Trump and Harris’s Positions on Health Policy: Medicare, Chronic Disease, and Drug Prices

November 3, 2024 TruthUSA

The two presidential candidates agree that Americans are paying too much for drugs.

Despite accounting for over 17 percent of the United States’ GDP, health care access and affordability seem to receive limited attention during the 2024 presidential campaigns.

“For perhaps the first election season since 2004, health coverage policies have had a relatively low profile,” Sharon Glied, dean of New York University’s Robert F. Wagner Graduate School of Public Service, wrote in her opinion piece in the New England Journal of Medicine.

“The two biggest problems in health care: Millions of people can’t afford the care they need, and millions of people don’t have access to care they need. And neither candidate is addressing these two problems in any serious way,” John C. Goodman, health economist and health policy expert, told The Epoch Times.

Though the United States spends more on health care than any other developed country—about $4.5 trillion annually—it still lags in key health outcomes.

The country has a life expectancy of around 77 years, which is lower than most other developed nations, and 60 percent of all American adults live with at least one chronic health condition, such as heart disease, diabetes, or obesity.

A focus for Vice President Kamala Harris in her campaign was to support seniors through long-term home-care services. Former President Donald Trump, on the other hand, said he would like Robert F. Kennedy Jr., who supports reducing chronic diseases and improving food safety, to “go wild on health.”

Both campaigns agree on the need to reduce drug costs, yet differ on how to handle health insurance.

Drug Pricing and Shortages

A rare point of agreement between the candidates is that Americans should pay less for drugs.

In his first term, Trump implemented a voluntary model for Medicare Part D enrollees to cap insulin costs at $35 a month. He also introduced the “Most Favored Nation” rule, aiming to tie Medicare payments for certain drugs to the lowest prices paid by other developed countries. Furthermore, he introduced a rebate rule aimed at lowering drug costs, which awarded drug discounts directly to patients at the pharmacy rather than to pharmacy benefit managers (PBMs).

Additionally, Trump proposed a drug reimportation plan, allowing states to import lower-cost prescription drugs from Canada. His administration also focused on transparency by requiring that pharmaceutical companies list drug prices in TV advertisements. He also issued an executive order to encourage domestic manufacturing of essential medications.

Some of these policies were never implemented, and the Biden administration overruled most of them, with the exception of the insulin drug cap, hospital price transparency, and the executive order to encourage domestic drug manufacturing.

The Biden-Harris administration has expanded on Trump’s $35 insulin cap, making the cap permanent through the Inflation Reduction Act (IRA), which also introduced a $2,000 annual out-of-pocket cap for Medicare Part D drug spending.

Researchers estimate that a $2,000 annual out-of-pocket cap for Medicare Part D would likely increase Part D premiums by $4.35, which Goodman says is a “good buy.”

The IRA granted Medicare the authority to negotiate prices with pharmaceutical companies, starting with 10 drugs in 2025.

Harris has campaigned on making these price caps universal for all Americans. Glied said this would be doable for all public programs under the Affordable Care Act (ACA) and Medicare.

Goodman disagreed, saying that both insurers and employers would oppose it.

Goodman also expressed concern about the IRA, saying that the government will be paying less for catastrophic coverage for Medicare Part D once it is phased in next year.

Catastrophic coverage in Part D is a safety net that kicks in when people meet their out-of-pocket spending limit for drug expenditures.

The government currently funds 80 percent of the coverage. However, with the IRA, the government will now fund only 20 percent. Private insurance will cover the rest.

Goodman is concerned that the increased funding from private insurers will lead to increased Medicare premiums, projecting that Part D premiums may double.

Obamacare

The ACA, introduced by the Obama administration in 2010, now provides health insurance coverage for around 45 million Americans who do not have Medicare or employer-sponsored health insurance.

The Obama administration required people who do not have Medicare or employer-sponsored health insurance to purchase ACA-compliant health plans, or they would be penalized monthly.

While Obamacare has low health premiums for some people who are low-income, allowing more people to gain access to health care, its above-average out-of-pocket costs disadvantage people who are really sick, Goodman said.

The most common plan for Obamacare is the silver plan which has an average deductible of $4,890 while the average deductible for people getting health insurance through their employer is around $1,700, according to health policy research group KFF.

Although the Trump administration attempted to repeal the ACA in 2017, the effort failed.

After that, the Trump administration switched direction and introduced new regulations aimed at stabilizing Obamacare enrollment and ensuring insurers do not exit the market. During a CBS presidential debate on Sept. 11, 2024, Trump stated that because back then the proposed repeal of ACA didn’t get enough support, he decided to “save it and make it as good as it can be.” Trump added that “I would only change it if we come up with something that’s better and less expensive.” He did not offer specific plans for the ACA during the debate.

“I certainly think that the ACA is here to stay. I think that repeal remains the fool’s errand,” Katy Talento, an epidemiologist and previous veteran health policy advisor to the Trump administration, told The Epoch Times.

During his first term, in an effort to reduce costs, Trump encouraged the sale of short-term insurance plans not compliant with the ACA, which typically covered fewer medical conditions at lower costs. Trump also reduced the penalty for not enrolling in the ACA to zero.

His administration also cut funding for advertising and outreach, leading to a decline in ACA enrollment from a peak of 12.7 million to an average of 11.4 million to 11.8 million by the end of his term.

The Biden administration reversed most of these changes, and Harris would likely maintain this course if elected. The vice president has pledged to expand and strengthen the ACA.

She has promised to make permanent the temporary tax credits introduced in 2021 through the American Rescue Plan, which lowered health care premiums by an average of $800 a year.

These enhanced subsidies played a significant role in increasing ACA enrollments by over 2 million. Before 2021, subsidies were available only to those earning up to 400 percent of the federal poverty level. The American Rescue Plan removed this cap to include higher-income Americans.

“What’s happening in the Obamacare exchange is that they’re giving insurance away almost for free. So if you have an average income, your premium is probably zero,” Goodman said.

The current premium subsidies are also being paid for with borrowed money, increasing national debt. However, these subsidies are set to expire in 2025.

While Harris has committed to making them permanent, it remains unclear whether Trump will extend or replace them if elected.

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