With less than one month until the presidential election, health care policy issues are at the forefront of voters’ minds, including issues around drug pricing, federal research funding and reproductive rights.
Former President Donald Trump and Vice President Kamala Harris faced off during the only presidential debate on Sept. 10, and Sen. JD Vance and Gov. Tim Walz held their vice-presidential debate on Oct. 1. According to recent polling, Harris is currently leading Trump, with Real Clear Polling (RCP) projecting Harris at +2.0, with a 49.1% to 47.1% difference. Several critical battleground states, including Arizona, Nevada, Wisconsin, Michigan, Pennsylvania, North Carolina and Georgia, show an extremely tight race. Trump is slightly favored to win at +0.1 across the top battleground states, including North Carolina, Arizona, Nevada and Georgia, and Trump and Harris are tied in Pennsylvania. Harris has a slight advantage in Wisconsin, Michigan and Nevada, although the data is constantly changing.
Both candidates have expressed an interest in reforming the health care industry and lowering the cost of health care, though they take different approaches. Increased health care transparency is one issue where we could see bipartisan consensus and could help either candidate gain favor. Similarly, both candidates have expressed adamant support for protecting in vitro fertilization (IVF), as well as an interest in lowering the cost of prescription drugs.
Potential Trump Administration
As Trump’s potential second-term health care priorities emerge, it is anticipated he will build on priorities from his first term. Trump has already outlined several specific health care policy promises in his platform, including lowering the cost of prescription drugs, increasing transparency, promoting choice and competition, and expanding access to new affordable health care and prescription drug options. The campaign has also promised to protect Medicare and ensure seniors receive the care they need without being burdened by high costs. Trump has also prioritized focusing on chronic disease prevention and management, long-term care, and benefit flexibility by expanding access to care and supporting policies that can ensure seniors maintain financial security.
Trump’s previous administration attempted to repeal and replace the Affordable Care Act (ACA). However, Trump has softened his approach on the ACA and backed away from his pledge to repeal it in a second term. Similarly, the previous Trump administration finalized regulations that allow states to import lower-cost drugs from Canada and finalized the Most Favored Nation (MFN) rule that would require pharmaceutical companies to offer the same discounts to the United States as they do to other nations. The MFN rule was reversed by the Biden administration and did not go into effect. The Trump campaign has since said Trump would not pursue MFN again, instead focusing efforts on the Inflation Reduction Act (IRA) Medicare drug price negotiation rules. Such shifts from his previous administration suggest that higher priorities have emerged in the health care space, including a focus on Food and Drug Administration (FDA) policies around food safety and regulations to promote better lifestyles and prevent chronic diseases, as well as increased federal research opportunities though the National Institutes of Health (NIH) related to prevention and management.
Chronic Disease Prevention
On the campaign trail, Trump continues to highlight the importance of “making America healthy again,” noting that the United States is not doing well with health care. He said he believes these issues can be resolved in a short period of time. He emphasized the importance of getting toxic chemicals, which can harm people, out of the food supply. Rumors have circulated that Robert F. Kennedy Jr. could be in line to serve in the Department of Health and Human Services (HHS) should Trump be elected, and both have been on the campaign trail touting their plans to tackle chronic diseases. Trump has also pledged to create a panel of experts to work with RFK Jr. to research the causes of increased chronic health problems and childhood illnesses, specifically autoimmune disorders, autism, obesity and infertility. RFK Jr. noted that if he is given the proper tools, the chronic disease burden can be lifted dramatically within two years.
Robert Redfield, the former Centers for Disease Control and Prevention (CDC) director under Trump, published an op-ed in Newsweek, highlighting that RFK Jr. is the right man for the job to help address chronic disease. He emphasized that obesity in children has increased dramatically, and the use of pesticides is a proven risk factor for neurodevelopmental outcomes in children. Redfield added that the health agencies suffer from agency capture, as a large portion of the FDA’s budget is provided by pharmaceutical companies and NIH scientists are allowed to collect royalties on drugs NIH licenses to pharma. Redfield emphasized that Trump would empower RFK Jr., and he supports their efforts to address chronic diseases.
