the issues: healthcare
Health care remains one of the most important and debated issues in American politics. The 2024 presidential election, with Kamala Harris representing the Democratic Party and Donald Trump running for the Republican Party, brings two distinct visions for the future of the U.S. health care system. Harris supports expanding access to health care and building on the Affordable Care Act (ACA), while Trump advocates for market-based solutions and has been a critic of the ACA. This essay will examine the health care plans of both candidates, relying on facts from their records and stated policies rather than speculation.
Kamala Harris' Health Care Plan
Kamala Harris has consistently supported efforts to expand health care coverage and reduce costs for Americans. As vice president and a former U.S. senator, Harris has aligned herself with the Democratic Party’s push for affordable, accessible, and comprehensive health care.
Building on the Affordable Care Act (ACA): Harris has been a strong proponent of the ACA, which was signed into law by President Obama in 2010. As vice president, Harris supported the Biden administration’s efforts to strengthen the ACA, which included increasing subsidies for individuals purchasing health insurance on the marketplace and expanding Medicaid in states that had not yet adopted the program. Harris believes that building on the ACA is the most effective way to ensure that more Americans have access to affordable health care, as the ACA has already extended coverage to millions of previously uninsured people. She opposes efforts to repeal or dismantle the law, which Republicans, including Trump, have pursued.
Public Option: A central component of Harris’ health care platform is the creation of a public health insurance option. This would provide Americans with the choice to enroll in a government-run insurance plan, similar to Medicare, as an alternative to private insurance. Harris believes that a public option would increase competition in the health care market, drive down costs, and offer affordable coverage to individuals who are unable to afford private insurance. The public option is seen as a compromise between those who support Medicare for All and those who prefer a system that includes both public and private insurance options.
Medicare for All Advocacy: During her 2020 presidential campaign, Harris initially expressed support for Medicare for All, a single-payer system that would eliminate private insurance and cover all Americans through a government-run program. However, as she progressed in her campaign, Harris shifted to a more moderate stance, advocating for a phased-in approach that would preserve private insurance while gradually expanding Medicare. As vice president, Harris has aligned more closely with President Biden’s position of maintaining the ACA and introducing a public option, rather than pursuing full Medicare for All.
Lowering Prescription Drug Costs: Harris has long advocated for policies to reduce the cost of prescription drugs, which she argues are too high due to pharmaceutical companies’ price gouging. She supports allowing the federal government to negotiate drug prices directly with pharmaceutical companies, a policy that was partially enacted in the Inflation Reduction Act of 2022. Under this legislation, Medicare gained the authority to negotiate the prices of certain high-cost drugs. Harris supports expanding this authority to cover more medications and reduce out-of-pocket costs for Americans. She also supports capping insulin prices, which has been a major issue for individuals with diabetes.
Medicaid Expansion: Harris has consistently supported expanding Medicaid in the remaining states that have not opted to do so. As of 2023, 10 states have yet to expand Medicaid, leaving millions of low-income individuals without access to affordable health care. Harris views Medicaid expansion as a critical step in reducing health disparities and ensuring that all Americans, regardless of their income, have access to health care. She supports providing federal incentives for states to expand Medicaid and opposes efforts to impose work requirements on Medicaid recipients, which she believes would limit access to care for vulnerable populations.
Reproductive Health and Women’s Health Services: Harris has been a vocal advocate for women’s health care, particularly in the areas of reproductive rights and maternal health. She supports expanding access to contraception, increasing funding for maternal health services, and protecting access to abortion services in the wake of the Supreme Court's decision to overturn *Roe v. Wade*. Harris has also championed policies to reduce racial disparities in maternal health, as Black women in the U.S. experience significantly higher rates of maternal mortality compared to their white counterparts.
Mental Health and Substance Abuse Treatment: Harris has called for increased funding for mental health services and substance abuse treatment. She supports integrating mental health care into primary care settings to make it more accessible, and she advocates for expanding telehealth services to provide mental health support to underserved populations. Harris has also emphasized the need to address the opioid crisis by increasing access to treatment and harm reduction services, such as overdose prevention programs.
Donald Trump’s Health Care Plan
Donald Trump’s approach to health care, both during his presidency and in his 2024 campaign, has centered on repealing the ACA and promoting market-based reforms that prioritize individual choice and competition. Trump’s health care policies reflect the broader Republican belief in limiting government intervention in the health care market and reducing federal spending on health programs.
