Within the ultimate days of the marketing campaign, stark disagreements between Vice President Kamala Harris and former President Donald Trump over the way forward for American well being care are on show — specifically, in sober warnings about abortion entry, the specter of future cuts to the Reasonably priced Care Act, and daring pronouncements about empowering activists keen to vary course and clear home.
Trump and his marketing campaign have been obscure about plans on well being care insurance policies, although present and former Trump aides have revealed blueprints that go effectively past reversing applications in power below the Biden administration, to overhauling public well being companies and enabling Trump to shortly fireplace officers who disagree.
Harris, however, has staked out positions primarily preserving and defending current well being care entry — on abortion, transgender well being care, insurance coverage protection, and extra.
Listed here are a number of the most consequential modifications in well being insurance policies that would hinge on who wins the White Home.
ACA Premiums
The election is more likely to have an effect on the price of medical insurance for tens of millions who purchase protection on the Reasonably priced Care Act marketplaces.
That’s as a result of additional, pandemic-era subsidies that decrease the price of premiums will expire on the finish of 2025 — except Congress and the following president act.
Harris has pledged to make the improved subsidies everlasting, whereas Trump has made no such dedication.
Letting them expire “would scale back fraud and waste,” stated Brian Blase, a former Trump adviser who’s president of the Paragon Well being Institute, a conservative coverage analysis agency.
About 19.7 million folks with ACA protection profit from a subsidy — 92% of all enrollees. The expanded subsidies, began in 2021, helped enhance ACA enrollment to a document excessive and cut back the uninsured fee to a document low.
They’ve additionally minimize premium funds by an estimated 44%. Many pay no premiums in any respect.
With out congressional motion, virtually all ACA enrollees will expertise steep will increase in premium funds in 2026, based on KFF. The City Institute estimates 4 million folks might wind up uninsured.
Letting the subsidies lapse might trigger blowback for Republicans in 2026, stated Jonathan Oberlander, a well being coverage professional on the College of North Carolina’s College of Drugs: “Is it well worth the ache politically?”
— Phil Galewitz
Abortion
When he was president, Trump promised — and delivered — Supreme Courtroom justices who would vote to overturn the constitutional proper to an abortion. Within the occasion of a second time period, he has promised to depart abortion coverage to the states — although he would have vital leeway to cut back entry nationwide.
Harris has promised to revive the protections of Roe v. Wade, although doing so would require Congress’ assist. On the very least, a Harris presidency would principally protect current protections and stop new federal restrictions.
Trump’s first actions would seemingly mirror these of many Republican presidents for the reason that Eighties: defunding Deliberate Parenthood and the United Nations’ household planning company, and, extra just lately, permitting employers with non secular or ethical objections to contraception to say no protection via job-sponsored well being plans.
However Trump might go significantly additional, successfully banning abortion even in states the place it’s authorized. As an example, the FDA might cut back availability of the abortion tablet mifepristone or cancel its approval. This has been the topic of quite a few lawsuits, together with one earlier than the Supreme Courtroom that was just lately revived.
Trump might additionally order the Justice Division to implement the Comstock Act, an 1873 legislation that bans mailing “each article or factor designed, tailored, or supposed for producing abortion, or for any indecent or immoral use.” That might apply not simply to abortion tablets, but in addition to provides for abortion procedures.
— Julie Rovner
Drug Costs
Each campaigns say they’re dedicated to decreasing drug costs. Trump has supplied few specifics, although the America First Coverage Institute, a suppose tank led by shut Trump allies, has put ahead insurance policies which might be significantly much less aggressive than Harris’ proposals.
Harris has stated she would broaden drug pricing negotiations and out-of-pocket drug spending caps enabled by the Inflation Discount Act. She has additionally referred to as for extra transparency necessities for pharmacy profit managers, or PBMs, the highly effective drug-industry middlemen.
America First’s plan would minimize prices by decreasing reimbursements to docs for some costly infused medication, utilizing commerce coverage to power different developed nations to extend what they pay for medication, and making extra prescription drugs out there over-the-counter.
The plan makes no point out of bipartisan laws into account in each chambers of Congress that seeks to attain decrease drug costs via new transparency necessities for PBMs.
— Arthur Allen
Trans Folks’s Well being
The presidential election might decide whether or not transgender Individuals maintain on to broad protections making certain entry to gender-affirming medical care. Trump has stated he would search to ban hormone alternative remedy, gender reassignment surgical procedure, and different remedies for minors — and make the providers tougher for adults to obtain.