Prescription Drug Pricing
The Trump campaign has reiterated that health care and prescription drug costs are out of control. Trump has promised to increase transparency, promote choice and competition and expand access to new, affordable prescription drug options. In a campaign video, Trump has promised to return production of essential medicines back to the United States and end Biden’s pharmaceutical shortages. Specifically, he highlighted that “as part of my plan to obtain total independence from China, we will phase in tariffs and import restrictions to bring back production of all essential medicines to the United States of America where they belong.” He added, “I signed an executive order to begin this process in 2020 but Biden has shamefully failed to follow through.” Trump specifically proposed restoring his EO 13944 on Ensuring Essential Medicines, Medical Countermeasures, and Critical Inputs Are Made in the United States, which requires federal agencies to “Buy American” by facilitating the domestic production of medicines and medical devices that the FDA designates as “essential” to public health, and requiring federal agencies buy medicines and medical devices that are entirely “produced in the United States.” He emphasized, “it will be one of my top priorities as President and also create countless new American jobs.”
As noted above, in a change from earlier statements, a spokesperson for the Trump campaign said Trump does not have plans to bring back the MFN policy that would set Medicare payments based on the lowest prices in other high-income nations. The statement provided to Inside Health Policy indicates that Trump has backed off his initial plan to revive the policy if he returned to the White House, and the MFN language was removed from his campaign site. The spokesperson said Trump would “get the best deal on drug pricing in the world done in his second term, not Most Favored Nation.” Trump previously pledged that he would immediately sign an executive order to ensure the United States does not pay the highest prices in the world for prescription drugs. Similarly, Alex Azar, former HHS secretary under Trump from 2018 to 2021, said Trump might not want to dismantle the Medicare drug price negotiation program if reelected, and could instead try to please more economic populists within the Republican party by out-negotiating the Biden administration and attempting to get even lower drug prices.
More broadly, Trump has proposed a 60% tariff on Chinese goods and phasing out Chinese imports of essential goods, as well as a 20% tariff on most other imports. In an op-ed published by Trump in Newsweek, he highlighted that “U.S.-based manufacturers will also be rewarded with expanded research and development tax credits to help build the sprawling, state-of-the art-plants our country needs to be an industrial superpower in the modern world.” He said he will also appoint a “manufacturing ambassador, whose sole task will be to go around the world and convince major manufacturers to move their production to the United States.”
Health Care Coverage and the ACA
Throughout Trump’s current campaign, he has disparaged the ACA, saying he would create a plan with “much better health care” and that Obamacare is a “catastrophe.” He has also highlighted that he is “seriously looking at alternatives” if he wins a second term. However, in recent months, Trump has softened his approach, instead saying, “we are going to make the ACA much better than it is right now and much less expensive.” This could take the form of supporting short-term limited duration coverage and opposing extending enhanced premium subsidies that expire at the end of 2025. During the presidential debate, Trump noted that his administration tried to make the ACA the best it possibly could be after it was not repealed, though he said the ACA would never be great. On Aug. 14 at a rally in North Carolina, Trump said he plans to keep the ACA unless a better plan is developed.
The Republican National Committee (RNC) has reiterated that Trump plans to protect Medicare’s finances from being crushed by the “Democratic plan to add tens of millions of new illegal immigrants to the rolls of Medicare.” Trump has also said he plans to ensure programs such as Medicare and Social Security remain solvent long-term by reversing harmful Democratic policies, promising to protect Medicare and ensure seniors receive the care they need without being burdened by excessive costs. At campaign events in Wisconsin on Sept. 7 and Oct. 1, Trump said he would protect Medicare, and there would be no cuts or age increases. His platform also emphasizes that he will not “cut one penny from Medicare or Social Security,” as he says the programs are vital to ensure economic stability. Additionally, Trump says he plans to expand access to primary care and support policies to help seniors remain in their homes and maintain financial security. Specifically, Trump wants to shift resources back to at-home senior care, overturn disincentives that lead to care worker shortages and support unpaid family caregivers through tax credits and reduced red tape. The campaign also emphasizes that Republicans will tackle inflation and restore economic growth to preserve Medicare and Social Security to ensure funding for the next generation and beyond.
