Election 2024: Health Care Issues on the Ballot

Although health care hasn’t been a central issue in the 2024 presidential campaign, the election’s outcome has the potential to affect a wide range of health policies.

Reproductive health, prescription drug costs, the opioid overdose epidemic, and lingering issues related to the COVID-19 pandemic are some of the broad health policy areas where former President Donald J. Trump and Vice President Kamala D. Harris have philosophical differences, said Anand Parekh, MD, MPH, chief medical advisor at the Bipartisan Policy Center in Washington, DC. There are several other areas where a Trump or Harris presidency could directly affect hematologists and their patients, he said.

The outcome of the presidential election is likely to sway whether Congress chooses to permanently extend subsidies that allow more Americans to receive lower-cost insurance plans purchased through the Affordable Care Act (ACA) Health Insurance Marketplace. Similarly, the next president is likely to influence the fate of Medicare drug negotiations put in place under the Inflation Reduction Act (IRA), Dr. Parekh said.

Another area to watch is a plan from Republicans in Congress to restructure the National Institutes of Health (NIH), including dramatic shifts in how institutes and centers are organized, he said.

“Whether it’s cost, access, or quality, there are so many important issues that impact the doctor-​patient relationship,” Dr. Parekh said.

Which party controls Congress will also be important in determining whether a campaign pledge can turn into policy, said Rakesh Singh, vice president of health policy initiatives at KFF, a nonprofit health policy research, polling, and news organization located in Washington, DC. “When there’s divided government, it’s really challenging to tackle a lot of key challenges facing the country,” he said. “You saw that in how legislation was passed early in the Trump administration and also in the Biden administration. As things progressed along, it became more challenging to pass meaningful legislation.”

Currently, Democrats hold a narrow majority in the U.S. Senate, while Republicans hold a narrow majority in the U.S. House, but in November, all 435 House seats and 33 Senate seats are up for election. It is anybody’s guess what will happen in the congressional races, whether one party will control both bodies or they will be split. “That will absolutely matter in terms of what gets done in the next two to four years,” Dr. Parekh said.

Below, ASH Clinical News breaks down the candidates’ positions on some of the top issues that have the potential to affect the hematology community.

Women’s Health

Access to abortion care has become a major issue since the Supreme Court overturned federal abortion rights with its Dobbs v. Jackson Women’s Health Organization decision on June 24, 2022. That decision essentially returned regulation of abortion to the individual states, setting off a crisis in health care access when most states implemented full or nearly full bans on access to abortion. A policy statement issued by the American Society of Hematology (ASH) in June 2022 states that maternal health can be adversely affected by hematologic disorders; that pregnancy termination is a key clinical consideration when the mother is at risk for serious health complications; that access to evidence-​based medical information and options, including the termination of a pregnancy, is a maternal right; and that decisions about terminating a pregnancy must be made between the patient and physician.¹

Trump: Mr. Trump has repeatedly taken credit for the Dobbs decision, saying his appointments to the Supreme Court helped tip the balance to overturn Roe v. Wade. Though he previously supported a national abortion ban, he has recently said he would not sign one.² During his June 2024 debate with President Joe Biden, Mr. Trump said he favored a state-by-state approach to abortion regulation.³ The Republican National Committee (RNC) Platform pledges to oppose “late-term abortion” and support policies that “advance prenatal care, access to birth control, and IVF (fertility treatments).”⁴

Harris: Vice President Harris has been a staunch defender of abortion rights and of abortion as health care. On March 14, 2024, she was the first vice president to visit an abortion clinic to talk about access to reproductive health care.⁵ She has urged Congress to enshrine a woman’s right to an abortion in federal law and has pledged to sign it if elected president.⁶ As vice president, she also challenged states to address the crisis of maternal mortality in the U.S. by expanding postpartum coverage under Medicaid. “We here believe in a future where all women and all mothers are safe,” she said during a speech on July 24 in Indianapolis, shortly after declaring her candidacy for president.⁷

Affordable Care Act

The ACA, passed in 2010, created individual insurance marketplaces and allowed states to expand Medicaid to millions more Americans. As of the most recent open enrollment period, 21.4 million people have selected insurance coverage through the ACA marketplace, and 40 states and the District of Columbia have expanded Medicaid, covering millions more people. The ACA is credited with decreasing the number of uninsured Americans from more than 45 million in 2013 to fewer than 27 million in 2022. Most recently, Congress temporarily offered enhanced premium subsidies through the American Rescue Plan in 2021 and extended them under the IRA. On average, premiums were reduced by $800 annually. However, those increased subsidies are set to expire at the end of 2025, setting up a major debate in Congress about how to move forward with the ACA.⁸

