Healthcare: Trump vs Harris

  

Comparison and Contrast: Healthcare Policy Under Trump vs. Harris

With the 2024 presidential election nearing, the stakes have never been higher for healthcare policy in the United States. The continuing fallout from the COVID-19 pandemic, skyrocketing costs, and huge disparities in access to care have pushed healthcare to the very top of the political agenda. And what we’re calling a “national conversation” is really unfolding as a somewhat fractious debate among a variety of players—with the potential outcome of the election as the big determining factor for which group’s policies will be enacted over the next four years. It's important to have a handle on the current healthcare dynamic before discussing possible future policies. The ACA (Affordable Care Act), which passed in 2010, made access to healthcare much better for the vast majority of individuals in this country. Whether it was through Medicaid expansion or subsidized private insurance, millions more now have the ability to get the care they need. That said, we are still left with an unfortunate number of people who have unmet healthcare needs. Some of that, of course, is due to the pandemic. But even without COVID-19, we have significant problems in this country related to mental healthcare access, telehealth in rural areas, and the overall lack of adequately staffed, open-to-all facilities. A central dispute in the 2024 election will be about universal healthcare. Some candidates will argue for a Medicare-for-All system that provides comprehensive healthcare to all Americans. Others, more moderate in their approach, will insist that we stick with our current system (if it can be called that) and make incremental reforms aimed mostly at expanding and improving the ACA, which in a recent survey by the federal Department of Health and Human Services received high marks for customer satisfaction. How this debate shakes out will influence the lives of millions of Americans. Voters care deeply about the increasing prices of prescription drugs; nearly half of Americans now say they can't afford them, and research shows that prices have nearly doubled in the last decade. Candidates at all levels of government are likely to point to the problem and propose various surefire solutions: allowing Medicare to negotiate prices, for instance, or imposing price caps on essential medicines. Where do Trump and Harris stand on critical issues?

Healthcare Access and Coverage

One of the fundamental differences between Trump and Harris lies in their approach to healthcare access and coverage. Trump’s policies aim to reduce government intervention and expand private sector participation. At the same time, Harris advocates for a more extensive role for the government, mainly through reforms that could lead toward universal healthcare.

• Trump’s Healthcare Vision: Trump’s tenure as president (2017–2021) was marked by efforts to repeal and replace the Affordable Care Act (ACA), often known as Obamacare. Although these efforts were largely unsuccessful, the Trump administration made regulatory changes to reduce ACA mandates. These included eliminating the individual mandate, which required Americans to have health insurance or face a penalty, and expanding short-term, limited-duration health insurance plans. In Trump's view, these short-term plans are cheaper but provide less comprehensive coverage, allowing consumers more choice and affordability. His administration emphasized "choice" and “freedom” in healthcare, supporting Health Savings Accounts (HSAs) and high-deductible health plans that put more financial responsibility on consumers.
• Harris’s Healthcare Vision: Kamala Harris has positioned herself as a significant proponent of expanding healthcare access. As a senator, she co-sponsored Bernie Sanders' "Medicare for All" bill, though her position on eliminating private insurance evolved. Harris eventually proposed a modified version of Medicare for All that would maintain a role for private insurance but expand the federal government’s involvement. Her plan called for a gradual transition to universal coverage over ten years. Harris supports expanding the ACA and reinforcing Medicaid while also ensuring coverage for undocumented immigrants, reflecting her view that healthcare is a human right.

Comparison: While Trump’s policies prioritize deregulation and limit the government’s role in healthcare provision, Harris’s vision expands government involvement and seeks to move toward universal coverage. Trump’s approach would likely increase consumer choice and flexibility, particularly for healthier individuals seeking cheaper, less comprehensive plans. Conversely, Harris’s policies emphasize broadening access to comprehensive coverage, especially for vulnerable populations, intending to reduce disparities.

Cost Control and Affordability

Controlling healthcare costs is another point of divergence between Trump and Harris. Both leaders agree that healthcare costs in the U.S. are unsustainably high, but their methods of addressing this issue differ significantly.

• Trump’s Approach to Cost Control: Trump’s strategy primarily revolves around deregulation and fostering competition to lower prices. His administration pushed for price transparency in hospital billing and pharmaceutical pricing, mandating hospitals to disclose service prices and drug companies to reveal prices in advertisements. Trump also signed executive orders aimed at reducing drug prices, including initiatives to allow the importation of cheaper drugs from abroad. However, these measures faced significant legal and logistical challenges. Trump’s administration also advocated block grants and per capita caps for Medicaid, which critics argue could lead to reduced funding and coverage for low-income individuals. However, proponents argue it incentivizes states to manage their Medicaid budgets more effectively.
• Harris’s Approach to Cost Control: Harris's approach to cost control is rooted in her support for Medicare for All, which would theoretically reduce administrative overhead, drug prices, and overall healthcare costs through government negotiation. Her plan envisions a single-payer system that would eliminate the need for private health insurance premiums, copays, and deductibles, shifting the burden of healthcare costs to the federal government through higher taxes, particularly on wealthier Americans and corporations. Harris has also strongly advocated for addressing the pharmaceutical industry's pricing practices, supporting legislation allowing the government to negotiate drug prices directly with manufacturers.

Contrast: Trump’s cost-control measures emphasize market-based solutions, such as competition and price transparency, to drive down prices, while Harris’s vision includes more direct government intervention through price negotiation and public financing. Trump’s policies would likely appeal to individuals who prefer less government involvement and want more control over their healthcare spending. On the other hand, Harris’s approach would significantly reduce out-of-pocket costs for most Americans but increase taxes to fund the broader healthcare system.

Role of Private Insurance

The role of private insurance in healthcare is one of the most significant dividing lines between the Trump and Harris healthcare philosophies.