Trump has been silent on addressing cuts to Medicaid, indicating that he would likely make additional attempts to limit spending on the program. Although the Trump administration never issued a detailed replacement plan for the ACA, he previously proposed a plan to convert the ACA into a block grant to states, allow states to relax the ACA’s rules protecting people with preexisting conditions and cap federal funding for Medicaid, among other changes, which was expected to have reduced federal spending by more than $1 trillion over a decade.
Health Care Costs and Transparency
Trump has continued to tout his administration’s efforts to increase price transparency and lower health care costs. The Trump administration previously signed into law the No Surprises Act, an effective transparency law that many surveys suggest has prevented millions of unexpected costly medical bills from out-of-network services. Health care price transparency is one rare point of agreement between Harris and Trump. Reports indicate that hospital price transparency rules continue to be marred by widespread noncompliance and a lack of federal enforcement. Further action by Trump to strengthen price transparency policies and make them more actionable for all consumers would likely be addressed in an effort to reduce the burden of high health costs on consumers. The Trump campaign reiterates that he would ensure efforts to address health care costs and transparency do not hinder competition or the function of the health care market.
Additionally, former HHS Secretary Alex Azar highlighted that “there is no way we are going back on transparency of pricing information. You can resist this, you could not comply with it. Or you can embrace this and figure out how it can be a competitive advantage for you.” He said the wheels set in motion during the Trump term and continued by the Biden administration will continue rolling, one way or another. Trump would likely continue to ensure policies from the No Surprises Act are enforced and expanded, as many areas in the transparency space are ripe for improvement.
Reproductive Health
On reproductive health, Trump noted during the presidential debate that he strongly believes in exceptions for abortion in the cases of rape, incest and the life of the mother. He added that abortion is now back in the hands of the states and the votes of the people instead of being tied up in the federal government. Trump reiterated he would not need to sign a national abortion ban because the decision is up to the states.
He said he also continues to be a leading conversative voice in protecting the right to IVF. In response to the Alabama Supreme Court’s IVF ruling, which found that frozen embryos are children under state law and those that destroy them could be held to blame for wrongful death, Trump noted that he “strongly supports the availability of IVF.” Trump added that “like the overwhelming majority of Americans, including the vast majority of Republican conservatives, Christians and pro-life Americans, I strongly support the availability of IVF for couples who are trying to have a baby.” He called on the Alabama legislature to act quickly to find an “immediate solution to preserve the availability of IVF in Alabama,” as several providers in the state began suspending their IVF programs. On Aug. 29 in Michigan and Sept. 12 in Arizona, Trump said his administration would require that government or private insurance pay for all costs associated with IVF and other fertility treatment.
Potential Harris Administration
Harris’ health care priorities as president would build on the Biden administration’s achievements, with a strong focus on expanding access to care, reducing costs and promoting health care equity. Her platform emphasizes lowering prescription drug prices by extending Medicare’s negotiated price caps to all Americans, capping out-of-pocket drug expenses and increasing transparency in health care pricing. Harris is also committed to addressing health disparities, strengthening women’s health care rights and tackling predatory medical debt practices. While she no longer supports Medicare for All, Harris remains focused on expanding health care coverage through marketplace plans. Health care affordability is a key theme of Harris’ platform, and the policy proposals largely focus on out-of-pocket costs for Americans.
Prescription Drug Pricing
Harris plans to expand the Biden administration’s efforts to reduce prescription drug costs, extending benefits to all Americans. During a campaign event, Harris promised to “lower the cost of insulin and prescription drugs for everyone with your support, not only our seniors.” A key aspect of Harris’s agenda is capping out-of-pocket drug costs. She intends to extend the $35 insulin cap and the $2,000 annual cap on prescription drugs—currently available only to Medicare beneficiaries—to the entire population. Harris’ plan also includes accelerating Medicare’s ability to negotiate prescription drug prices, a historic provision that she helped pass through her tie-breaking vote on the IRA. The Biden administration and the Centers for Medicare and Medicaid Services (CMS) announced significant discounts on the list prices of 10 drugs as a result of their negotiations. Discounts range from 38% for blood cancer medication Imbruvica to 79% for diabetes drug Januvia. Though these prices do not take effect until 2026, other aspects of the law will lower costs sooner such as a $35-a-month out-of-pocket price cap on insulin for Medicare enrollees and a $2,000 yearly out-of-pocket spending cap for Part D drugs, effective in January.
