ So it often has a broader effect than just Medicare; there is every intention that this is a stepping stone to a broader process of drug price negotiation.”

Grogan adds that it’s still an open question whether Republicans in Congress will sign up for price negotiation expansions, especially under pressure from Big Pharma. “The pharmaceutical companies are incredibly powerful and they have strong lobbyists,” she says.

• Under Biden, ACA health care tax credits increased under both the American Rescue Plan and the Inflation Reduction Act. The effect of those tax credits was less expensive plans sold through ACA. Those tax credits are expiring at the end of 2025. Harris has promised to expand and make the credits permanent and there’s appetite among Democrats in Congress to do so as well. 

Bivens: “[The tax credits] really boosted enrollment quite a bit and made it a lot more affordable for many people.” He says that while Harris would extend or make permanent the ACA premium tax credits, Trump is unlikely to do the same.

Frank: He says that making ACA tax credits permanent would bring stability to the marketplaces. Frank adds that negotiating the package of ACA subsidies, as well as the expiring Trump tax provisions, will be a major thread in legislative activity next year. “My guess is there will be some kind of a grand bargain, in part depending on how the election comes out, that creates a sort of revised constellation of those two sets of provisions on taxes and subsidies,” he says.

Grogan: “Enrollment in the exchanges has gone way up since [the American Rescue Plan] and I think I think they would want to continue with that.”

• During Trump’s first term, he tried to repeal and replace the Affordable Care Act, but was unsuccessful. During the debate he said he has only “concepts” of a new plan. His running mate, JD Vance, later clarified during an NBC interview that Trump’s plan would include deregulating insurance markets to promote competition.  

Bivens: “My guess is that it will not be like the same kind of frontal assault on it that there was in 2017, but there will just be a lot of undermining of different provisions of it. I think [the ACA] is very popular now; in 2017 it was still pretty new and more vulnerable.”

Frank: He says that Trump has no clear alternative plan and he’s unsure of the appetite in Congress to take on the messiness and complexities of replacing the ACA.

“I think that the issue is that there are things that can be done to shrink the reach of the Affordable Care Act,” says Frank. “And there are things that were done in the last Trump administration to try to make it more difficult to sustain the markets in the Affordable Care Act. But those have largely been restored through various bipartisan legislation over the last few years and those markets are doing quite well. They’re insuring more people than they ever have.”

Grogan: She says Trump is unlikely to pursue repealing the ACA and Republicans, in general, know it’s not popular. However, she points out that in Project 2025 — a blueprint for the next Republican president, which was released by the Heritage Foundation, a conservative think tank — there is a provision that would allow private insurance companies more flexibility around “essential health benefits.” She says, “When you do that, what you’re doing is indirectly allowing flexibility on risk rating — that’s not a popular approach.” She adds that most Americans are happy to move away from preexisting conditions preventing health insurance eligibility or driving up costs of insurance.

It’s worth noting that Trump has tried to distance himself from Project 2025, but many former Trump administration officials were involved in creating the document.

• Harris says she would expand Medicare to cover long-term care at home for seniors and those with disabilities who receive Medicare. That includes at-home services like home health aids, personal care attendants or state-certified direct care workers. She would also cover vision and hearing for recipients.

• She also wants to end the practice in which seniors’ homes are seized by states following long-term Medicaid care; the proposal would require action by Congress. 

• Harris also says the expanded benefits would be funded primarily by savings from her proposal to negotiate power with prescription drug companies. 

• Trump hasn’t publicly addressed long-term care, but the 2024 Republican Party platform includes a provision to protect Medicare and ensure seniors receive care without an excessive cost burden. Details are unclear. 

Bivens: “The Biden-Harris administration tried to include something pretty big on long-term care in the Build Back Better Act. They had a really big increase on the order of $400 billion over 10 years for home-based health and community-based care services that are paid for through Medicaid, which would have provided a lot of relief for people looking for elder care.”

• Harris says she’s committed to working with states to relieve medical debt. Her package of economic policy proposals points to her work with cities and states to eliminate $7 billion of medical debt for nearly 3 million people. 

• While in office, Trump signed the No Surprises Act to protect people from certain unexpected medical bills. 

• The Republican Party platform for 2024 promises to “increase transparency, promote choice and competition and expand access to new affordable health care and prescription drug options.” The details are unclear. 

Bivens: He says medical debt is likely to become a bigger political issue moving forward.