Within the closing days of the marketing campaign, Trump and his political motion committees have leaned into divisive advertisements attacking Harris for previous feedback supporting entry to look after transgender people who find themselves incarcerated.
Backed by Republicans desperate to stoke culture-war social points, Trump has pledged to repeal Biden insurance policies affecting transgender well being care, together with guidelines prohibiting federally funded suppliers and insurers from discriminating primarily based on gender id.
As some states handed laws that opposed transgender rights, the Biden administration expanded protection for gender-affirming care and elevated analysis funding for the Nationwide Institutes of Well being.
In a video on his marketing campaign website, Trump vowed to order federal companies to “stop all applications that promote the idea of intercourse and gender transition at any age” and bar authorities applications akin to Medicare and Medicaid from paying for gender-affirming care.
Trump additionally stated he would strip federal funding from hospitals that present such care, create a proper to sue docs who carry out gender-affirming procedures on kids, and examine whether or not the pharmaceutical {industry} and hospitals have “intentionally lined up horrific long-term unwanted side effects” of transition remedies.
Harris has been largely silent on the Trump marketing campaign’s rhetoric focusing on trans folks. However she has stated she would “comply with the legislation” in offering transgender Individuals the identical proper as others to entry medically essential care.
— Daniel Chang
Medicaid
Although the phrase “Medicaid” was barely uttered on the marketing campaign path this yr, the election will decide future advantages for its 80 million primarily low-income and disabled enrollees.
“The stakes are very excessive,” stated UNC’s Oberlander.
Whereas Harris has described Medicaid as a key program to enhance well being, Trump has framed it as a damaged welfare program in want of cuts.
Practically half of Medicaid enrollees are kids, and this system pays for about 40% of births nationwide.
The ACA expanded Medicaid protection to just about all adults with incomes as much as 138% of the federal poverty degree, or $20,783 this yr. All however 10 states, that are GOP-led, have opted to broaden their program.
The Biden administration has largely centered on efforts to guard and broaden Medicaid to cut back the variety of uninsured folks.
The Trump administration, and GOP proposals since then, sought to cut back Medicaid spending by stiffening eligibility requirements, akin to including work necessities, and by altering federal financing to a block grant, which might put extra burden on states.
— Phil Galewitz
Shaking Up Biomedical Companies
Trump stated at an Oct. 27 rally in New York Metropolis that he would give anti-vaccine activist Robert F. Kennedy Jr. free rein to “go wild” on well being and meals coverage in a second time period.
Even a Republican-controlled Senate can be unlikely to substantiate Kennedy for any high authorities place. No matter whether or not he had a selected function, RFK Jr.’s affect could possibly be highly effective, stated Georges Benjamin, govt director of the American Public Well being Affiliation.
Kennedy stated Trump promised to offer him “management” of public well being, together with naming leaders of the NIH, FDA, and the Facilities for Illness Management and Prevention. He has advocated for a health care provider who made a reputation for herself as a right-wing well being guru, Casey Means, to move the FDA. This week, in a dialogue on CNN throughout which he put ahead the debunked concept that vaccines trigger autism, Trump transition workforce co-chair Howard Lutnick stated Kennedy wished information on vaccines “so he can say this stuff are unsafe,” at which level “the businesses will yank the vaccines proper off … the market.”
Quite a few Trump allies have urged disempowering public well being companies — stripping the CDC of a lot of its analysis and promotional authority whereas streamlining NIH and including congressional oversight over its grant-making.
Undertaking 2025, the Heritage Basis blueprint disavowed by Trump however whose authors embody many former Trump officers, says the drug {industry} and different firms have “captured” regulatory companies: “We should shut and lock the revolving door” between companies just like the NIH, CDC, and FDA, and the industries they regulate, it states.
Kennedy just lately posted on the social platform X that “FDA’s battle on public well being” — by which he meant restrictions on disproven therapies and cure-alls like uncooked milk and ivermectin — “was about to finish.”
He warned FDA staff who’re “a part of the corrupt system” that they need to “1. Protect your data, and a couple of. Pack your baggage.”
— Arthur Allen
aallen@kff.org,
@ArthurAllen202
pgalewitz@kff.org,
@philgalewitz
jrovner@kff.org,
@jrovner
dchang@kff.org,
@dchangmiami