Trump: In 2017, Mr. Trump tried unsuccessfully to repeal the ACA, but he continued to chip away at the law’s effectiveness throughout his term. He reduced funding for advertisements and navigators to promote the insurance exchanges, and he reduced the number of open enrollment days. He also cut subsidies to insurance companies offering plans on the exchanges, put forward rules allowing lower-​quality insurance plans on the exchanges, and approved state waivers that imposed work requirements on some Medicaid enrollees.⁹ As a candidate in the current election cycle, he has promised to once again try to replace the ACA with a better, less costly alternative.¹⁰

Harris: The Biden-Harris administration has taken several steps to strengthen the ACA and expand coverage and affordability. The Biden administration reversed the Trump administration rules that allowed lower-quality health plans on the exchanges, devoted additional funds to outreach for enrollment, and fixed the so-called “family glitch” to allow dependents with high-cost employer coverage to be eligible for ACA subsidies. President Biden also signed both the American Rescue Plan Act and the IRA, which contained expansions of the ACA subsidies, and has called for those enhanced subsidies to be permanent.¹¹ During her previous presidential campaign in the 2020 election, Vice President Harris proposed a version of Medicare for All that would have allowed people to immediately buy into the program and others to transition over a 10-year period and included a role for private insurers. As a candidate in 2024, she has focused instead on strengthening the ACA and working with states to cancel medical debt.^12,13

Prescription Drug Costs

Ensuring that patients can access needed medical treatments is harder than ever because of rising prescription costs, as well as prior authorization and step therapy requirements put in place by insurers. An ASH policy statement issued in April 2024 states that treatment decisions should be made between a physician and a patient, not influenced by policies made by the government or insurers. Additionally, ASH asserts that patients should be able to access innovative therapies, such as chimeric antigen receptor (CAR) T-cell or gene therapy, while physicians should be reimbursed fairly for delivering those treatments.¹⁴ Both presidential candidates have called for a reduction in prescription drug prices, though their policy approaches differ.

Trump: As president, Mr. Trump established a voluntary program in which some Medicare Part D drug plans offered insulin that was capped at $35 per month. The temporary program ran from 2021 through 2023.¹⁵ He also supported the importation of lower-priced prescription drugs from other countries by creating a pathway that allowed states to apply to import drugs from Canada.¹⁶ Mr. Trump also set up a demonstration project that sought to tie the price paid for Medicare Part B drugs to the lowest price charged in similar countries. This Most Favored Nation approach was challenged in court and later rescinded under the Biden administration.^17,18 The 2024 RNC platform, supported by Mr. Trump, calls for increased transparency and greater choice and competition to control drug prices.⁴

Harris: Vice President Harris has campaigned for the right to affordable health care, including lowering prescription drug costs. During the Biden-​Harris administration, President Biden signed the IRA, which included several changes to expand benefits, lower drug costs, and keep prescription drug premiums stable in the Medicare program. The IRA requires the Medicare program to negotiate drug prices, beginning with 10 drugs in 2026 (including three drugs prescribed by hematologists). The law also requires drug companies to pay rebates to the Medicare program if their prices rise faster than inflation, smooths out-of-pocket costs for Medicare Part D drugs with an annual cap of $2,000, and makes insulin available at $35 per month per covered prescription for all Medicare beneficiaries.¹⁹ As a candidate for president, Vice President Harris has proposed expanding those benefits to all Americans, accelerating Medicare drug price negotiations, and cracking down on anti-competitive practices by pharmaceutical companies and pharmacy benefit managers.¹³

Medical Research Funding

Ensuring that the NIH has adequate funding to pursue cutting-edge medical research funding has been a top priority for ASH and other health and science organizations. While the NIH has historically had bipartisan support, the agency’s budget has fallen victim to government-wide cost cutting and to increased scrutiny over its response to the COVID-19 pandemic. Recently, some House Republicans have advanced a reform plan for the NIH that calls for greater congressional oversight, greater transparency from the agency, greater scrutiny of grantees, and a dramatic restructuring of the NIH’s institutes and centers. The proposal would reduce the number of institutes and centers from 27 to 15, largely through consolidation. For example, the reform plan would combine the National Heart, Lung, and Blood Institute; the National Institute of Arthritis and Musculoskeletal and Skin Diseases; and the National Institute of Diabetes and Digestive and Kidney Diseases into a single center.²⁰