In an official statement, Harris noted that under the IRA, “additional prescription drugs will be selected each year as part of our Medicare drug price negotiation program. This includes up to 15 additional drugs covered under Medicare Part D for negotiation in 2025, up to an additional 15 Part B and Part D drugs in 2026, and up to 20 drugs every year after that.” More recently, Harris has indicated interest in expanding the scope of drug price negotiations in line with a previous White House proposal to build on the IRA. This includes an increase in the number of drugs subject to Medicare price negotiations to 50 per year, up from 20, starting in 2028. The IRA currently enables Medicare to negotiate prices for as many as 140 drugs cumulatively by 2033 and the proposal could increase this to up to 300 by 2033. Harris has committed to expanding President Biden’s policies to include more drugs in the negotiation program and make discounted drugs available for more Americans. She intends to use savings from expanded negotiations to help pay for a comprehensive new proposal that would cover long-term care at home for Medicare recipients.
Harris’s platform also seeks to address monopolistic practices within the pharmaceutical industry. She intends to crack down on pharmaceutical companies that limit competition, as well as the middlemen who inflate drug prices while cutting into the profits of small pharmacies. An official statement from the Harris campaign states that Harris “will increase competition and demand transparency in the health care industry, starting by cracking down on pharmaceutical companies who block competition and abusive practices by pharmaceutical middlemen.” This reiterates her stance on fostering innovation in the pharmaceutical industry while lowering costs. During the Biden administration, the Federal Trade Commission (FTC) launched an investigation into six of the largest pharmacy benefit managers (PBMs) followed by an interim staff report arguing that PBMs overcharge patients and weaken drug access. To create cost-savings for a Medicare at Home initiative, the Harris campaign proposes “cracking down on pharmaceutical benefit managers to increase transparency, disclose more information on costs and regulate other practices that raise prices.” It remains unclear what policy actions will be taken to do this.
Health Care Coverage and Costs
Harris has made it clear that expanding health care coverage will remain a cornerstone of her health policy agenda. She said her administration will prioritize ensuring that more Americans have access to affordable health care, with a focus on strengthening the ACA and further expanding Medicaid. Harris’ platform calls for expanding “traditional Medicare coverage to include dental, vision, and hearing services.” Harris is also proposing a “Medicare at Home” plan to expand Medicare to cover in-home aides for seniors, helping families avoid the costs of nursing homes. The plan would provide coverage for home care services and nurses, funded through savings from expanded Medicare price negotiations with drug manufacturers, which are expected to reduce prescription costs. While the plan focuses on Medicare, not Medicaid, allowing it to coexist with private insurance, the exact costs of the new benefits remain unclear.
Looking ahead, Harris plans to build on the ACA’s successes. During her time as vice president, more than 9 million additional Americans gained health care coverage through ACA marketplaces, and nearly 10 million more enrolled in Medicaid. Harris intends to expand and make permanent the enhanced Advanced Premium Tax Credit (eAPTC) for ACA marketplace plans. According to the Harris campaign, some individuals could save an average of $800 per year on their ACA health insurance premiums.
As vice president, Harris championed removing medical debt from credit reports and supported the cancellation of $7 billion in medical debt, which was a part of the American Rescue Plan. Harris and Consumer Financial Protection Bureau (CFPB) Director Rohit Chopra announced actions to remove medical debt from credit reports of more than 15 million Americans. Harris’ economic plan notes that she would work with states to relieve people of their medical debt and “help them avoid accumulating such debt in the future, because no one should go bankrupt just because they had the misfortune of becoming sick or hurt.” Harris remains committed to ensuring “affordable health care is a right, not a privilege.” In an official release, the Harris campaign stated that they will “work with states to cancel medical debt for millions of Americans and to help them avoid accumulating such debt in the future.” This plan builds off Harris’ leadership in removing medical debt from credit reports and using American Rescue Plan funds to cancel medical debt for millions of Americans.
