Where Harris and Trump Stand on Top Issues in Healthcare

With this condensed primer, MedPage Today looks at the health policy records of Democratic presidential candidate Kamala Harris and Republican presidential candidate Donald Trump.

Abortion

Harris’ Stance:

Trump’s Stance:

Why It Matters:

• According to polling by the Pew Research Center, 63% of adults in the U.S. support abortion in all or most cases. Furthermore, in at least seven different states where abortion has been on the ballot (including conservative states like Kansas, Montana, and Kentucky), voters have come down on the side of abortion rights.

Healthcare Reform

Harris’ Stance:

• In 2019, during her first presidential campaign, Harris voiced support for Medicare for All, then appeared to waver on that approach.
• Soon afterwards, she introduced “KamalaCare,” a more moderate proposal that preserved a role for private health plans and suggested a 10-year glide path to a single-payer system. However, in late July, a Harris spokesperson said that Harris “will not push single payer as president.”
• As California’s Attorney General, Harris defended the Affordable Care Act’s (ACA) constitutionality in multiple amicus briefs.
• She is expected to extend the enhanced ACA subsidies, which will otherwise sunset at the end of 2025. These subsidies help Americans afford health insurance on the exchanges by capping premiums at a percentage of their income on a sliding scale.
• Harris is also expected to work to expand Medicaid coverage in the 10 remaining non-expansion states.
• As for Medicare, she previously supported President’s Biden’s plan to increase taxes for Americans who earn more than $400,000 annually to help keep the program solvent.

Trump’s Stance:

• During the 2016 presidential campaign, Trump pledged to immediately repeal and replace the ACA.
• That promise went unfulfilled, but Republican lawmakers did pass a bill that zeroed out the penalty for not complying with the individual mandate — a provision of the ACA requiring individuals who fail to purchase “minimum essential benefits” to face a tax penalty.
• In January, Trump doubled down on his repeal pledge before backpedaling on the idea 2 months later, claiming, in a post on Truth Social, that he wanted to instead make the ACA “better.”
• With regard to Medicare, Trump suggested in March that he was amenable to cuts to the program before quickly walking back his statement.
• As president, however, his administration proposed spending reductions for both Medicare and Medicaid.
• The HHS under Trump also encouraged the use of work requirements as a condition of eligibility for the Medicaid program.
• The 2024 GOP Platform pledges to protect Social Security and Medicare, and to support long-term care, chronic disease management, and homecare for the elderly, but does not provide policy details.

Why It Matters:

Healthcare Costs, Drug Prices

Harris’ Stance:

• During her first presidential campaign in 2019, Harris proposed granting the HHS secretary the authority to set a fair price for all drugs sold nationally based on prices in other developed countries.
• Harris supported “march-in rights,” a provision of the Bayh-Dole Act that allows the government to seize control of patents for high-priced drugs under certain circumstances. She also supported drug importation for high-priced drugs.
• As California’s attorney general, she took on healthcare consolidation and anti-competitive pricing among insurers, hospital chains, and drug companies, laying the groundwork for a landmark lawsuit against Sutter Health.
• Harris is expected to continue to defend the Inflation Reduction Act (IRA), which, for the first time ever, allowed the HHS secretary to negotiate the prices of 10 select drugs. Multiple drug companies and other stakeholders have sued the government over the negotiation process, but, to date, the government has won every case.
• For Medicare beneficiaries, the IRA also capped insulin prices at $35 per month and will cap out-of-pocket costs at $2,000 annually for Part D prescription drugs beginning in 2025.
• Harris has said she would support extending the IRA’s cost protections to Americans who are not Medicare enrollees.

Trump’s Stance:

• In 2018, then-President Trump blamed “global freeloading” for the high costs of drugs in the U.S., and proposed aligning Medicare Part B drugs with prices paid in other developed countries, using a mechanism known as reference pricing; the policy, however, never took effect.
• In July 2020, Trump signed an executive order to allow drug importation by pharmacies and wholesalers from Canada, as well as another executive order meant to prevent pharmacy benefit managers or middlemen from pocketing large discounts.
• In late 2020, Congress passed and Trump signed the No Surprises Act, a bill that aimed to protect patients from “surprise” or unexpected out-of-network medical bills, which the Biden administration implemented.
• According to conservative policy experts, Trump’s priorities in his prior administration included increasing transparency, choice, and competition in healthcare, all of which are among his stated priorities in a potential second term, according to the 2024 GOP Platform.

Why It Matters:

• Drug prices have led many Americans to ration or skip doses of medication, including more than 1 million patients taking insulin, according to a CDC survey.

Maternal Health

Harris’ Stance:

Trump’s Stance:

Why It Matters:

Pandemic Response

Harris’ Stance:

• In 2020, then-vice presidential nominee Harris said she would not trust a COVID-19 vaccine that Trump distributed before the election, unless a “credible” source could ensure its safety.
• Harris, however, did receive a COVID vaccine in December 2020 on live television.
• She also publicly supported vaccines, boosters, and masks, casting them as tools to help schools and businesses reopen.
• In July 2023, the Biden-Harris administration, responding to congressional legislation, launched a new Office of Pandemic Preparedness and Response Policy.

Trump’s Stance:

• Trump is credited with overseeing Operation Warp Speed, the federal program that accelerated the development of multiple COVID-19 vaccine candidates and led to effective and life-saving vaccine options in record time.
• However, during his administration, Trump also repeatedly downplayed the pandemic, and frequently contradicted his own public health experts on issues such as mask-wearing and the effectiveness of hydroxychloroquine.
• During Trump’s hospitalization for COVID, medical experts raised concerns over his decision to participate in a drive-by procession, noting that although he was masked, he may have endangered the Secret Service agents inside the car.
• In April, Trump said in an interview that, if elected, he “probably would” disband the White House Office of Pandemic Preparedness and Response Policy.
• He also pledged to defund schools with vaccination requirements.

Why It Matters:

• Trust in public health experts and physicians waned during the pandemic. There are more than 30 different pathogens that could spark a future pandemic, including mpox, avian flu, and dengue virus, according to the WHO.

Gun Control

Harris’ Stance:

• Under the Biden-Harris administration, the Department of Justice issued a final rule in 2022 to curb the spread of “ghost guns” (unserialized privately made firearms), building on previous executive actions.
• Congress also passed and Biden signed the Bipartisan Safer Communities Act, which called for enhanced background checks for individuals under 21, support for implementing extreme risk protection orders (also known as “red flag” laws), expanding access to mental health services, and growing community violence intervention programs.
• In 2023, President Biden launched, and Harris agreed to oversee, the White House Office of Gun Violence Prevention to partner with cities and encourage support for survivors of gun violence, strengthen background checks, and advocate for responsible gun ownership.
• As a presidential candidate in 2019, Harris shared that she owns a gun “for personal safety,” but supports an assault weapons ban and universal background checks.

Trump’s Stance:

Why It Matters: