Here’s where Harris and Trump stand on three big health care issues | WFAE 90.7

As the 2024 election heads into its final weeks, the direction of policies affecting the health of millions of Americans is at stake.

The next president and Congress will have the power to put your mark in major health care programs like Medicare and Medicaid that combined cover nearly 150 million Americans. They will be able to direct resources toward how the United States fights the drug overdose crisis and how the country prepares for the next pandemic.

TO recent survey found that two-thirds of Americans say health care should receive more attention in the presidential campaign, and there are several crucial health policy decisions the next president will likely face in his first year. Here are the candidates’ opinions on three issues:

1. What is the future of Medicare drug price negotiations?

The Biden-Harris Administration won a historic victory by giving Medicare the power to directly negotiate prices for some of the most expensive prescription drugs. The first 10 prices negotiated by federal health officials will take effect in 2026, saving patients and Medicare $7.5 billion in total.

Some high-ranking Republicans in Congress want repeal that authorityarguing that the reduction in drug manufacturers’ profits will be reduced your incentive to develop the next blockbuster treatment. Several pharmaceutical companies have also sued the federal government, alleging that Medicare’s bargaining powers are unconstitutional.

Trump has not said whether he supports repealing the law or whether he would continue to defend it in court. Stacie Dusetzina, a health policy professor at Vanderbilt University Medical Center, says the new Medicare authority is still vulnerable.

“Once you offer better benefits to Medicare beneficiaries, it’s very difficult to take them away,” Dusetzina acknowledged. “But I think since the negotiated prices won’t come into effect until 2026, no one will miss them (if they are repealed).”

Harris has said during the election campaign that she wants Medicare to “accelerate speed of negotiations so that the prices of more drugs fall more quickly.” Experts believe that would likely mean negotiating the price of more drugs or starting to negotiate earlier in a drug’s shelf life. Either measure would require congressional approval.

Harris’ campaign says she would invest any additional savings into new policy proposals, such as expanding Medicare. home health care coverage. But a recent report from the Congressional Budget Office estimates that Additional funds from such an effort would be minimal..

Dusetzina said it’s also unclear whether Harris’ plan would slow down the process of obtaining new drugs.

“I think it’s worth being a little cautious about how big and broad you can go right away,” he said. “I want to see what that means for drug development. What does that mean for patient access?”

Trump has not explained how his administration would conduct the negotiations. Health care experts note that a Trump administration would have limited ability to undermine the law if it remained in place, because the rules tell Medicare which drugs to choose for negotiation and set minimum discounts the government must seek.

2. Should Congress expand the Affordable Care Act’s enhanced subsidies?

For people who buy their own health insurance on the ACA marketplaces, the federal government covers a portion of the monthly health insurance premiums that many pay. Under the original law, lawmakers limited that assistance to people who made up to 400% of the federal poverty level; today that is around $125,000 for a family of four.

Democrats in Congress eliminated the income limit in 2021 and increased the size of the subsidies. The share of consumer premiums has been almost cut in halfaccording to the nonpartisan health research organization KFF. Since the subsidy increase, the number of people enrolling in ACA coverage has increased. almost doubled to more than 21 million people.

These enhanced subsidies, as they are called, will expire at the end of 2025. If that happens, KFF estimates that monthly premiums for people with subsidized ACA plans would increase double in many states, and the Congressional Budget Office estimates that enrollment in ACA coverage would decline by 7 or 8 million people. (The CBO estimates that about half of those people would get coverage through work.)

Vice President Harris says she wants to make these subsidies permanent, which will cost Washington approximately 335 billion dollars during the next decade. Former President Trump has not expressed a position, but manyrepublicansincluding former Trump officialsThey argue that the benefit should expire.

Many Republicans point to a report published this year by the conservative Paragon Health Institute that found that up to 5 million people misreported their income, potentially trying to defraud the government and qualify for $0 premium health plans. According to Paragon, this activity costs taxpayers up to 26 billion dollars.

Other health policy experts say there is a less dire explanation. Cynthia Cox, vice president of KFF, said it can be very difficult, especially for people with many low-wage jobs, to forecast their annual income. What may seem shady on paper may actually be an assumption gone wrong.

“It can depend on how many tips you get, how many rides you pick up, or how many shifts you work,” Cox said. “So that’s where I think there are some important nuances to consider, like, is it really a fraud or not?”

There are provisions in the law, Cox added, to force people to return all or part of their subsidy if their estimate was incorrect.

Michael Cannon, health policy director at the libertarian Cato Institute, blames subsidies for fueling another form of fraud: that perpetrated by insurance brokers. Federal health officials have received 275,000 complaints this year on brokers signing people up for Obamacare coverage without your consent. Brokers receive a commission for each person they enroll in coverage, and consumers who don’t have to pay a monthly premium are less likely to notice a change in their insurance.

“If more enrollees had to pay at least a small amount to enroll in these plans, it would curb much of this unscrupulous behavior by brokers,” Cannon said.

Federal officials have 850 runners suspendedproposed new rules We have cracked down on unscrupulous broker behavior and have resolved almost all complaints.

3. Will medical abortion still be available?

Nearly two thirds of abortions in the US now are medication abortions, which typically involve a two-pill regimen: mifepristone and misoprostol. In June, the U.S. Supreme Court rejected an attempt by anti-abortion advocates to overturn the Food and Drug Administration’s long-standing approval and expanded access to mifepristone. But depending on the election, the FDA’s new leaders could take steps to restrict (or further expand) access to medical abortion.

Under the Biden-Harris administration, the FDA has allowed doctors to prescribe mifepristone to any patient via telehealth rather than requiring patients to see a provider in person. Telehealth prescriptions now allow 1 in 5 abortions in the United States, and Harris has made protecting and expanding access to abortion a centerpiece of her campaign.

Trump has flip flops. On some occasions the former president has said that would not restrict access, and in others that he would be open to federal restrictions. Project 2025, the conservative government plan written by former Trump officials and other close advisers, calls for the FDA withdraw its approval of mifepristone.

“I think a lot of people don’t know that we can trust what they say because it’s consistently different,” said Ederlina Co, an associate professor of law at Pacific University.

If a Trump administration were to restrict or cut off access to mifepristone, people would still be able to undergo medication abortions using only the other pill. misoprostol. Misoprostol used alone is safe and effective, but may have more side effects.

Uncertainty around Trump’s health policy

Harris’s position on these three issues is clear. She supports expanding ACA-enhanced subsidies. She supports medication abortion and would like to speed up Medicare drug negotiations.

It’s harder to guess what would happen to health policy under a second Trump administration because he hasn’t taken public positions on many important issues.

“When former President Trump describes his plans, the language is often so general that it is difficult to interpret,” KFF’s Cox said.

For example, until recently one of Trump’s clearest positions on prescription drug prices was the “most favored nation” policy he proposed at the end of his first term. It would have forced drug makers to sell certain drugs to Medicare at prices paid by other countries.

In recent weeks, the Trump campaign said political and statistics that the former president would not return to politics for a second term.

Beyond that now-abandoned policy, Ben Ippolito, a health economist at the conservative American Enterprise Institute, said it’s “a little bit harder to predict” how Trump would approach health care.

This story comes from the health policy news organization Tradeoffs. Ryan Levi is a reporter/producer for the show, where a version of this story ran. appeared for the first time. You can listen here:

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