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As Dr. Drew Altman, President and CEO of the Kaiser Family Foundation noted in a recent “Beyond the Data” columns, the 2024 presidential election is not all about health care. There are issues about which voters are divided, but the Affordable Care Act (ACA) is not the headline issue. Still, the exit of President Joe Biden from the 2024 race – and the elevation of Vice President Kamala Harris to the top of the Democratic ticket – has shaken things a bit.
 
With voting already underway in some parts of the country, here’s a summary of the views of former President Donald Trump and Vice President Harris on a few health care-related matters.
 

Affordable Care Act (ACA)

Access to health insurance dramatically changed with the introduction of the ACA. There are millions more Americans with health insurance today than in 2010. The uninsured rate was 18.2% that year. By 2022, more than 92% of people in the U.S. had health insurance.
 
USA Today reported on September 3^rd that under Trump, 39 states had increases in their uninsured rates. In the first two years of the Biden administration, all but three states experienced decreases in their uninsured ranks. The ACA includes mandated Essential Health Benefits like preventive care, prescription drugs, emergency services, and hospitalization, among others. It also includes protections for people with pre-existing health conditions.
 
President Trump sought to repeal and replace the ACA. However, his efforts fell short, when Sen. John McCain and two other Republican senators voted to preserve the law. Congressional Budget office analysts say Trump’s actions could have boosted uninsured Americans to 51 million. The Trump administration discontinued cost-sharing subsidies, leading to increased premiums for ACA Marketplace participants. Funding for outreach advertising was also cut. Together these actions helped reduce ACA Marketplace enrollment in 2017, 2018, 2019, and 2020.
 
The Trump administration also proposed ACA changes that would have weakened pre-existing condition protections. It advocated for increased availability of short-term health plans. Critics note that short-term plans often do not cover pre-existing health conditions – or do so at a higher cost for participants. The California legislature passed a prohibition on the sale of short-term health plans effective in 2019.
 
As part of the Tax Cuts and Jobs Act of 2017, former President Trump reduced the financial penalties associated with the ACA Individual Mandate. That portion of the law required most Americans to enroll in health insurance or face a financial penalty. Today, there is no penalty at the federal level for not having health insurance. However, there is a California state penalty, which became effective in 2020.
 
In campaigning for the 2024 election, former President Trump has called to “never give up” on the repeal of the ACA. He says he will deliver a “much better” program at “far less money,” but he has offered no details. He said in the September 10 debate with Vice President Harris that he has “concepts of a plan.” The day after the debate, Sen. Bill Cassidy (R-La) said any future action to amend the ACA would need to be bipartisan. Cassidy would likely become the U.S. Senate health committee chair if the GOP takes control after the November election.
 
President Biden campaigned in 2020 to expand and protect the ACA. He and Vice President Harris advocated for the American Rescue Plan Act (ARPA). That legislation expanded the eligibility rules and ACA Marketplace cost-sharing subsidies. The temporary subsidies are set to expire in 2025. It’s uncertain whether a re-authorization is likely.
 
The ACA “family glitch” was amended by the Biden administration. Those with unaffordable employer-sponsored health care can qualify for ACA subsidies. The White House also announced a 2024 plan to curb the sale of non-ACA-compliant short-term health plans. Enrollment in ACA Marketplace plans is currently at an all-time high of more than 21.4 million.
 

Prescription Drug Prices

The Trump administration created a voluntary model allowing Medicare Part D plans to offer insulin at a monthly cost of $35 (from 2021 to 2023). It also developed a program allowing import of prescription drugs from Canada where prices are lower than in the U.S. Former President Trump proposed eliminating drug rebates in Medicare Part D; however, implementation was delayed. The Trump proposal to require drug manufacturers to disclose pricing in their TV advertising was also blocked.
 
Vice President Harris cast the tie-breaking vote in the U.S. Senate for the Inflation Reduction Act. The IRA enables the U.S. government to negotiate the price for some Medicare-covered medications. It also mandates rebates if drug prices increase more than the rate of inflation. The IRA limits insulin costs to $35 for Medicare Part B and Part D plan participants, while boosting assistance for low-income Medicare beneficiaries.
 

Abortion and Contraception

President Trump has taken credit for overturning Roe v. Wade by appointing three anti-choice justices to the U.S. Supreme Court. He said previously he would consider a national 15- or 16-week ban on abortion. However, in the September debate, he appeared to waffle – and expressed support for leaving the matter to individual states.
 
In an August interview with CBS News, Trump said he would not use the 1873 Comstock Act to ban mail delivery of mifepristone. It is a medication that blocks a hormone needed for a pregnancy to continue. Some conservatives and anti-abortion activists have attacked this stance. While in office, Trump took action to prohibit Planned Parenthood from receiving federal Title X funds. He also issued a regulation allowing employers to claim a religious or moral exemption from the ACA’s contraception coverage requirement.
 
The leading voice for the Biden White House on reproductive rights, Vice President Kamala Harris supports a federal law to restore Roe v. Wade. She is the only vice president or president to visit a Planned Parenthood clinic while in office. During her time in the U.S. Senate, Harris co-sponsored the Women’s Health Protection Act. It would have blocked states from imposing restrictive policies to limit abortion access. She strongly supports the ongoing availability of mifepristone and the ACA’s contraception coverage mandate.
 

Health Care Costs/Cancellation of Medical Debt

Former President Trump signed the No Surprises Act. This bipartisan legislation protects patients from unexpected medical bills from out-of-network care. He also issued an order requiring hospitals to post negotiated charges online.
 
The Biden-Harris administration has proposed cancelling medical debt for millions of Americans. It announced a proposal to remove medical debt from the credit reports of 15 million Americans. It is encouraging local and state government actions to reduce the burden of medical debt.
 
In implementing the No Surprises Act, the Biden-Harris administration proposed expanding protections to include ground ambulance providers. As noted, the Inflation Reduction Act that passed in 2022 empowers Medicare to negotiate prescription drug prices effective in 2026. The estimated savings on the 10 selected drugs for the first year could top $1 billion. Negotiated discounts range from 38% to 79% off list prices. More drugs will be added in subsequent plan years.
 
For more information about health care and the 2024 election, consider reading The Politics of Health Care and the 2024 Election, authored by KFF Executive Vice President Larry Levitt. Another worthwhile article is What Will the 2024 Elections Mean for Health Policy, published by Avalere. You might also consider visiting the campaign websites of the two candidates.
 

Exercise Your Voting Right in November

Health care is a very personal decision – for you and those you serve. As the November 5, 2024, election approaches, we hope this column will help you determine what issues are most important to you and how you might vote.
 
It’s also important that you know these seven things about the 2024 Election:

• The last day to register to vote for the November 5, 2024, General Election is October 21, 2024.
• All California active registered voters will receive a vote-by-mail ballot for the November 5, 2024, General Election.
• California county elections officials will begin mailing ballots by October 7, 2024.
• Ballot drop-off locations open on October 8, 2024.
• Vote-by-mail ballots can be returned by mail, at a drop-off location, or at a county elections office. You can look up your county’s elections offices on the California Secretary of State’s website.
• Vote centers open for early in-person voting in all Voter’s Choice Act counties beginning on October 26, 2024.
• Vote-by-mail ballots must be postmarked on or before Election Day and received by November 12, 2024.

 
We encourage you to share these dates with your clients.