While neither top presidential candidate is heavily focusing on health policy, analysts in the field expect major changes after the election regardless of who wins. Access and cost of care could change drastically for most Americans.
From the political history and campaign promises of former President Donald Trump and Vice President Kamala Harris, health policy analysts anticipate action on the Affordable Care Act, Medicare and Medicaid, price controls, market regulations, and other major U.S. health policies.
“Both candidates will pursue an aggressive health agenda through expansive regulatory and legislative efforts,” says Joel White, founder and president of Horizon Government Affairs. He said this would likely include changes to government-run programs, increasing controls on drug prices, and addressing inflation effects.
The number one voter health concern in swing states is affordability, which people are right to be concerned about, White said. If current trends continue, the typical American family will spend 40 percent of its income on health care by 2030.
Although more than 90 percent of Americans have some form of health insurance, Americans still worry about cost and access to care, which have worsened in recent decades. A poll by KFF found that nearly 3 in 4 Americans older than 18 rank health cost concerns above their concerns about gas, food, and rent.
Big Government Versus Individual Choice
Trump and Harris both promise more affordable health care, yet largely through different delivery mechanisms. Harris favors federal regulation while Trump’s presidency was marked by the deregulation of health care and expanding access to short-term insurance plans that were re-regulated under Biden.
“Under the Trump administration, I believe there would be an emphasis on expanding coverage options for middle-income families and small businesses,” said Brian Blase, president of the Paragon Health Institute. “These could include less-regulated and much more affordable plans relative to Obamacare as well as ways for small businesses to join together to offer coverage.”
A Harris administration would damage the middle class, White said, while reducing access to private insurance across the socio-economic spectrum.
“Both in the campaign and as president, Harris will offer a sense of security by promising government-run health care will be the fix people need,” White said. “She will seek to expand Obamacare subsidies [set to expire in 2025] for the well-off and further weaken access to and affordability of employer coverage and private insurance generally.”
Addressing health costs by expanding competition and unleashing market innovation rather than empowering bureaucrats are Trump’s primary focus, White said. He expects a Trump administration to make efforts to reform broken insurance markets, maybe to address the Affordable Care Act’s built in cost spiral and high deductibles and Medicaid’s degrading access to care. Expanding health savings accounts, short-term plans, and off-ACA exchange options, as well as Medicaid reforms and addressing core cost drivers, can be expected under Trump, said policy analysts.
“In a Trump-Vance administration…expect most, if not all, previous Trump health care initiatives, such as short-term, limited-duration insurance policies, to be re-upped,” said Twila Brase, Citizens’ Council for Health Freedom president and co-founder. “Expect freedom of conscience rights to be resurrected.”
Price Controls for Drug Costs
Trump and Harris both support price controls for prescription drugs. Trump’s proposal for international reference pricing set by foreign bureaucrats would reduce Americans’ access to medicine, White said. More than 50 years of history on drug price controls supports this expectation, he said.
Harris promises to expand the Inflation Reduction Act price controls on drugs that have been increasingly enacted under Biden’s presidency. Federal drug pricing is one step away from outright socialized medicine, White said.
“Innovation will be crippled by government strong-arm tactics,” said Grace-Marie Turner, president of the Galen Institute. “Most of the progress in modern medicine has come from new and more effective medicines, biologics, devices, and diagnostics. They have contributed more to improvements in life expectancy and quality of life than any other type of health care services, yet they are in the bullseye with politicians … We cannot price-control our way to better health outcomes or to reducing spending on health care.”
Waste, Fraud, and Abuse
A Paragon analysis published in June found an estimated 5 million enrollees under Obamacare receive health-insurance subsidies far above the legally entitled amount. The Trump administration would likely combat waste, fraud, and abuse like this in government programs, which increased substantially during the Biden administration, Blase said.
Trump would likely issue another executive order to create Schedule F, Brase said. This would allow the administration to fire bureaucrats, including HHS employees, at will.
“A Harris administration would push gender identity confusion, suppress parents’ rights, and advocate for whatever public health officials deem the theme of the day, the month, or the year, posing dangers to the economy, individual rights, and health,” Brase said.
Harris would also require medical providers to collect data to manage such social issues in medical settings, adding burden and cost to medical providers, White said.
Harris for Government-Run Medicine
Democrats currently vary in approaches to Medicaid and Medicare, with prominent figures like Sen. Bernie Sanders advocating for government-run health care, or “Medicare for All.” Harris’ campaign has recently distanced itself from a ‘Medicare for All’ platform, but Brase believes she would pursue the initiative if elected.
“Harris will push for ‘Medicare for All,’” Brase said. “Whether she’d want health plans running the operation is unclear.”
Under Trump, reform could depend on what Congress looks like after the election, Blase said.
“Under a Trump administration, I expect a focus to ensure that Medicaid is not open to illegal immigrants,” Blase said. “If the Trump administration has a Republican Congress, I expect potential efforts to reform Obamacare’s Medicaid expansion so that the program no longer discriminates against the most vulnerable.”
This would mean equalizing reimbursements for able-bodied, working-age adults with children, pregnant women, seniors, and the disabled on the program, Blase said.
“The real question is how much Trump has learned about health care and who to trust in the last eight years,” Brase said.
Ashley Bateman is a policy writer for The Heartland Institute and blogger for Ascension Press. Her work has been featured in The Washington Times, The Daily Caller, The New York Post, The American Thinker and numerous other publications. She previously worked as an adjunct scholar for The Lexington Institute and as editor, writer and photographer for The Warner Weekly, a publication for the American military community in Bamberg, Germany. Ashley is a board member at a Catholic homeschool cooperative in Virginia. She homeschools her four incredible children along with her brilliant engineer/scientist husband.
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