Trump: Mr. Trump has not commented on plans for medical research funding in a second term, but he proposed cuts to the NIH in each of his budgets during his first term.²¹ Although Mr. Trump is widely credited with supporting the successful Operation Warp Speed that accelerated the development of COVID-19 vaccines, his administration was also accused of politicizing science and interfering in the work of public health experts.²²

Harris: Vice President Harris speaks frequently about the influence of her late mother, Shyamala Gopalan, PhD, who was a prominent breast cancer researcher and died of colon cancer in 2009. She has also said that President Biden’s Cancer Moonshot and efforts to cure cancer are personal for her.²³ As a presidential candidate in 2019, Vice President Harris proposed investing $60 billion in historically Black colleges and universities and some other institutions to support STEM education.²⁴

Be Informed and Vote

Although both presidential candidates have established records from their time in the White House, it can be difficult to find specifics on their health care agendas for the next four years. Neither candidate has come out with a detailed health care platform, and it is unclear how differently Vice President Harris might govern from President Biden. Mr. Trump has offered conflicting statements about his health policy plans, and he has denied involvement with efforts like Project 2025, a wide-ranging conversative agenda for reshaping the federal government released by the Heritage Foundation.

“It’s really difficult to take other platforms in the political sphere and attach them to candidates,” Mr. Singh said. “The best indication is what happened in the previous administrations and to draw your own conclusions about what would happen.”

Dr. Parekh advised hematologists to look to nonpartisan sources of information on health policy, such as KFF’s side-by-side analysis of the candidates’ health care positions and published review articles. Independent, credible sources are “the best way to break through the noise and the bias,” he said.

Everyone who is eligible to vote should do so, but physicians, in particular, have a special responsibility to their patients and their communities, said Bart L. Scott, MD, a hematologist and transplant specialist in Seattle and the vice chair of the ASH Committee on Government Affairs. “We see things that not everyone sees because of our role as health care providers,” he said.

Jennifer Holter-Chakrabarty, MD, a hematologist in Oklahoma City and chair of ASH’s Committee on Government Affairs, said a lot is at stake in this election for physicians, namely their ability to provide evidence-based care without government interference. But no matter the outcome, she said ASH will continue to work to protect patients.

“No matter who sits in Congress or the Oval Office, ASH will continue to advocate to make sure we protect patients and get what we need for our patients,” she said. “But the more people we have who value women’s health care, sickle cell disease, access to care, and equitable health care, the more likely we are to be successful at moving the needle.”