• Trump’s Vision for Private Insurance: Under Trump’s administration, private health insurance was viewed as a central component of the healthcare system. His healthcare reforms focused on expanding access to cheaper, less comprehensive plans that allow more flexibility for consumers and employers. Trump's push for association health plans and short-term limited-duration insurance plans underscored his commitment to expanding private market options. His approach allowed for a reduction in the coverage mandates imposed by the ACA, providing more flexibility but also resulting in less comprehensive coverage for many.
• Harris’s Vision for Private Insurance: Harris initially strongly advocated eliminating private health insurance entirely through Medicare for All. However, she modified her stance to support a system where private insurance could still exist alongside a government-run plan. Harris’s reworked plan envisions a broader government role, with private insurance primarily supplementing a Medicare for All-like system. This approach aligns with the idea that private insurance could still offer coverage for non-essential services or serve as a backup for those who prefer private over public coverage.

Comparison: Trump’s vision is to maintain a robust private insurance market with fewer regulatory mandates and more consumer choice. Harris’s plan, while softened from her earlier Medicare for All stance, still envisions a more limited role for private insurance, positioning it as secondary to a government-run system. Trump’s approach is likely to appeal to proponents of a market-driven healthcare system, while Harris’s vision would attract those who believe in more equitable access through government intervention.

Government Programs: Medicaid and Medicare

Medicaid and Medicare serve as the backbone of the U.S. healthcare safety net. Trump and Harris’s views on these programs diverge sharply on expansion and reform.

• Trump’s Approach to Government Programs: Trump’s administration took steps to curtail the growth of Medicaid by promoting work requirements and proposing block grants to states. These block grants would allow states more flexibility in managing their Medicaid budgets but could reduce funding over time. Trump’s administration also sought to introduce more privatization into Medicare through Medicare Advantage plans offered by private insurers as alternatives to traditional Medicare.
• Harris’s Approach to Government Programs: Harris has consistently supported the expansion of Medicaid and Medicare. As a senator, she fought against Medicaid cuts and advocated for increasing funding for both programs. Harris’s long-term healthcare vision, particularly her support for a Medicare for All system, would greatly expand Medicare’s role, eventually providing coverage for all Americans. Her approach to Medicaid also focuses on ensuring that it continues to serve low-income populations without the restrictions proposed by Trump’s administration, such as work requirements.

Contrast: Trump’s policies on Medicaid and Medicare seek to reduce federal spending and give states more control, potentially limiting access for low-income individuals. In contrast, Harris’s policies would significantly expand these programs to increase access and coverage, particularly for underserved populations.

Mental health and substance use disorders have gotten worse during the pandemic. These are now clear areas of focus for the incoming administration. Candidates must detail substantive plans to better mental health care, increase capacity and funding for addiction treatment, and integrate both into the primary care system. The next president will decide whether these issues get the desperately needed attention and resources they have not for too long. The pandemic underscored the importance of a robust public health system. Now, the question is whether our next set of leaders will prioritize strengthening public health, improving pandemic preparedness, and investing in preventive medicine. Those are the most important things they could do to enhance our future health.

The 2024 election will likewise confront the disparities in healthcare that hit our most marginalized communities the hardest. Those running for office must put forth substantial plans that address the access-to-care problem for a largely ignored population, deal with the long-ignored social determinants of health, and confront the long-fought battle for health equity. How candidates commit to these issues will help determine the inclusivity of our healthcare policies. The future of healthcare policy will be shaped fundamentally by voter engagement. As U.S. citizens inform themselves increasingly about the far-reaching effects of healthcare policies on their daily lives, they will unfailingly be driven to hold their elected representatives responsible and to demand transparency in the development and execution of healthcare policies. This accountability-seeking normalizes as it appears to citizens that healthcare, as a public policy matter, ought to be a pivotal election issue. Advocates also appear to be right in thinking that it is possible to drive comprehensive healthcare reforms by, in Citizens United fashion, making healthcare a "top of the ticket" campaign priority.

Voters have the chance in 2024 to shape the future of U.S. healthcare when they cast their ballots for president and congressional leaders. Why is that? Because pressing problems—from universal coverage and drug prices to mental health, public health infrastructure, and healthcare equity—could be affected by the outcome. It is essential that the public understand the candidates' healthcare proposals and that the public push the candidates toward proposing good, sensible, and affordable ideas. The next election and four years could make a massive difference to millions of Americans.

The healthcare policies that would be implemented under Donald Trump versus Kamala Harris offer a stark contrast between market-driven reforms and government-driven solutions. Trump’s healthcare vision focuses on deregulation, consumer choice, and reducing the government’s role in healthcare, which could result in greater flexibility for some but reduced access for others. On the other hand, Harris advocates for expanding government involvement to ensure universal coverage and equity, particularly for vulnerable populations. Both approaches aim to address the U.S. healthcare system's key challenges—such as cost, access, and quality—but through radically different ideological frameworks. The future of healthcare under either leader would reflect these core ideological differences, with significant implications for the accessibility, affordability, and structure of healthcare in America.

Healthcare policy remains one of American political discourse's most contentious and polarizing areas. The healthcare systems envisioned by Donald Trump, a former U.S. president, and Kamala Harris, the current Vice President and a prominent Democrat, offer starkly contrasting visions. Trump’s policies reflect conservative ideologies focused on market-driven solutions, deregulation, and curbing the expansion of government-sponsored healthcare programs. In contrast, Harris has consistently aligned herself with progressive Democrats advocating for a more robust government role in providing healthcare, universal coverage, and equity-driven reforms. This analysis critically compares and contrasts the healthcare policies that might unfold under their leadership, focusing on key dimensions such as access to care, cost control, the role of private insurance, government programs, and innovation in healthcare delivery.