“I think it really is bubbling up from people’s lived experiences,” he says, adding “I think the details will be a little hard to work out, but I think it’s a real pressure point that politicians are going to feel like whoever takes a big swing at solving it will get some real rewards.”

Grogan: She says Harris’ promise to eliminate medical debt is a viable one. So far, states have funneled funds from the American Rescue Plan to the local level and, ultimately, to hospitals to relieve medical debt.

“What’s interesting to me about that is the subsidies are going to the hospitals because the hospitals are the major way in which people are taking out medical debt, and so that’s important that people are getting that relief,” she says. “I’m a little bit troubled, to be honest, that it’s the hospitals getting the subsidy.”

She says there should be regulations that prevent hospitals who receive subsidies from charging exorbitant prices to individuals. “I’m worried that we’re not taking that approach; we’re just sort of throwing more money at the hospitals to behave in ways which I think are problematic.”

The September KFF poll showed that most voters (61%) think that this year’s election will have a major impact on abortion access in the U.S. The same portion of voters say they support restoring a nationwide right to abortion.

• Harris says she will bring back protections under Roe v. Wade and would ensure there would never be a federal abortion ban. 

• Harris says she’ll protect access in vitro fertilization (IVF).

• Trump says states should set their own laws.

• He says he would veto any federal abortion ban. 

• Trump says the government or insurance companies should cover IVF, but many Republicans oppose this idea. 

Bivens: “I think [Trump’s] stance is pretty incoherent,” he says. “It just shows the incredible cross-pressures of a big part of the Republican base who really would like something like a full ban that’s incredibly unpopular amongst the electorate at large. It’s just a very hard needle to thread.”

Biven says Trump’s position on IVF seems “half-baked” as he pulls away from the Republican party’s more restrictive stance on IVF. He adds, “If I see a serious plan on this side, I’d be surprised. But for now, I think he just sort of says what he has to say to get out of a rough couple of minutes of a debate or an interview.”

Grogan: She says Harris is limited in what she can do to protect abortion without support in Congress. Same goes for IVF.

Grogan says that Trump doesn’t have support from some Republicans in Congress to have insurance or the government pay for IVF. As for Trump’s stance on abortion, she says “It’s not clear whether he’s saying what he wants to say to get elected.” She points to Project 2025, again, “There’s really, really conservative stances on reproductive rights in that document and he has dissociated himself with that, but the people around him are supporting it.” She adds, “I think people have reason to be wary.”

Little has been said about the opioid crisis in terms of concrete actions. Here’s what we know.

• Harris says she would “stand-up to drug traffickers and pharmaceutical companies, while also working to help those struggling with addiction get the treatment they need,” according to her packet of economic policy proposals. There are no further details. 

• Trump has linked the opioid crisis in America to migrants. During the Republican National Convention, he claimed that migrants entering the U.S. illegally have smuggled fentanyl into the U.S., which he claims killed hundreds of thousands of people. Both are incorrect. In 2023, overdose deaths from all opioids, including fentanyl, killed 81,083 people, according to the Center for Disease Control. U.S. Customs and Border Protection says 27,000 pounds of fentanyl were seized in 2023 — that’s the total among 549,000 pounds of all drugs seized in 2023, the majority of which are methamphetamines and marijuana. However, an August 2023 analysis by the libertarian think tank, the Cato Institute, found that the majority of drug smuggling over the border is done by U.S. citizens. 

Frank: “I think that we have sort of failed to get people into treatment for these conditions that have grown enormously over the last 30 years,” he says. “And I think that, you know, our failure to talk about that has been quite notable.”

Both candidates have ignored pandemic preparedness during the campaign. From a public policy perspective, it’s an odd choice in the wake of a pandemic. Politically, it’s unsurprising that both candidates would want to distance themselves from the last health crisis, let alone suggest the possibility of a future one.

Bivens: He says there’s an obvious reason that neither Trump or Harris has focused much on pandemic preparedness. “I think it’s the collective, ‘Let’s just hope it never happens again,” he says.

Frank: He says the Biden Administration’s budget proposed an increase of money for the CDC to support public health infrastructure, including pandemic preparedness. “I think more or less where you might expect a Harris administration to go,” Frank says. “You haven’t heard much explicit from Trump, but if you look at proposals in the Congress through the appropriations process coming from the Republican side of the aisle, you’ll see a variety of proposals to cut back pretty significantly on the CDC budget. And so I and I think that, you know, I think that that is something to pay attention to now.”