Reproductive Health
Harris’ policy platform emphasizes restoring and protecting reproductive freedoms. Since the overturning of Roe v. Wade, Harris has prioritized the Biden administration’s efforts to defend reproductive freedom and protect the privacy of both patients and providers. She has stated her support for “eliminat[ing] the filibuster for Roe” to restore nationwide reproductive rights. Harris said she will “continue to call on Congress to finally pass a bill that restores reproductive freedom.” These freedoms include access to abortion, contraception and fertility treatments.
Harris has kept firm in her support for restoring the protections within Roe. During the debate, she expressed strong support for reinstating Roe v. Wade protections and emphasized her commitment to signing these protections into law. As vice president, Harris launched the Reproductive Freedoms Tour and became the only vice president or president to visit a Planned Parenthood clinic while in office. In an interview, Harris emphasized the broad impacts of recent reproductive health care restrictions, noting that many clinics that provide abortions also provide other essential services such as contraception. Harris additionally supported access to abortion medication and mifepristone in retail pharmacies.
Harris has emphasized the importance of protecting fertility treatments and released a statement following the failure of the Right to IVF Act in the Senate. She stated that “Republicans in Congress have once again made clear that they will not protect access to the fertility treatments many couples need.” The Harris campaign alleges that abortion bans could jeopardize IVF access in multiple states.
Health Care – Overview of Presidential Priorities
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Kamala Harris
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Donald Trump
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- Harris has cemented herself as a staunch advocate of abortion rights. She promises to codify abortion-related protections enshrined in Roe v. Wade into federal law.
- She has promised to expand and strengthen health care coverage provided by the ACA and reduce health care costs, pivoting from her previous support of a single-payer health care system.
- Harris supports extending Medicaid coverage in the 10 states that have not yet expanded it under the ACA.
- Harris continues to support efforts to lower the cost of prescription drugs and provisions included in the IRA, including Medicare drug price negotiations. When Harris was running for president, she wanted to go further on drug pricing and proposed capping U.S. prices to the lowest ones negotiated by other countries to no more than the OECD average. Harris also previously endorsed “march-in” rights under the Bayh Dole Act.
- When Harris was attorney general of California, she focused heavily on health care consolidation and anticompetitive behavior in pharmaceutical, insurance and hospital industries. She filed an antitrust lawsuit to block a proposed $54 billion merger of two insurers.
- As vice president, she took the lead on medical debt initiatives and announced rules that ban medical debt from credit reports.
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- Trump said he wants to leave abortion in the hands of the states after the Supreme Court overturned Roe v. Wade and declined to endorse a federal abortion ban. Trump has also advocated for exceptions and strongly supports the availability of IVF.
- Trump has softened his “repeal and replace” approach to the ACA, instead highlighting that he is looking at alternatives to make it less expensive. He previously supported establishing Medicaid block grants, Medicaid work requirements and upper payment limits. His administration repealed the individual mandate tax penalty and protected insurance coverage for people with preexisting conditions.
- Trump has been critical of both the pharmaceutical industry and PBMs, often rallying against the high cost of prescription drugs. His previous administration finalized regulations that allow states to import lower-cost drugs from Canada and issued regulations requiring hospitals and health insurers to provide consumers list prices for specific drugs and services.
- Trump has promised to end surprise medical billing and increase fairness through price transparency, building on his previous administration’s efforts.
- Trump has recently prioritized addressing chronic disease prevention and promoting healthier lifestyles.
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THIS DOCUMENT IS INTENDED TO PROVIDE YOU WITH GENERAL INFORMATION REGARDING DIFFERNCES IN HEALTH CARE POLICY BETWEEN THE PRESIDENTIAL CANDIDATES. THE CONTENTS OF THIS DOCUMENT ARE NOT INTENDED TO PROVIDE SPECIFIC LEGAL ADVICE. IF YOU HAVE ANY QUESTIONS ABOUT THE CONTENTS OF THIS DOCUMENT OR IF YOU NEED LEGAL ADVICE AS TO AN ISSUE, PLEASE CONTACT THE ATTORNEYS LISTED OR YOUR REGULAR BROWNSTEIN HYATT FARBER SCHRECK, LLP ATTORNEY. THIS COMMUNICATION MAY BE CONSIDERED ADVERTISING IN SOME JURISDICTIONS.