Trump and Harris's potential impact on U.S. health care: Drug costs, abortion, and Obamacare.

• The rising complexity and cost of health care in the U.S. have made it a major concern during the presidential election.
• If elected, Kamala Harris and Donald Trump have different approaches to making health care more affordable in the U.S.
• A candidate's track record can give insight into how drug costs, healthcare, and reproductive rights may evolve in the near future.

Prescription drug costs. Abortion rights. The future of Obamacare.

The upcoming presidential election between Vice President Kamala Harris and former President Donald Trump could result in significant consequences for patients regarding healthcare issues and other aspects of the vast U.S. healthcare system.

The two candidates in the U.S. are promising to make healthcare more affordable, which is unusual in the developed world due to its high healthcare spending, poor patient outcomes, and access barriers. However, if elected, the candidates seem to have different strategies for achieving this goal.

Although health policy is not at the top of voters' minds, the candidates' track records offer insights into how drug costs, health care, and reproductive rights might be addressed in the future.

"A Trump administration aims to cut federal health spending to fund tax cuts and decrease the government's role in healthcare, while a Harris administration plans to expand on existing programs and boost federal spending to make healthcare more affordable for individuals."

A May poll by KFF found that about half of American adults struggle to afford healthcare, which can result in debt or delayed care for some patients.

Harris and Trump have contrasting views on crucial health care matters.

Prescription drug costs

According to the March KFF survey, approximately 20% of adults have not filled a prescription due to cost, while about 10% have cut pills in half or skipped doses.

In 2022, Harris voted to pass the Inflation Reduction Act, which aims to lower health-care costs for Medicare seniors, and now plans to expand certain provisions of the act.

Harris' campaign states that she plans to implement two provisions for all Americans: a $35 monthly cap on insulin costs and a $2,000 annual cap on out-of-pocket drug expenses.

Medicare drug price negotiations with manufacturers will be accelerated and expanded under a landmark policy, despite opposition from the pharmaceutical industry, which has challenged its constitutionality in court.

Trump has not indicated what he intends to do about IRA provisions.

Numerous Republicans have been outspoken against drug pricing negotiations, asserting that they stifle innovation and will result in fewer cures, as stated by Dr. Mariana Socal, a health policy professor at the Johns Hopkins Bloomberg School of Public Health. Trump echoed this sentiment in 2020 when he opposed a separate Democratic bill that would enable Medicare to negotiate drug prices.

During his presidency, Trump's efforts to lower drug prices "didn't really come to fruition," according to Socal.

In 2020, he issued an executive order to prevent Medicare from paying more than the lowest price that other developed countries pay for drugs. However, the Biden administration later reversed that policy after a court order halted it.

The former president will not attempt to revive the plan if he is reelected, according to the Trump campaign this month.

Medicare prescription drug plans, also known as Part D plans, had the option to join a temporary program initiated by Trump that set a $35-per-month cap on some insulin products for seniors. The program was in effect from 2021 to 2023, but less than half of all Part D plans participated each year, according to KFF.

The Biden administration's insulin price cap is more comprehensive than the previous measure, which only required Part D plans to charge no more than $35 per month for all covered insulin products and did not limit cost-sharing for insulin covered by Medicare Part B plans.

Pharmacy benefit managers, who negotiate rebates with manufacturers on behalf of insurance plans, are likely to continue being scrutinized by both administrations, according to Dr. Stephen Patrick, chair of the health policy and management department at Emory University.

PBMs have been accused by lawmakers and the Biden administration of profiting while increasing prescription medication prices and causing harm to U.S. patients and pharmacies.

Health-care coverage

For many Americans, health-care coverage is a critical and sometimes life-or-death issue, and Harris and Trump would take different approaches to it.

In her 2020 presidential campaign, Harris advocated for a "Medicare for All" bill that would guarantee healthcare to all Americans by eliminating private insurance. However, her campaign has since clarified that she would not support the program as president.

The Affordable Care Act (ACA) aimed to provide health coverage to millions of uninsured Americans and make changes to the insurance industry. The law increased Medicaid eligibility, required Americans to have health insurance, and prohibited insurance companies from denying coverage based on pre-existing conditions, among other measures.

If elected, Harris intends to make permanent the IRA's enhanced subsidies that made ACA health plans more affordable for millions of households through 2025.

Some experts suggested that Harris could collaborate with Congress to extend Medicaid coverage in the 10 states that haven't done so under the ACA. Medicaid covers 81 million people, or more than 1 in 5 Americans, according to KFF.

The largest source of federal funding to states is the program, which provides coverage for low-income patients and families, as well as those with complex and costly needs, such as people with disabilities and individuals experiencing homelessness.

The Democrats are struggling to maintain their narrow Senate majority, while the Republicans are fighting to keep their slim control of the House.