Repealing the Affordable Care Act: One of Trump’s central health care goals throughout his presidency was to repeal and replace the ACA, which he and other Republicans have long criticized. Trump argued that the ACA, also known as "Obamacare," increased insurance premiums, reduced consumer choice, and represented government overreach in the health care market. While Trump was unable to fully repeal the ACA during his time in office, his administration made several efforts to weaken the law. In 2017, the Trump administration and Republican-controlled Congress succeeded in eliminating the individual mandate penalty, which required most Americans to have health insurance or face a financial penalty. Trump’s 2024 campaign continues to advocate for the repeal of the ACA and its replacement with a system that prioritizes private insurance and state-level control over health care decisions.
Promoting Private Insurance and Competition: Trump has consistently advocated for market-based solutions to health care, arguing that increased competition among private insurers would lower costs and improve quality. His health care proposals focus on giving consumers more choice and flexibility in purchasing health insurance, including expanding the availability of short-term health plans that do not meet ACA requirements. Trump supports policies that allow individuals to purchase health insurance across state lines, believing that this would increase competition and reduce premiums. He has also called for expanding Health Savings Accounts (HSAs), which allow individuals to save money tax-free for medical expenses.
Medicaid Block Grants and State Flexibility: Trump has proposed restructuring Medicaid by converting it into a block grant program, which would give states a fixed amount of federal funding to administer their Medicaid programs as they see fit. This would provide states with more flexibility to design their Medicaid programs but could also lead to reductions in coverage if states choose to cut benefits or eligibility in order to stay within their block grant budgets. Trump has argued that states are better equipped than the federal government to determine how to allocate health care resources, but critics of block grants worry that they could lead to fewer low-income individuals receiving coverage.
Lowering Prescription Drug Prices: Although Trump has positioned himself as an advocate for reducing prescription drug prices, his approach has differed from that of Harris. During his presidency, Trump signed several executive orders aimed at lowering drug costs, including one that sought to link the prices of certain drugs in the U.S. to lower prices in other countries. Trump also supported increasing transparency in drug pricing and proposed requiring drug companies to disclose prices in television advertisements. However, his administration’s efforts to allow Medicare to negotiate drug prices were less aggressive than Democratic proposals, and Trump did not pursue the kind of broad negotiations that Harris supports. His 2024 platform includes continuing efforts to reduce drug prices through market-based reforms, such as encouraging competition in the pharmaceutical industry.
Price Transparency in Health Care: One of Trump’s significant health care initiatives during his presidency was an executive order aimed at increasing price transparency in the health care system. The order required hospitals to disclose the prices they negotiate with insurers, with the goal of allowing consumers to make more informed decisions about their health care. Trump argued that increased transparency would lead to lower prices, as patients would be able to shop around for the best deals on medical services. While the price transparency rule went into effect in 2021, its long-term impact on health care costs remains unclear.
Mental Health and Veterans' Health Care: Trump’s health care platform includes support for improving mental health services, particularly for veterans. During his presidency, Trump signed the Commander John Scott Hannon Veterans Mental Health Care Improvement Act, which expanded mental health services for veterans and increased funding for suicide prevention programs. Trump has continued to advocate for improving access to mental health care for veterans as part of his 2024 campaign, while also emphasizing the importance of improving the overall quality of care provided by the Department of Veterans Affairs (VA).
Key Differences
Affordable Care Act (ACA): Harris supports building on and expanding the ACA, while Trump wants to repeal and replace it with a system that prioritizes private insurance and state control.
Public Option vs. Market-Based Reforms: Harris advocates for a public option to compete with private insurers, while Trump focuses on promoting private insurance and competition in the marketplace, including expanding the availability of short-term health plans.
Medicaid: Harris supports expanding Medicaid and opposes work requirements, while Trump supports converting Medicaid into a block grant program, giving states more control over how they administer the program.
Prescription Drug Costs: Both candidates support lowering prescription drug prices, but Harris favors allowing Medicare to negotiate prices, while Trump focuses on market-based reforms and transparency measures.
Reproductive Health: Harris supports expanding access to reproductive health services, including contraception and abortion, while Trump has pursued policies to restrict access to abortion and reduce federal funding for organizations like Planned Parenthood.