References

1. ASH Policy Statement. The right to maternal health care. American Society of Hematology. June 24, 2022. Accessed July 29, 2024. https://www.hematology.org/advocacy/policy-news-statements-testimony-and-correspondence/policy-statements/2021/the-right-to-maternal-health-care-in-hematology.
2. Contorno S, Sullivan K. Trump says he wouldn’t sign federal abortion ban. CNN. April 10, 2024. Accessed July 29, 2024. https://www.cnn.com/2024/04/10/politics/trump-says-he-wouldnt-sign-federal-abortion-ban/index.html.
3. READ: Biden-Trump debate transcript. June 28, 2024. Accessed July 29, 2024. https://www.cnn.com/2024/06/27/politics/read-biden-trump-debate-rush-transcript/index.html.
4. The American Presidency Project. 2024 GOP platform: make America great again. July 8, 2024. Accessed July 29, 2024. https://www.presidency.ucsb.edu/documents/2024-republican-party-platform.
5. The White House. Remarks by Vice President Harris and Doctor Sarah Traxler during the nationwide “Fight for Reproductive Freedoms” tour. March 14, 2024. Accessed July 29, 2024. https://www.whitehouse.gov/briefing-room/statements-releases/2024/03/14/remarks-by-vice-president-harris-and-doctor-sarah-traxler-during-the-nationwide-fight-for-reproductive-freedoms-tour-st-paul-mn/.
6. Messerly M, Ollstein AM. Kamala Harris’ call for ‘reproductive freedom’ means restoring Roe. Politico. July 29, 2024. Accessed July 29, 2024. https://www.politico.com/news/2024/07/29/kamala-harris-abortion​-restoring-roe-00171657.
7. The White House. Remarks by Vice President Harris at Zeta Phi Beta Sorority, Incorporated’s Grand Boule. July 24, 2024. Accessed July 29, 2024. https://www.whitehouse.gov/briefing-room/speeches-remarks/2024/07/24/remarks-by-vice-president-harris-at-zeta-phi-beta-sorority-incorporateds-grand-boule/.
8. Sullivan J, Orris A, Luken G. Entering their second decade, Affordable Care Act coverage expansions have helped millions, provide the basis for further progress. Center on Budget and Policy Priorities. March 25, 2024. Accessed July 29, 2024. https://www.cbpp.org/research/health/entering-their-second-decade-affordable-care-act-coverage-expansions-have-helped.
9. Thompson F.J. Six ways Trump has sabotaged the Affordable Care Act. Brookings Institution. Oct. 9, 2020. Accessed July 29, 2024. https://www.brookings.edu/articles/six-ways-trump-has-sabotaged-the-affordable-care-act/.
10. Donald J. Trump. I don’t want to terminate Obamacare, I want to REPLACE IT with MUCH BETTER HEALTHCARE. Obamacare Sucks!!! Accessed July 29, 2024. https://truthsocial.com/@realDonaldTrump/posts/111492215056460142.
11. Election 2024: compare the candidates on health care policy. July 15, 2024. Accessed July 29, 2024. https://www.kff.org/compare-2024-candidates-health-care-policy/.
12. Harris K. My plan for Medicare for all. Medium. July 29, 2019. Accessed July 29, 2024. https://kamalaharris.medium.com/my-plan-for-medicare-for-all-7730370dd421.
13. Harris, Walz Campaign. Vice President Harris lays out agenda to lower costs for American families. Aug. 16, 2024. Accessed Aug. 23, 2024. https://mailchi.mp/press.kamalaharris.com/vice-president-harris-lays-out-agenda-to-lower-costs-for-american-families.
14. ASH Policy Statement. Access to hematology care in an age of innovation. American Society of Hematology. April 2, 2024. Accessed July 29, 2024. https://www.hematology.org/advocacy/policy-news-statements-testimony-and-correspondence/policy-statements/2019/access-to-hematology-care-in-an-age-of-innovation.
15. Cubanski J, Neuman T. The facts about the $35 insulin copay cap in Medicare. KFF. June 12, 2024. Accessed July 29, 2024. https://www.kff.org/policy-watch/the-facts-about-the-35-insulin-copay-cap-in-medicare/.
16. U.S. Food and Drug Administration. Final rule. Importation of prescription drugs. Oct. 1, 2020. Accessed July 29, 2024. https://www.hhs.gov/sites/default/files/importation-final-rule.pdf.
17. Centers for Medicare and Medicaid Services. Trump administration announces prescription drug payment model to put American patients first. Nov. 20, 2020. Accessed July 29, 2024. https://www.cms.gov/newsroom/press-releases/trump-administration-announces-prescription-drug-payment-model-put-american-patients-first.
18. King R. CMS pulls Trump-era Most Favored Nation drug price model. Fierce Healthcare. Jan. 4, 2022. Accessed July 29, 2024. https://www.fiercehealthcare.com/payer/cms-pulls-trump-era-most-favored-nation-drug-price-model.
19. Centers for Medicare and Medicaid Services. Inflation Reduction Act and Medicare. Accessed July 29, 2024. https://www.cms.gov/inflation-reduction-act-and-medicare.
20. Rodgers C.M. Reforming the National Institutes of Health: framework for discussion. Energy & Commerce Committee, U.S. House of Representatives. June 2024. Accessed July 29, 2024. https://d1dth6e84htgma.cloudfront.net/NIH_Reform_Report_f6bbdca821.pdf.
21. Jaffe S. US election 2020: research and health institutions. Lancet. 2020;396(10259):1320-1321.
22. McNutt M, Dzau VJ. NAS and NAM presidents alarmed by political interference in science amid pandemic. National Academies. Sept. 24, 2020. Accessed July 31, 2024. https://www.nationalacademies.org/news/2020/09/nas-and-nam-presidents-alarmed-by-political-interference-in-science-amid-pandemic.
23. The White House. Remarks by Vice President Harris at an event to reignite the Cancer Moonshot. Feb. 2, 2022. Accessed July 29, 2024. https://www.whitehouse.gov/briefing-room/speeches-remarks/2022/02/02/remarks-by-vice-president-harris-at-an-event-to-reignite-the-cancer-moonshot/.
24. Vagianos A. Kamala Harris proposes plan to invest $60 billion in historically black colleges. HuffPost. July 26, 2019. Accessed July 29, 2024. https://www.huffpost.com/entry/kamala-harris-hbcu_n_5d3b06dae4b0ef792e0b4f1c.