Trump's efforts to repeal the ACA were unsuccessful during his first term, and he has since shifted his focus to improving the law rather than terminating it. In a campaign video in April, Trump stated that he was not running on terminating the law and would instead make it "much, much better and far less money." However, he has not provided any specific plans for achieving this goal. Many Republicans have abandoned their promises to repeal the law after it grew more popular in recent years.

In the Sept. 10 debate, Trump repeated his stance that the ACA is substandard healthcare. However, when asked for a replacement, he only mentioned having ideas for a plan.

Trump's previous replacement proposals would have reduced the cost of the ACA for the federal government but would have raised out-of-pocket premiums for patients, resulting in more uninsured Americans and increased risks for states.

A Trump administration would likely have major implications for Medicaid, Altman said.

Although Trump has stated that he will not reduce funding for Medicare and Social Security, this has led to Medicaid, which costs the federal government over $600 billion annually, being a potential target for significant reductions, according to Altman.

Trump could revisit some of his earlier attempts to reduce spending on Medicaid, such as eligibility restrictions and a proposed "block grant" program.

The government offers states a fixed amount of money for Medicaid services in exchange for more flexibility and less oversight.

If elected, Harris is likely to pursue expanding Medicaid coverage and reducing health disparities, as the Biden administration did by withdrawing some restrictions and encouraging waivers.

According to Altman, any sweeping changes to Medicaid would likely be blocked by a Democratic House or Senate.

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Reproductive rights

The issue of abortion is crucial and may influence many voters' choices in the upcoming election. A recent poll by The New York Times and Siena College revealed that the number of swing state voters who consider abortion as their top election concern has increased since the spring.

Since the Supreme Court overturned Roe v. Wade, the landmark ruling that established the constitutional right to abortion in the U.S. in 1973, this is the first presidential election held.

Since the court's decision in 2022, the access to abortion in the U.S. has been subject to changes, with conservative governors and legislatures imposing restrictions in their states. As per PBS's report from last year, over 25 million women aged 15 to 44 reside in states where abortion access is now more limited than before the court's ruling.

The reproductive well-being of many women, especially lower-income people and people of color, could be at risk depending on which candidate is elected, according to Stacey Lee, professor of health law and ethics at the Johns Hopkins Carey Business School.

Democrats have not been able to pass a national law codifying abortion rights due to a lack of votes in Congress, despite her accusations against Trump for appointing conservative Supreme Court justices who overturned Roe v. Wade.

Harris also stated that she supports abolishing the filibuster in the U.S. Senate to reinstate federal abortion rights as they were under Roe v. Wade. The filibuster rule necessitates a 60-vote majority for most legislation to pass, making it challenging for legislators to pass bills in a closely divided Senate.

Harris has been a staunch advocate for the availability of the abortion pill mifepristone, according to Lee. In 2023, anti-abortion physicians waged an unprecedented legal battle against the Food and Drug Administration over its 20-year-old approval of the medication.

The Supreme Court unanimously upheld the use of mifepristone and the Biden administration's FDA revised restrictions on medication abortion, allowing certain certified retail pharmacies to dispense the pills.

Trump hinted in August that he might order the FDA to withdraw mifepristone access, but his running mate, Sen. JD Vance of Ohio, later tried to clarify that Trump did not intend to take such action.

Trump's recent comments regarding mifepristone access seem to contradict his statement in June, where he declared during a CNN debate that he would not obstruct access to the drug.

Trump's anti-abortion measures included a "gag rule" that would have denied federal health funds to clinics, such as Planned Parenthood, if they offered abortions or referrals for them.

Vance this month also said a future Trump administration would defund Planned Parenthood.

Trump has recently shown signs of moderation on his stance on abortion policy, potentially to attract more moderate and independent voters.

Trump has reshaped the court and now believes that states should set abortion policy, but earlier this year he criticized certain state laws for going "too far."

In a March radio interview, Trump expressed his willingness to impose a nationwide prohibition on abortions performed after approximately 15 weeks of gestation.

Lee stated that although it is challenging to find consistency in his policies, the lack of consistency should emphasize the possibility of a more restrictive stance on abortion and reproductive rights.

In vitro fertilization, a type of fertility treatment performed outside of the body in a lab, is supported by both Harris and Trump. Although it accounts for only 2% of births in the U.S., it is extremely costly for many low- and middle-income people who need the technology to start families.

The ruling by the Alabama Supreme Court in February that frozen embryos created through IVF could be considered children posed a threat to the availability of those services in the state, making it a campaign issue.

Trump has advocated for government or private insurers to cover the cost of IVF treatment, while Harris has pledged to safeguard the right to both IVF and contraception, though she has not disclosed her specific plan of action.