Health Policy Issues in the Presidential Race

September 13, 2024

The “Concept of a Plan” President Trump Proposed to Replace the ACA
KFF QUICKTAKES
Sep 11, 2024
By Larry Levitt

When asked in the debate whether he had a replacement plan for the Affordable Care Act, former President Donald Trump said he had the “concepts of a plan.”

If you look at Trump’s record as president, there is truth in that statement. He did, in fact, propose the concept of an ACA replacement plan in his 2020 budget, though it has never gotten much attention.

Trump’s conceptual ACA replacement plan would have repealed the ACA’s premium subsidies and Medicaid expansion, replacing them with a block grant to states. It also would have capped federal Medicaid spending. All told, Trump’s plan would have reduced federal spending on the ACA and Medicaid by over $1 trillion over a decade.

Trump also proposed providing “relief” from the ACA’s “insurance rules and pricing restrictions.”

Trump has long talked about making the ACA less expensive, but the question is less expensive for whom. Trump’s past proposals would certainly have made the ACA less expensive for the federal government, but with the trade-off of higher out-of-pocket premiums for people, more uninsured, and higher spending and greater risk for states.

Polling: Harris v. Trump on Key Health Care Issues
KFF
Sep 10, 2024
By Ashley Kirzinger et al.

How Voters Are Prioritizing Health Care Issues in 2024

The economy and inflation continue to dominate the list of issues that voters are focusing on during this year’s presidential election with four in ten voters (38%) saying it is the most important issue determining their vote in the 2024 presidential race. Following the economy is threats to democracy (22%), immigration and border security (12%), then several individual health care issues including: abortion (7%), Medicare and Social Security (7%), and health care costs including prescription drugs (5%). Altogether, health care issues are seen as the most important issue by about one in five voters (19%). Gun policy (3%) and the war between Israel and Hamas in Gaza (2%) rank the lowest among the issues included in the list provided to voters.

Voters Want to Hear Candidates Talk About Lowering Health Care Costs

An indication of how the economy and health care consistently overlap for voters, economic concerns also rear up when voters are asked what health care issue they most want to hear the candidates talk about. Across partisans, the recurring theme is costs. Responses related to health care costs are offered by four in ten (42%) Democratic and Democratic-leaning independent voters when asked to say in their own words what is the one health care issue they would most like Vice President Harris to talk about. This includes voters who mentioned general health care costs (20%), prescription drug costs (15%), and the cost of insurance or reducing their monthly premiums (6%). About one in seven offered abortion as the one health care issue they want Harris to talk about and 13% mentioned universal health care – an issue that was largely debated during the 2020 Democratic primaries.

 

Comment by: Jim Kahn

Health issues are fairly high profile In this presidential campaign – collectively, the most important issue for one in five voters. Abortion is seen as the leading election issue for 7% of voters. Medicare & social security (combined, oddly in my view) are also at 7%, and health care costs are at 5%.

Trump proposes to replace the ACA with something TBD cheaper and better. His actual approach, per his 2020 federal budget request, seems to be repealing ACA premium subsidies and Medicaid expansion, placing these programs into state block grants. Which would cut federal costs by >$1 trillion over 10 years. Also, end the ACA’s “insurance rules and pricing restrictions.” This is all consistent with Project 2025, as summarized in HJM. He waffles on abortion, but is largely seen as a threat to abortion rights.

Harris aims to strengthen the status quo. She proposes to strengthen the ACA: to make permanent COVID subsidy increases and fix a “family glitch”. For drug prices she favors accelerating Medicare drug price negotiations, and extending two caps in Medicare ($35 insulin copay and drug out-of-pocket total) to the entire population. She wants to end drug companies blocking competition and abusive practices of drug intermediaries. She avidly supports abortion rights.

See a side-by-side comparison here.

Drew Altman notes that the “do not mention” program is Medicaid, since Medicare and the ACA are considered higher priority for voters. Yet the consequences for Medicaid are substantial, per above.

Of course, Medicare for All / single payer gets no favorable mention – despite its ability to sharply reduce health care costs for families, a leading concern of voters. Instead, it is used by Trump to attack Harris since pre-2020 she endorsed Bernie Sanders M4A bill. Don’t expect Harris to return to single payer. But if state reform efforts, such as currently in Oregon and California, are to garner federal regulatory cooperation (“waivers”), a Harris administration may be more flexible.